Oral cyclophosphamide versus chlorambucil in the treatment of patients with membranous nephropathy and renal insufficiency
Oral cyclophosphamide versus chlorambucil in the treatment of patients with membranous nephropathy and renal insufficiency
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DOI：
10.1093/qjmed/91.5.359
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发表时间：
1998-05-01
期刊：
影响因子：
--
通讯作者：
Wetzels, JFM
中科院分区：
文献类型：
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作者：
Branten, AJW;Reichert, LJM;Wetzels, JFM
我们治疗特发性膜性肾病（iMGN）和肾功能不全患者，使用：(i) （n=15）每月周期的类固醇（1 g甲基强的松连续3天静脉注射，随后口服强的松0.5 mg/kg/天，第1、3和5个月）和氯霉素（0.15 mg/kg/天，第2、4和6个月）；或（ii） （n=17）口服环磷酰胺（1.5-2.0 mg/kg/天，1年）和类固醇，剂量相当。两组在年龄、肾功能和蛋白尿水平上具有可比性。在治疗前6个月，氯霉素组血清肌酐水平从148+/-50上升到219+/-73 mu mol/l，环磷酰胺组从164+/-86上升到274+/-126 mu mol/l。中位（范围）随访时间为：氯苯38个月（8-71）；环磷酰胺26个月（5-68）（NS）。两组患者肾功能均有改善，但氯霉素组的改善是短暂的；治疗12个月后，氯霉素组平均血清肌酐降低6.3 mu mol/l，环磷酰胺组平均血清肌酐降低121 mu mol/l （p < 0.01）。氯苯bubuil组有4例发生ESRD， 5例需要第二疗程治疗，而环磷酰胺组只有1例发生ESRD （p < 0.05）。环磷酰胺治疗后蛋白尿缓解的发生率更高（15/17比5/15；p < 0.01）。环磷酰胺组6例，氯苯丁酸组11例，因不良反应中断治疗（p < 0.05）。在我们的患者中，椭圆形环磷酰胺比口服氯霉素耐受性更好。口服环磷酰胺方案的更大疗效需要通过更长的随访来确定。
We treated patients with idiopathic membranous nephropathy (iMGN) and renal insufficiency, using: (i) (n=15) monthly cycles of steroids (1 g methyl-prednisolone i.v. on three consecutive days, followed by oral prednisone 0.5 mg/kg/day months 1, 3 and 5) and chlorambucil (0.15 mg/kg/day months 2, 4 and 6); or (ii) (n=17) oral cyclophosphamide (1.5-2.0 mg/kg/day for 1 year) and steroids in a comparable dose. The groups were comparable in age, renal function and levels of proteinuria. During the 6 months preceding treatment, serum creatinine levels increased from 148+/-50 to 219+/-73 mu mol/l in the chlorambucil group and from 164+/-86 to 274+/-126 mu mol/l in the cyclophosphamide group. Median (range) follow-ups were: chlorambucil 38 months (8-71); cyclophosphamide 26 months (5-68) (NS). Renal function improved in both groups, but the improvement was short-lived in the chlorambucil group; 12 months after starting treatment, mean serum creatinine was 6.3 mu mol/l lower in the chlorambucil group and 121 mu mol/l lower in the cyclophosphamide group (p < 0.01). Four chlorambucil-treated patients developed ESRD, and five needed a second course of therapy, whereas only one cyclophosphamide-treated patient developed ESRD (p < 0.05). Remissions of proteinuria occurred more frequently after cyclophosphamide treatment (15/17 vs. 5/15; p < 0.01). Side-effects necessitated interruption of treatment in six patients on cyclophosphamide and in 11 on chlorambucil (p < 0.05). In our patients, oval cyclophosphamide was better tolerated than oral chlorambucil. The suggested greater efficacy of the oral cyclophosphamide regimen needs to be ascertained by longer follow-up.