Kawasaki Yukihiko, Suzuki Junzo, Suzuki Hitoshi
Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima 960-1295, Japan.
Nephrol Dial Transplant. 2004 Apr;19(4):858-64. doi: 10.1093/ndt/gfg617.
There have been few controlled studies of combined therapy with multiple drugs, including immunosuppressives, for severe Henoch-Schoenlein nephritis (HSPN). We evaluated the efficacy of methylprednisolone and urokinase pulse therapy combined with cyclophosphamide for patients with HSPN of at least grade IVb.
We studied 37 patients who had been diagnosed with HSPN of at least grade IVb. Of them, 20 (Group A) were treated with methylprednisolone and urokinase pulse therapy, and 17 (Group B) were treated with methylprednisolone and urokinase pulse therapy combined with cyclophophamide. We analysed the clinical features, laboratory and pathological findings of the two groups retrospectively.
After 6 months of treatment, mean urinary protein excretion in Group B had significantly decreased compared with Group A, and the activity index of both groups at the second biopsy was lower than that at the first. Furthermore, at the second biopsy, the chronicity index of Group B was lower than that of Group A. Four patients of Group A but none of Group B had persistent nephropathy (P<0.05).
Our study suggests that methylprednisolone and urokinase pulse therapy combined with cyclophosphamide is useful for patients with severe HSPN.
对于重症紫癜性肾炎（HSPN），包括免疫抑制剂在内的多种药物联合治疗的对照研究较少。我们评估了甲泼尼龙和尿激酶冲击疗法联合环磷酰胺对至少IVb级HSPN患者的疗效。
我们研究了37例被诊断为至少IVb级HSPN的患者。其中，20例（A组）接受甲泼尼龙和尿激酶冲击治疗，17例（B组）接受甲泼尼龙和尿激酶冲击治疗联合环磷酰胺。我们回顾性分析了两组的临床特征、实验室和病理结果。
治疗6个月后，B组的平均尿蛋白排泄量与A组相比显著降低，两组第二次活检时的活动指数均低于第一次。此外，在第二次活检时，B组的慢性指数低于A组。A组有4例患者出现持续性肾病，而B组无1例出现（P<0.05）。
我们的研究表明，甲泼尼龙和尿激酶冲击疗法联合环磷酰胺对重症HSPN患者有效。
