A 10-YEAR FOLLOW-UP OF A RANDOMIZED STUDY WITH METHYLPREDNISOLONE AND CHLORAMBUCIL IN MEMBRANOUS NEPHROPATHY
A 10-YEAR FOLLOW-UP OF A RANDOMIZED STUDY WITH METHYLPREDNISOLONE AND CHLORAMBUCIL IN MEMBRANOUS NEPHROPATHY
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DOI：
10.1038/ki.1995.453
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发表时间：
1995-11-01
影响因子：
19.6
通讯作者：
BANFI, G
中科院分区：
文献类型：
--
作者：
PONTICELLI, C;ZUCCHELLI, P;BANFI, G
特发性膜性肾病的自然病程各不相同，一些患者缓慢进展为肾功能衰竭，而另一些患者则始终保持正常的肾功能。由于缺乏治疗长期效果的对照数据，是否治疗这种疾病存在争议。我们在 10 年更新了一项对照试验的结果，其中 81 名特发性膜性肾病和肾病综合征患者被随机分配接受对症治疗（39 名患者）或接受 6 个月的甲泼尼龙和苯丁酸氮芥治疗（42 名患者）。接受甲基泼尼松龙和苯丁酸氮芥治疗的患者 10 年未患终末期肾病的存活概率为 92%，而对照组为 60%（P = 0.0038）。治疗患者长达 10 年的血浆肌酐倒数斜率明显优于对照组（P = 0.035）。接受治疗的患者肾病综合征完全或部分缓解的概率显着较高（P = 0.000）。分配接受治疗的患者与未接受治疗的患者相比，未出现肾病综合征的时间明显更长（P = 0.0001）。由于可逆的副作用，四名患者不得不停止治疗。从长远来看，一名接受治疗的患者患上了糖尿病，另一名患者变得肥胖。总之，为期六个月的甲基强的松龙和苯丁酸氮芥治疗可以增加蛋白尿缓解的可能性，并且即使从长期来看也可以防止肾功能恶化。这种治疗可以使大约三分之一的膜性肾病肾病患者在10年内避免透析或死亡。
The natural course of idiopathic membranous nephropathy is variable, with some patients slowly progressing to renal failure while others maintain normal renal function over the entire time. Whether to treat this disease or not is controversial due to the lack of controlled data about the long-term effects of treatment. We updated at 10 years the results of a controlled trial in which 81 patients with idiopathic membranous nephropathy and nephrotic syndrome were randomly assigned to receive symptomatic therapy (39 patients) or a treatment of six months with methylprednisolone and chlorambucil (42 patients). The probability of surviving without developing end-stage renal disease at 10 years was 92% in patients given methylprednisolone and chlorambucil versus 60% in controls (P = 0.0038). The slope of the reciprocal of plasma creatinine up to 10 years was significantly better in treated patients than in controls (P = 0.035). The probability of having a complete or partial remission of the nephrotic syndrome was significantly higher in treated patients (P = 0.000). Patients assigned to therapy spent significantly longer time without nephrotic syndrome than untreated patients (P = 0.0001). Four patients had to stop treatment because of reversible side-effects. In the long-term one treated patient developed diabetes and another one became obese. In conclusion, a six-month therapy with methylprednisolone and chlorambucil increases the probability of remission of proteinuria and protects from renal function deterioration even in the long-term. This treatment may avoid dialysis or death within 10 years to about one third of nephrotic patients with membranous nephropathy.