Lai Kar Neng, Tang Sydney C W, Mok Chi Chiu
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong.
Nephrology (Carlton). 2005 Apr;10(2):180-8. doi: 10.1111/j.1440-1797.2005.00372.x.
The optimal treatment of severe lupus nephritis remains unclear. Regimens consisting of steroid and cyclophosphamide (CYC) appear to be most effective. Infection and gonadal toxicity is a major concern of CYC use in patients of reproductive age. In addition, failure to respond or refractory to CYC treatment may lead to the development of end-stage renal disease. Mycophenolate mofetil (MMF) is a new immunosuppressive agent that selectively inhibits activated lymphocytes and renal mesangial cells. Data from experimental lupus nephritis and controlled studies, albeit small and lacking statistical power, have revealed that MMF is as effective in lupus patients as CYC in the induction of renal remission or as maintenance therapy to reduce renal flare in the short term. The significantly less ovarian toxicity and infection when compared to CYC are particularly attractive for the consideration of MMF in lupus nephritis. The potential of other new therapeutic agents is discussed together with the need for patient recruitment in future trials of lupus nephritis to address the importance of ethnicity as well as histological grading.
重症狼疮性肾炎的最佳治疗方法仍不明确。由类固醇和环磷酰胺（CYC）组成的治疗方案似乎最为有效。感染和性腺毒性是CYC用于育龄患者时的主要顾虑。此外，对CYC治疗无反应或难治可能会导致终末期肾病的发生。霉酚酸酯（MMF）是一种新型免疫抑制剂，可选择性抑制活化淋巴细胞和肾系膜细胞。来自实验性狼疮性肾炎和对照研究的数据，尽管规模较小且缺乏统计学效力，但已显示MMF在诱导狼疮患者肾脏缓解方面与CYC一样有效，或作为短期维持治疗以减少肾脏复发。与CYC相比，MMF的卵巢毒性和感染明显较少，这使其在狼疮性肾炎治疗中极具吸引力。文中还讨论了其他新型治疗药物的潜力，以及在未来狼疮性肾炎试验中招募患者以解决种族因素和组织学分级重要性问题的必要性。
