SUSTAINED REMISSION OF MEMBRANOUS GLOMERULONEPHRITIS AFTER CYCLOPHOSPHAMIDE AND PREDNISONE
SUSTAINED REMISSION OF MEMBRANOUS GLOMERULONEPHRITIS AFTER CYCLOPHOSPHAMIDE AND PREDNISONE
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DOI：
10.7326/0003-4819-114-9-725
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发表时间：
1991-05-01
影响因子：
39.2
通讯作者：
SEGEL, DP
中科院分区：
文献类型：
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作者：
BRUNS, FJ;ADLER, S;SEGEL, DP
目的：探讨环磷酰胺和泼尼松对膜性肾小球肾炎患者进行性肾功能衰竭和肾病特征的影响。设计：前瞻性、非随机时间序列。地点：一所大学医学中心的门诊。患者：连续11例经活检证实的膜性肾小球肾炎患者，血肌酐水平升高至少6个月。干预：环磷酰胺和泼尼松10例，单用环磷酰胺1例。测量和主要结果：在10例同时使用这两种药物的患者中，血肌酐中位数较治疗前上升53mU/L(0.6 mg/dL)，从141mU/dL升至194mU/dL(1.6mgdL至2.2 mg/dL)(95%可信区间，27至141mU/L；P=0.002)。综合治疗6个月后，血肌酐中位数降至133mU/L(1.5 mg/dL)，中位数下降62mU/L(0.70 mg/dL)(CI：44~150mU/L；P=0.006)。治疗前10例患者的血肌酐水平在15 9~371mU·mol/L(1·8~4·2 mg/dL)之间，6个月后下降，8例患者中7例在治疗结束后24~54个月保持稳定。治疗12个月后，10例患者尿蛋白排泄量中位数由11.9g/d降至2.3g/d(CI，6.0g/d~15.1g/d；P<；0.001)。血浆白蛋白中位数由24 g/L上升至38 g/L(CI，11至19 g/L；P<；0.001)。血浆胆固醇中位数由10.45降至6.5 2，降至4 0 5至2 5 2 mg/dL(CI，1.4 2至7.16，P=0.0 1)；L(14 0 mg/dL)降至6.5 2，P=0.0 1。一名患者在完成治疗30个月后复发，在再次治疗后肾功能和肾病变量恢复正常。第11例患者单用环磷酰胺治疗，其病程与联合治疗组相似。结论：即使在肾功能已经下降的情况下，环磷酰胺联合泼尼松也能促进膜性肾小球肾炎的长期缓解。
Objective: To determine the effect of cyclophosphamide and prednisone on progressive renal failure and on nephrotic features in patients with membranous glomerulonephritis.Design: Prospective, nonrandomized time series.Setting: Outpatient clinic at a university medical center.Patients: Eleven consecutive patients with biopsy-proven membranous glomerulonephritis and rising plasma creatinine levels over at least 6 months.Intervention: Cyclophosphamide and prednisone in ten patients and cyclophosphamide alone in one patient.Measurements and Main Results: In ten patients treated with both agents, the median plasma creatinine rose 53-mu-mol/L (0.6 mg/dL) over the months before treatment from 141 to 194-mu-mol/L (1.6 to 2.2 mg/dL) (95% CI, 27 to 141-mu-mol/L; P = 0.002). After combined therapy for 6 months, the median plasma creatinine fell to 133-mu-mol/L (1.5 mg/dL) for a median decline of 62-mu-mol/L (0.7 mg/dL) (CI, 44 to 150-mu-mol/L; P = 0.006). Pretreatment plasma creatinine levels, which ranged from 159 to 371-mu-mol/L (1.8 to 4.2 mg/dL), decreased in the ten patients by 6 months and remained stable in seven of the eight patients followed 24 to 54 months after therapy was completed. The median urine protein excretion decreased by 9.6 g/d with 12 months of therapy in the ten patients from 11.9 to 2.3 g/d (CI, 6.0 to 15.1 g/d; P < 0.001). The median plasma albumin rose by 14 g/L from 24 to 38 g/L (CI, 11 to 19 g/L; P < 0.001). The median plasma cholesterol fell by 3.26-mu-mol/L (140 mg/dL) from 10.45 to 6.52-mu-mol/L (405 to 252 mg/dL) (CI, 1.42 to 7.16-mu-mol/L; P = 0.01). One patient who had a relapse 30 months after completing therapy responded to re-treatment with renal function and nephrotic variables returning toward normal. The eleventh patient received cyclophosphamide alone and had a course similar to that of the combined therapy group.Conclusion: Cyclophosphamide plus prednisone can promote prolonged remissions in membranous glomerulonephritis even when renal function is already declining.