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目的前瞻性研究霉酚酸酯(MMF)治疗乙型肝炎病毒相关性肾炎的临床疗效和安全性。方法选择血清HBV标记物阳性、病理诊断为乙型肝炎病毒相关性肾炎的患者共18例,随机分为两组,每组9例,第一组采用MMF联合皮质激素治疗方案,MMF初始剂量1.0～1.5g/d,同时口服强的松0.5～0.8mg·kg-·1d-1。第二组采用皮质激素治疗,强的松0.5～0.8mg·kg-·1d-1。两组中有HBV蛳DNA复制的均给予干扰素蛳α或拉米夫定治疗。结果①治疗3个月时,MMF组尿蛋白定量如(2.7±2.5)g/d较治疗前的(4.9±2.9)g/d明显减少(P<0.05),血浆白蛋白为(34.7±7.3)g/L较治疗前的(26.0±6.2)g/L明显升高(P<0.05);对照组尿蛋白定量和血浆白蛋白与治疗前相比无显著改善(P>0.05)。治疗6个月时,MMF组尿蛋白定量为(1.4±0.7)g/24h较治疗前的(4.9±2.9)g/24h明显减少(P<0.01),血浆白蛋白为(35.1±5.6)g/L较治疗前的(26.0±6.2)g/L明显升高(P<0.01)。对照组尿蛋白定量为(2.7±1.6)g/24h较治疗前的(5.6±2.2)g/24h明显减少(P<0.05),血浆白蛋白为(33.8±9.5)g/L较治疗前的(26.2±6.0)g/L显著升高(P<0.05)。治疗6个月时MMF组尿蛋白定量为(1.4±0.7)g/24h显著低于对照组的(2.7±1.6)g/24h(P<0.05)。MMF组6个月时的完全缓解率(44.4%)与对照组(11.1%)比较无显著性差?
Objective To prospectively study the clinical efficacy and safety of mycophenolate mofetil (MMF) in the treatment of hepatitis B virus-associated nephritis. Methods A total of 18 patients with positive serum HBV markers and pathologically diagnosed as hepatitis B virus associated nephritis were randomly divided into two groups with 9 patients in each group. The first group was treated with MMF combined with corticosteroid. The initial dose of MMF 1.0 ~ 1.5g / d, while oral prednisone 0.5 ~ 0.8mg · kg- · 1d-1. The second group used corticosteroids, prednisone 0.5 ~ 0.8mg · kg- · 1d-1. HBV DNA replication in both groups were given interferon 蛳 α or lamivudine treatment. Results ① At 3 months of treatment, urinary protein in MMF group was significantly lower than that of pretreatment (4.9 ± 2.9g / d, 2.7 ± 2.5g / d, P <0.05) and plasma albumin was (34.7 ± 7.3) ) g / L was significantly higher than that before treatment (26.0 ± 6.2) g / L (P <0.05). The urinary protein and plasma albumin in the control group had no significant improvement compared with those before treatment (P> 0.05). At 6 months, urinary protein in MMF group was (1.4 ± 0.7) g / 24h, which was significantly lower than that before treatment (4.9 ± 2.9) g / 24h and serum albumin was (35.1 ± 5.6) g / L was significantly higher than that before treatment (26.0 ± 6.2) g / L (P <0.01). The urinary protein in the control group was (2.7 ± 1.6) g / 24h, which was significantly lower than that before the treatment (5.6 ± 2.2) g / 24h, and the plasma albumin was (33.8 ± 9.5) g / (26.2 ± 6.0) g / L were significantly increased (P <0.05). The proteinuria of urinary protein in MMF group was (1.4 ± 0.7) g / 24h at 6 months after treatment, which was significantly lower than that of the control group (2.7 ± 1.6) g / 24h (P <0.05). The complete response rate (44.4%) at 6 months in the MMF group was not significantly different from that in the control group (11.1%).