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目的 :探讨霉酚酸酯 (MMF)治疗狼疮性肾炎 (特别是Ⅲ和Ⅳ型 )疗效及其安全性。方法 :91例狼疮性肾炎患者 ,67例行肾活检 (其中Ⅲ型狼疮性肾炎 2 0例 ,Ⅳ型狼疮性肾炎 47例 )。将患者分为糖皮质激素和环磷酰胺(CYC)联合治疗组 (CYC组 ) 1 5例、糖皮质激素和MMF联合治疗组 (MMF组 ) 76例 ,治疗时间 6个月 ,CYC用量为1 g/月 ;MMF前 3月 1 .5g/d ,后 3月 1 .0 g/d ,应用 6个月。定期了解尿改变、肾脏功能、血清免疫学指标并记录副作用。结果 :①MMF的疗效 :应用 6个月后 2 4h尿蛋白量明显低于用药前 (P <0 .0 1 )和同期CYC组 (P <0 .0 5) ;尿红细胞减少 50 %的例数为 59例 ,显著高于CYC组 (P <0 .0 5) ;MMF可明显降低狼疮性肾炎患者血尿素氮和肌酐的水平 ;②MMF对狼疮性肾炎患者血清免疫学的影响 :MMF治疗 6个月后 ,血清IgG水平降低 ,C3、C4 水平升高。MMF治疗 1 2周后 ,抗ds DNA抗体阳性率明显低于CYC组。③MMF副作用 :主要为感染 (8例 )、胃肠道反应 (8例 )等。结论 :应用MMF是治疗狼疮性肾炎 (特别是Ⅲ、Ⅳ型 )有效的方法 ,其副作用较小 ,安全性较强
Objective: To investigate the efficacy and safety of mycophenolate mofetil (MMF) in the treatment of lupus nephritis (especially type Ⅲ and Ⅳ). Methods: 91 cases of lupus nephritis patients, 67 cases of renal biopsy (including 20 cases of type Ⅲ lupus nephritis, Ⅳ type 47 cases of lupus nephritis). Patients were divided into glucocorticoid and cyclophosphamide (CYC) combined treatment group (CYC group) 15 cases, glucocorticoid and MMF group (MMF group) 76 cases, the treatment time of 6 months, the CYC dosage was 1 g / month; MMF before March 1.5g / d, after March 1.0 g / d, application of 6 months. Regular understanding of urinary changes, renal function, serum immunological parameters and record side effects. Results: (1) The curative effect of MMF: urinary protein levels at 24 hours after application were significantly lower than those before treatment (P <0.01) and CYC at the same period (P <0.05); urinary erythrocytes decreased by 50% Was significantly higher than that of CYC group (P <0.05); MMF could significantly reduce the level of blood urea nitrogen and creatinine in patients with lupus nephritis; ②The influence of MMF on serum immunology in patients with lupus nephritis: MMF treatment of 6 Months later, serum IgG levels decreased and C3 and C4 levels increased. After 12 weeks MMF treatment, the positive rate of anti-ds DNA antibody was significantly lower than that of CYC group. ③ MMF side effects: mainly for infection (8 cases), gastrointestinal reactions (8 cases) and so on. Conclusion: MMF is an effective treatment for lupus nephritis (especially type Ⅲ and type Ⅳ) with less side effects and higher safety