Kasitanon N, Petri M, Haas M, Magder L S, Fine D M
Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Lupus. 2008 Jan;17(1):40-5. doi: 10.1177/0961203307085114.
Studies of immunosuppressive therapy, particularly mycophenolate mofetil (MMF), in membranous lupus nephritis (MLN) are limited. We report on our experience with primary (first-line) MMF therapy to induce and sustain renal remission in MLN with and without a concurrent proliferative lesion. Systemic lupus erythematosus (SLE) patients were studied, retrospectively, if treated with MMF for newly diagnosed MLN. Complete remission was defined as proteinuria less than 0.5 g/24 h, inactive urine sediment and normal estimated glomerular filtration rate. Response in pure MLN (Group I, n=10) was compared with mixed MLN and proliferative lupus nephritis (Group II, n=19). By 12 months, 4 (40%) patients in Group I and 7 (36.8%) in Group II achieved complete remission (P=0.87). One (10%) patient in Group I and 2 (10.5%) in Group II had worsening renal disease (P=0.97). Mean time to remission was more than seven months in both groups. The remaining patients had stable disease without improvement or worsening. Only 2 of 11 achieving initial remission had a relapse with an average of 28 months of follow-up after remission. Self-limited gastrointestinal symptoms occurred in 12 patients, none requiring withdrawal of the drug. Mycophenolate mofetil as a primary therapy in MLN was successful in inducing complete remission in about 40% of MLN, particularly in patients with mild proteinuria. However, 12 months of therapy was necessary for best outcomes. Response rate was not different in the presence or absence of a proliferative lesion.
关于免疫抑制疗法，尤其是霉酚酸酯（MMF）在膜性狼疮性肾炎（MLN）中的研究有限。我们报告了我们使用原发性（一线）MMF疗法诱导并维持伴有或不伴有并发增殖性病变的MLN患者肾脏缓解的经验。对系统性红斑狼疮（SLE）患者进行回顾性研究，这些患者因新诊断的MLN接受MMF治疗。完全缓解定义为蛋白尿少于0.5 g/24小时、尿沉渣无活性且估计肾小球滤过率正常。将单纯MLN组（I组，n = 10）的反应与混合性MLN和增殖性狼疮性肾炎组（II组，n = 19）进行比较。到12个月时，I组4例（40%）患者和II组7例（36.8%）患者实现完全缓解（P = 0.87）。I组1例（10%）患者和II组2例（10.5%）患者出现肾脏疾病恶化（P = 0.97）。两组的平均缓解时间均超过7个月。其余患者病情稳定，无改善或恶化。在11例实现初始缓解的患者中，只有2例复发，缓解后平均随访28个月。12例患者出现自限性胃肠道症状，无一例需要停药。MMF作为MLN的一线治疗方法，在约40%的MLN患者中成功诱导了完全缓解，尤其是轻度蛋白尿患者。然而，为了获得最佳结果，需要进行12个月的治疗。无论是否存在增殖性病变，缓解率均无差异。
