Scheel Paul J, Piccini Jonathan, Rahman M Hafizur, Lawler Leo, Jarrett Thomas
Division of Nephrology, Department of Medicine, The Johns Hopkins Medical Institution, Baltimore, Maryland 21205, USA.
J Urol. 2007 Jul;178(1):140-3; discussion 143-4. doi: 10.1016/j.juro.2007.03.057. Epub 2007 May 17.
We determined the efficacy of a combination of corticosteroids and mycophenolate mofetil for retroperitoneal fibrosis.
We performed a prospective observational study of the treatment of 7 patients with biopsy proven retroperitoneal fibrosis. Patients were treated with 40 mg prednisone daily with a gradual taper over 6 months. Mycophenolate mofetil was administered at a starting dose of 1,000 mg twice daily and continued for 6 months following resolution of systemic symptoms and extubation of affected ureters. Outcomes included normalization of laboratory evidence of inflammation, regression of fibrosis by computerized tomography and the ability to discontinue ureteral stents.
Seven patients were treated with mycophenolate mofetil and prednisone. Five of the 7 patients had bilateral ureteral obstruction and 1 had unilateral obstruction requiring ureteral stents. Baseline and followup laboratory values were C-reactive protein 8.9 and 1.3 mg/dl (p=0.07), hemoglobin 10.7 and 12.7 gm/dl (p=0.001), erythrocyte sedimentation rate 76 and 14.5 mm per hour (p=0.015) and serum creatinine 3.32 and 1.08 mg/dl (p=0.07), respectively. Six of the 7 patients had a mean 32% regression of the retroperitoneal mass on computerized tomography. Ten of the 11 obstructed ureters were free of obstruction following ureteral stent removal. The mean time to stent removal was 10.5 months. One patient had a distal ureteral stricture and continued to require decompression. There were no treatment related side affects.
Mycophenolate mofetil combined with prednisone was safe and efficacious in this small cohort of patients with retroperitoneal fibrosis. Larger trials are needed to confirm these results.
我们确定了皮质类固醇与霉酚酸酯联合治疗腹膜后纤维化的疗效。
我们对7例经活检证实为腹膜后纤维化的患者进行了前瞻性观察性治疗研究。患者每日服用40mg泼尼松，并在6个月内逐渐减量。霉酚酸酯起始剂量为每日两次，每次1000mg，在全身症状消退且受累输尿管拔管后持续服用6个月。观察指标包括炎症实验室指标恢复正常、计算机断层扫描显示纤维化消退以及拔除输尿管支架的能力。
7例患者接受了霉酚酸酯和泼尼松治疗。7例患者中有5例双侧输尿管梗阻，1例单侧梗阻需要输尿管支架。基线和随访实验室值分别为：C反应蛋白8.9和1.3mg/dl（p=0.07），血红蛋白10.7和12.7g/dl（p=0.0（此处原文有误，推测为0.001）），红细胞沉降率76和14.5mm/小时（p=0.015），血清肌酐3.32和1.08mg/dl（p=0.07）。7例患者中有6例计算机断层扫描显示腹膜后肿块平均消退32%。11根梗阻输尿管中有10根在拔除输尿管支架后解除梗阻。拔除支架的平均时间为10.5个月。1例患者输尿管远端狭窄，仍需减压。未出现与治疗相关的副作用。
在这一小群腹膜后纤维化患者中，霉酚酸酯联合泼尼松治疗安全有效。需要更大规模的试验来证实这些结果。
