Matsuyama Naomi, Morimoto Shinji, Tokano Yoshiaki, Amano Hirofumi, Nozawa Kazuhisa, Isonuma Hiroshi, Hashimoto Hiroshi, Takasaki Yoshinari
Department of General Medicine, Juntendo University, School of Medicine, Tokyo.
Intern Med. 2010;49(9):823-8. doi: 10.2169/internalmedicine.49.2291. Epub 2010 Apr 30.
Patients with lupus nephritis receiving intravenous cyclophosphamide (IVCY) therapy were divided into groups according to their clinical course, and the long-term prognosis was evaluated.
A total of 67 patients with lupus nephritis were enrolled and divided as follow into the following groups: Group A: patients with fresh nephritis, Group B: patients with relapse nephritis, Group C: patients with nephritis as a transition of the main clinical manifestation. IVCY (500 mg or 750 mg) was administered every month, and continued for two to more than six months.
The rate of remission was 78%; group A revealed a significantly higher rate of remission as compared with the other groups. Although long-term remission was revealed in most patients, some patients in Group B demonstrated a decreased rate of remission. Concerning the total dose administered, there was no relation to prognosis; a high dose was not required, especially for patients in Group A. On the other hand, the combination of steroid pulse therapy with IVCY revealed a moderate relation to the increased rate of remission in Group A. However, this combination therapy was not related to the maintenance of remission. There was no adverse effect at late onset.
The long-term prognosis of IVCY differed according to the patient's clinical course, and the result differed from those reported in other countries. Therefore, we should consider the clinical course and race specificity for the Japanese subject.
将接受静脉注射环磷酰胺（IVCY）治疗的狼疮性肾炎患者根据其临床病程分组，并评估长期预后。
共纳入67例狼疮性肾炎患者，分为以下几组：A组：新发肾炎患者；B组：复发肾炎患者；C组：以肾炎为主要临床表现转变的患者。每月给予IVCY（500mg或750mg），持续两至六个多月。
缓解率为78%；A组的缓解率显著高于其他组。虽然大多数患者实现了长期缓解，但B组的一些患者缓解率有所下降。关于给药总量，与预后无关；不需要高剂量，尤其是A组患者。另一方面，类固醇脉冲疗法与IVCY联合应用与A组缓解率增加呈中度相关。然而，这种联合疗法与缓解的维持无关。晚期无不良反应。
IVCY的长期预后因患者临床病程而异，结果与其他国家报道的不同。因此，对于日本患者，我们应考虑临床病程和种族特异性。
