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目的 多中心、前瞻性观察吗替麦考酚酯 (MMF)治疗弥漫增生性狼疮性肾炎的临床疗效和不良反应。方法 全国 9家医院共收集系统性红斑狼疮患者 75例 (男 1 3例 ,女 62例 ) ,均经肾活检确定为活动性弥漫增生性狼疮性肾炎 (LN IV) ,年龄 (31 0± 1 0 1 )岁 ,病程 (38 9± 52 5)个月 ;其中经正规激素联合环磷酰胺治疗无效者 2 6例 ,复发者 2 1例 ,初治患者 2 8例。治疗方案采用激素联合MMF。MMF起始剂量为 0 5～ 2 0g/d ,随访时间≥ 6个月。 38例治疗后行重复肾活检 ,并进行急性指数 (AI)、慢性指数 (CI)、免疫球蛋白 (Ig)及补体沉积半定量评分。结果 MMF平均起始剂量 (1 2 6±0 30 )g/d ,治疗 3、6个月时MMF平均剂量分别为 (1 2 1± 0 30 )g/d、(0 95± 0 33)g/d。治疗 3个月狼疮活动分数 (SLE DAI)由 1 6 9± 6 7降为 8 1± 4 8(P <0 0 1 ) ,血红蛋白由 (92± 2 1 )g/L升至 (1 1 2± 2 8)g/L(P <0 0 5) ,尿蛋白由 (4 2 4± 2 66)g/d降至 (2 1 8± 3 75)g/d(P <0 0 5) ,血清白蛋白升至 (35 3±6 9)g/L(P <0 0 1 ) ,肾功能明显改善 ,无活动性尿沉渣 ;治疗 6个月尿蛋白继续下降至 (1 54± 1 60 )g/d ,血红蛋白、血清白蛋白继续升高。血清A dsDNA抗体阳性及低补体血症患者比例显著降低。
Objective To investigate the clinical efficacy and adverse reactions of mycophenolate mofetil (MMF) in the treatment of diffuse proliferative lupus nephritis. Methods A total of 75 patients with systemic lupus erythematosus (123 males and 62 females) were collected from 9 hospitals across the country. All of them were confirmed by renal biopsy as active diffuse proliferative lupus nephritis (LN IV), age (31 ± 1) 0 1) years old, duration of disease (38 9 ± 52 5) months; of which 26 were ineffective with normal hormones and cyclophosphamide, 21 were relapsed and 28 were untreated. Treatment options using hormones combined with MMF. MMF initial dose of 0 ~ 20g / d, follow-up time ≥ 6 months. Thirty-eight patients underwent repeat renal biopsy and the semi-quantitative scores of acute index (AI), chronic index (CI), immunoglobulin (Ig) and complement deposition were measured. Results The mean initial dose of MMF was (126 ± 0 30) g / d, and the mean MMF doses at 3 and 6 months of treatment were (112 ± 0 30) g / d and (95 ± 0 33) g / d. After 3 months of treatment, the lupus activity score (SLE DAI) decreased from 169 ± 6 7 to 81 ± 48 (P <0.01), and hemoglobin increased from (92 ± 2 1) g / L to The urinary protein decreased from (42 4 ± 2 66) g / d to (21 8 ± 3 75) g / d (P 0 05), ± 2 8) g / L Serum albumin increased to (35 3 ± 6 9) g / L (P 0 01), renal function improved significantly, no activity of urinary sediment; urinary protein 6 months after treatment continued to decline to (54 ± 1 60) g / d, hemoglobin, serum albumin continue to rise. Serum A dsDNA antibody-positive and hypo -invasive patients significantly reduced the proportion of patients.