Vachvanichsanong P, Dissaneewate P, Winn T
Department of Pediatrics, Prince of Songkla University, Hat Yai, Thailand.
Scand J Rheumatol. 2004;33(5):339-42. doi: 10.1080/03009740410006448.
To evaluate the efficacy of a 36-month course of intravenous cyclophosphamide therapy for severe lupus nephritis in Thai children between October 1993 and December 2000.
Intravenous cyclophosphamide combined with oral prednisolone was given for 36 months to patients with systemic lupus erythematosus (SLE) who had severe renal involvement. Serum creatinine (Cr), creatinine clearance (CCr), urinary protein, C3, and complete blood count (CBC) were measured each visit for intravenous cyclophosphamide. Repeated measures ANOVA and Kaplan-Meier survival analysis were used.
Of 21 patients enrolled in the study, three died and two were lost to follow-up, leaving 16 patients who completed therapy (13 females and three males) with age at diagnosis 12.1+/-2.3 years (range 7.2-20.6 years). The follow-up period was 6.3+/-2.3 years (range 3.3-13.8 years). Fourteen patients had lupus nephritis WHO classification class IV and two had lupus nephritis WHO classification class II. Hypertension was detected in ten patients. Lowess smoothing curves and repeated measures ANOVA indicated no significant change in Cr and CCr [probability (p) > 0.05)], but significantly increased C3 and haemoglobin and significantly decreased urinary protein and white blood cell count (p < 0.001). Five patients had six episodes of acute renal failure; one died, renal function returned to normal in two patients, two continued to chronic renal failure, and one died of chronic renal failure. The 5-year survival and renal survival were 86.5% and 87.5% (95% CI 55.8-96.5% and 58.6-96.7%), respectively.
Intravenous cyclophosphamide in severe lupus nephritis in Thai children showed a satisfactory outcome with minimal complications. Further follow-up is needed.
评估1993年10月至2000年12月间静脉注射环磷酰胺治疗泰国儿童重症狼疮性肾炎36个月疗程的疗效。
对有严重肾脏受累的系统性红斑狼疮（SLE）患者给予静脉注射环磷酰胺联合口服泼尼松龙治疗36个月。每次静脉注射环磷酰胺时均测量血清肌酐（Cr）、肌酐清除率（CCr）、尿蛋白、C3和全血细胞计数（CBC）。采用重复测量方差分析和Kaplan-Meier生存分析。
纳入研究的21例患者中，3例死亡，2例失访，16例完成治疗（13例女性和3例男性），诊断时年龄为12.1±2.3岁（范围7.2 - 20.6岁）。随访期为6.3±2.3年（范围3.3 - 13.8年）。14例患者狼疮性肾炎WHO分类为IV级，2例患者狼疮性肾炎WHO分类为II级。10例患者检测到高血压。局部加权回归平滑曲线和重复测量方差分析表明，Cr和CCr无显著变化[概率（p）>0.05]，但C3和血红蛋白显著升高，尿蛋白和白细胞计数显著降低（p<0.001）。5例患者发生6次急性肾衰竭；1例死亡，2例患者肾功能恢复正常，2例继续发展为慢性肾衰竭，1例死于慢性肾衰竭。5年生存率和肾脏生存率分别为86.5%和87.5%（95%可信区间55.8 - 96.5%和58.6 - 96.7%）。
泰国儿童重症狼疮性肾炎静脉注射环磷酰胺显示出令人满意的结果，并发症最少。需要进一步随访。
