Kim Y G, Kim H W, Cho Y M, Oh J S, Nah S-S, Lee C-K, Yoo B
Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea.
Rheumatology (Oxford). 2008 Mar;47(3):311-4. doi: 10.1093/rheumatology/kem365. Epub 2008 Jan 19.
To evaluate the response to induction therapy with intravenous (i.v.) cyclophosphamide (CYC) in Korean patients with class IV-G (diffuse global proliferative glomerulonephritis) and class IV-S (diffuse segmental proliferative glomerulonephritis) lupus nephritis (LN) according to the classification system of the International Society of Nephrology/Renal Pathology Society (ISN/RPS).
Of the 52 patients with biopsy-proven diffuse proliferative LN, who had been treated with i.v. CYC over a 10-yr period, 42 had been treated with i.v. CYC (equal to or more than 500 mg) for 6 consecutive months and had biopsy specimens containing more than nine glomeruli. The renal pathology of these 42 patients was reclassified according to the International Society of Nephrology and the Renal Pathology Society 2003 classification, and their renal response rates and laboratory indices after induction therapy were analysed.
Of the 42 patients assessed, 30 (71%) had IV-G and 12 (29%) had IV-S. Pre-treatment 24 h urinary protein was significantly higher and pre-treatment concentration of anti-dsDNA antibody was significantly lower in IV-G than in IV-S patients. Following induction therapy, complete remission rates were significantly higher in patients with IV-S (67%, 8/12) than in patients with IV-G (33%, 10/30) LN.
Class IV-G LN responded more poorly to induction therapy with i.v. CYC pulse than class IV-S LN.
根据国际肾脏病学会/肾脏病理学会（ISN/RPS）的分类系统，评估韩国IV - G级（弥漫性球性增生性肾小球肾炎）和IV - S级（弥漫性节段性增生性肾小球肾炎）狼疮性肾炎（LN）患者对静脉注射环磷酰胺（CYC）诱导治疗的反应。
在52例经活检证实为弥漫性增生性LN且在10年期间接受静脉注射CYC治疗的患者中，42例连续6个月接受静脉注射CYC（等于或超过500mg）治疗，且活检标本包含9个以上肾小球。根据国际肾脏病学会和肾脏病理学会2003年分类对这42例患者的肾脏病理进行重新分类，并分析诱导治疗后的肾脏反应率和实验室指标。
在评估的42例患者中，30例（71%）为IV - G级，12例（29%）为IV - S级。IV - G级患者治疗前24小时尿蛋白显著更高，治疗前抗双链DNA抗体浓度显著低于IV - S级患者。诱导治疗后，IV - S级LN患者的完全缓解率（67%，8/12）显著高于IV - G级LN患者（33%，10/30）。
IV - G级LN对静脉注射CYC脉冲诱导治疗的反应比IV - S级LN更差。
