Suki W N, Trimarchi H, Frommer J P
Renal Section, Department of Medicine, Baylor College of Medicine, and The Methodist Hospital, Houston, TX 77030, USA.
Am J Nephrol. 1999;19(4):474-9. doi: 10.1159/000013501.
Although controversial, treatment of membranous nephropathy appears to yield a reduction in the degree of proteinuria and conservation of renal function.
We report herein our experience with the treatment with steroids alone (group II, n = 13), or in combination with immunosuppressants (group III, n = 19) of patients with membranous nephropathy and the nephrotic syndrome, with a mean follow-up of 8.37 years.
All patients underwent a first remission, with 24-hour urine protein excretion falling to 0.63 +/- 0.25 g in group II and 0.62 +/- 0.26 g in group III (p = NS) after 12.69 +/- 10.94 months of treatment in group II and 18.95 +/- 13.17 months in group III (p = NS). Three patients from group II (23%) and seven patients from group III (36.8%) experienced four and eight relapses, respectively (proteinuria in 24 h 4.0 +/- 0.80 g in group II relapsers and 4.4 +/- 0.87 in group III relapsers; p = NS). On treatment, all relapses remitted (second remission) after 7 +/- 6.93 months of therapy for group II and 8.6 +/- 6.70 months of treatment for group III (p = NS). Thereafter, no patients from group II, but 3 patients from group III (33.3%) had a second relapse. After treatment, all relapses remitted (third remission) in 3.3 +/- 1.53 months of therapy.
These studies show that relapses, which occur in one-third of patients, respond favorably to treatment albeit remitting in approximately half the time, and that the duration of remission gets progressively longer in the later compared to the earlier remission.
尽管存在争议，但膜性肾病的治疗似乎能降低蛋白尿程度并保护肾功能。
我们在此报告对膜性肾病合并肾病综合征患者单独使用类固醇（第二组，n = 13）或联合免疫抑制剂（第三组，n = 19）进行治疗的经验，平均随访8.37年。
所有患者均首次缓解，第二组治疗12.69±10.94个月后24小时尿蛋白排泄降至0.63±0.25 g，第三组治疗18.95±13.17个月后降至0.62±0.26 g（p =无显著性差异）。第二组3例患者（23%）和第三组7例患者（36.8%）分别经历了4次和8次复发（第二组复发者24小时蛋白尿为4.0±0.80 g，第三组复发者为4.4±0.87 g；p =无显著性差异）。治疗后，第二组复发者经7±6.93个月治疗、第三组复发者经8.6±6.70个月治疗后所有复发均缓解（第二次缓解）（p =无显著性差异）。此后，第二组无患者复发，但第三组有3例患者（33.3%）再次复发。再次治疗后，所有复发者经3.3±1.53个月治疗均缓解（第三次缓解）。
这些研究表明，三分之一的患者会出现复发，复发对治疗反应良好，尽管缓解时间约为一半，且后期缓解持续时间比早期缓解持续时间逐渐延长。
