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目的 :Ⅴ型狼疮性肾炎 (WHO分型LN Ⅴ型 )主要表现为蛋白尿或肾病综合征 ,本文分析环孢霉素A(CsA)对LN Ⅴ型的疗效。 方法 :分析 16例经肾活检明确诊断为LN Ⅴ型患者CsA治疗的近期及远期的治疗反应。 16例患者治疗前均处于肾病综合征状态。治疗方法 :CsA 5mg/(kg·d)诱导治疗 3个月 ,以后每月减 1mg/(kg·d)直至 2mg/(kg·d)维持 ,CsA治疗同时采用强的松维持。总疗程 12～ 2 4月 ,随访时间 18月～ 4年。 结果 :诱导期CsA平均血药谷浓度为 185± 30 8μg/L。经CsA治疗 3个月后 ,4例 (2 5 % )缓解 ,6例 (37 5 % )部分缓解。治疗 6个月 ,平均尿蛋白为 0 3± 0 4g/2 4h ,血清白蛋白为 40 7± 4 9g/L。 12例 (75 % )缓解 ,3例 (18 7% )部分缓解 ,1例(6 3 % )无效 ,总有效率达 93 7%。 8例伴有镜下血尿者有 6例血尿消失 ,血清学指标也有所改善。CsA停药两年后有 5例 (4 1 7% )复发。CsA治疗 1月内 81 2 %患者 (13/16 )血尿素氮和肌酐有一过性升高。其它副作用有血压升高(6 /16 ) ,少数患者出现多毛及齿龈增生。 3例重复肾活检未见条索状间质纤维化或典型CsA导致的小动脉病变。结论 :本研究证实CsA治疗降低Ⅴ型LN蛋白尿短期内疗效肯定 ,且CsA≤ 5mg/(kg·d)用于肾功能正常LN患者未出现严重肾毒性。但?
Objective: V type lupus nephritis (WHO type LN Ⅴ type) is mainly manifested as proteinuria or nephrotic syndrome, the analysis of cyclosporine A (CsA) of LN Ⅴ type curative effect. Methods: The short-term and long-term response to CsA in 16 patients with LN Ⅴ diagnosed by renal biopsy was analyzed. All 16 patients were in nephrotic syndrome before treatment. Treatment: CsA 5mg / (kg · d) induction therapy for 3 months, after a monthly reduction of 1mg / (kg · d) until 2mg / (kg · d) to maintain, while CsA treatment with prednisone to maintain. The total course of treatment 12 ~ 2 April, 18 months to 4 years follow-up time. Results: The mean serum concentration of CsA in induction period was 185 ± 30 8μg / L. After 3 months of CsA treatment, 4 (25%) were relieved and 6 (37.5%) were partially relieved. After 6 months of treatment, the average urinary protein was 0 ± 0.4g / 2 4h and serum albumin was 40 7 ± 49g / L. 12 cases (75%) were relieved, 3 cases (18.7%) were partly relieved, 1 case (6 3%) was ineffective and the total effective rate was 93.7%. 8 cases of hematuria accompanied by microscopic hematuria disappeared in 6 cases, serological indicators also improved. Five patients (41.7%) relapsed after CsA withdrawal two years later. One month after CsA treatment, 81.2% patients (13/16) had a transient increase in blood urea nitrogen and creatinine. Other side effects of elevated blood pressure (6/16), a small number of patients with hirsutism and gingival hyperplasia. Three cases of repeated renal biopsy without cord-like interstitial fibrosis or typical small artery lesions caused by CsA. CONCLUSIONS: This study confirms the short-term curative effect of CsA treatment for reducing type Ⅴ LN proteinuria and does not cause severe nephrotoxicity in patients with normal renal function with CsA ≤ 5 mg / (kg · d). but?