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目的:比较霉酚酸酯(MMF)与环磷酰胺(CTX)冲击治疗新月体型IgA肾病(IgAN)的疗效和安全性。方法:经肾活检诊断为新月体型IgAN37例,男女比例为21∶16,年龄在12～50岁之间,随机分为MMF组19例,CTX组18例。两组患者均采用静脉甲基泼尼松龙冲击治疗后口服泼尼松(起始剂量0.8mg/(kg.d))治疗。MMF剂量1.5或2.0g/d,6个月后减量;CTX剂量为0.75g/m2 BSA,每月静脉滴注一次,6个月后改为每3个月一次。两组患者基础临床病理资料无统计学差异。比较两组12个月内的疗效及安全性。结果:(1)MMF组缓解率显著高于CTX组(P<0.05),两组中位缓解时间分别为5个月和8个月。MMF组12个月完全缓解率和总缓解率均显著高于CTX组(66.7%vs25.0%,P<0.05;94.4%vs64.4%,P<0.05)。(2)MMF组12月时尿蛋白水平显著低于CTX组[(0.52±0.47)g/dvs(1.03±0.70)g/d,P<0.05],血浆白蛋白显著高于CTX组[(42.2±3.2)g/Lvs(38.9±5.4)g/L,P<0.05]。两组12月时尿沉渣红细胞计数和血肌酐增高发生率无统计学差异。CTX组1例患者在治疗9个月时出现肌酐倍增。(3)MMF组不良反应包括2例胃肠道不适、1例白细胞低下、1例上呼吸道感染和1例带状疱疹。MMF治疗各项不良反应发生率均低于CTX治疗组。治疗期间CTX组1例患者并发肺部感染退出治疗。结论:MMF治疗新月体型IgAN的近期疗效优于CTX冲击治疗,且不良反应少、耐受性好。
Objective: To compare the efficacy and safety of mycophenolate mofetil (MMF) and cyclophosphamide (CTX) in the treatment of crescentic IgA nephropathy (IgAN). Methods: 37 cases of crescent type IgAN were diagnosed as crescent by renal biopsy. The male-female ratio was 21:16. The patients were 12 to 50 years old and were randomly divided into MMF group (n = 19) and CTX group (n = 18). Both groups received oral prednisone (initial dose of 0.8 mg / (kg · d)) after intravenous methylprednisolone pulse therapy. MMF dose of 1.5 or 2.0g / d, 6 months after the reduction; CTX dose of 0.75g / m2 BSA, a monthly intravenous infusion, 6 months later changed to once every 3 months. The two groups of patients based on clinical pathological data without statistical difference. The efficacy and safety of the two groups were compared within 12 months. Results: (1) The remission rate of MMF group was significantly higher than that of CTX group (P <0.05), and the median remission time was 5 months and 8 months respectively. The complete remission rate and total remission rate in 12-month MMF group were significantly higher than those in CTX group (66.7% vs 25.0%, P <0.05; 94.4% vs64.4%, P <0.05). (2) Compared with CTX group, the level of urinary protein in MMF group was significantly lower than that in CTX group ([(0.52 ± 0.47) g / d vs (1.03 ± 0.70) g / d, ± 3.2) g / L vs (38.9 ± 5.4) g / L, P <0.05]. There was no significant difference in the incidence of urinary sediment erythrocyte count and serum creatinine between December and December. One patient in the CTX group developed creatinine doubling at 9 months of treatment. (3) The adverse reactions of MMF group included 2 cases of gastrointestinal discomfort, 1 case of leukopenia, 1 case of upper respiratory tract infection and 1 case of shingles. The incidence of adverse reactions in MMF was lower than that in CTX treatment group. During the treatment, one patient in the CTX group withdrew from the pulmonary infection. CONCLUSION: The short-term effect of MMF on crescent-shaped IgAN is better than that of CTX shock therapy with less adverse reactions and better tolerability.