Sahin Gulizar Manga, Sahin Sevgi, Kiziltas Safak, Masatlioglu Seval, Oguz Fusun, Ergin Hulya
Goztepe Research and Training Hospital, Istanbul, Turkey.
Ren Fail. 2008;30(9):865-9. doi: 10.1080/08860220802353843.
Renal involvement is one of the major determinants of the outcome in patients with systemic lupus erythematosus. Renal involvement contributes to both morbidity and mortality of the patients as well as indirectly through side effects of therapy directed at the renal lesions. The aim of the study was to evaluate the efficacy of mycophenolate mofetil (MMF) and azathioprine (AZA) in the maintenance therapy of lupus nephritis.
Thirty-two patients from our center with diagnosed lupus nephritis World Health Organization Class III, IV, V were treated with IVC (0.75-1g/month) for six months in addition to steroid therapy, and then with AZA (n = 15) or MMF (n = 17) as a maintenance therapy. The efficacy of two drugs was compared with changes in serum creatinine, creatinine clearance, 24 hour urine protein excretion, cholesterol, anti-dsDNA antibody, and urine sediment.
Mean follow-up time was 41.5 + 7 months. The total remission occurred in 84% of patients (82% with MMF and 87% with AZA), with a complete remission rate of 59.3% (58% with MMF and 60% with AZA) and a partial remission rate of 25% (22% with MMF and 27% with AZA). The urinary protein excretion before MMF treatment was 1.9 + 1 g/dL and decreased significantly to 0.91 + 0.6 g/dL (p = 0.028) after treatment, and decreased from 1.58 + 0.7 g/dL to 0.4 + 0.23 g/dL in the AZA group (p = 0.04). The serum creatinine level decreased from 1.32 + 0.7 mg/dL to 1.12 + 0.68 mg/dL in the MMF group (p = 0.23), and decreased from 0.91 + 0.23 mg/dL to 0.88 + 0.23 mg/dL in the AZA group (p = 0.49). There was no significant change between two groups (p = 0.1). The serum cholesterol decreased from 229 + 57 mg/dL to 171 + 9 mg/dL (p = 0.002), and serum triglyceride level decreased from 228 + 116 mg/dL to 98 + 35 mg/dL (p = 0.004) in the MMF treatment, but no significant change was seen in AZA group. There was no significant difference between the two groups considering the rates of doubling of serum creatinine, progression to end-stage renal failure, relapses, and documented side effects, as well.
Both therapeutic approaches with MMF or AZA, in combination with corticosteroids, are effective as a maintenance therapy for lupus nephritis.
肾脏受累是系统性红斑狼疮患者预后的主要决定因素之一。肾脏受累不仅会导致患者发病和死亡，还会通过针对肾脏病变的治疗副作用间接产生影响。本研究的目的是评估霉酚酸酯（MMF）和硫唑嘌呤（AZA）在狼疮性肾炎维持治疗中的疗效。
我们中心的32例确诊为世界卫生组织III、IV、V级狼疮性肾炎的患者，除接受类固醇治疗外，还接受了静脉环磷酰胺（IVC，0.75 - 1g/月）治疗6个月，然后分别接受AZA（n = 15）或MMF（n = 17）作为维持治疗。通过比较血清肌酐、肌酐清除率、24小时尿蛋白排泄、胆固醇、抗双链DNA抗体和尿沉渣的变化来评估两种药物的疗效。
平均随访时间为41.5 ± 7个月。84%的患者实现了完全缓解（MMF组为82%，AZA组为87%），完全缓解率为59.3%（MMF组为58%，AZA组为60%），部分缓解率为25%（MMF组为22%，AZA组为27%）。MMF治疗前尿蛋白排泄为1.9 ± 1g/dL，治疗后显著降至0.91 ± 0.6g/dL（p = 0.028），AZA组从1.58 ± 0.7g/dL降至0.4 ± 0.23g/dL（p = 0.04）。MMF组血清肌酐水平从1.32 ± 0.7mg/dL降至1.12 ± 0.68mg/dL（p = 0.23），AZA组从0.91 ± 0.23mg/dL降至0.88 ± 0.23mg/dL（p = 0.49）。两组之间无显著变化（p = 0.1）。MMF治疗后血清胆固醇从229 ± 57mg/dL降至171 ± 9mg/dL（p = 0.002），血清甘油三酯水平从228 ± 116mg/dL降至98 ± 35mg/dL（p = 0.004），而AZA组未见显著变化。在血清肌酐翻倍率、进展至终末期肾衰竭、复发率和记录的副作用发生率方面，两组之间也无显著差异。
MMF或AZA与皮质类固醇联合使用的两种治疗方法，作为狼疮性肾炎的维持治疗均有效。
