Makino H, Yamasaki Y, Hayashi Y, Haramoto T, Shikata K, Kumagai I, Taniai K, Takahashi K, Ota Z
Third Department of Medicine, Okayama University Medical School.
Nihon Jinzo Gakkai Shi. 1990 Jul;32(7):791-9.
To determine indications for treatment with high-dose intravenous methylprednisolone pulse therapy in lupus nephritis, we retrospectively assessed the response to pulse therapy over oral prednisolone administration in 120 biopsy proven lupus nephritis patients according to WHO morphologic classification. In the pulse group, 1 g of methylprednisolone was administered on three consecutive days and oral steroid therapy (40-30 mg) was started. In many occasions in treating class III and IV-b, repeated pulse therapy was performed. In control oral prednisolone group, middle-dose steroid therapy (50-30 mg) was started. In patients with minor glomerular abnormalities and mesangial lupus nephritis, rapid improvement of serological activities was observed in pulse group assessed by serum complement level, anti-DNA antibodies, and anti-nuclear antibodies. In patients with focal lupus nephritis, rapid rise in serum complement level and fall in proteinuria was observed in the pulse group. In patients with diffuse proliferative lupus nephritis with active necrotizing lesions, faster rise in serum complement level and proteinuria were observed in the pulse group. In patients with membranous lupus nephritis there was no significant difference between two groups. In comparison with the effect of pulse therapy among each morphologic class, the rise of serum complement level was slowest in class IV-b. Both group of IV-b and V manifested nephrotic syndrome and by pulse therapy the decrease in urinary protein was faster and more significant in class IV-b compared with class V. No significant adverse effect of methylprednisolone was observed during about 150 times of pulse therapy. Bacterial, viral infections such as herpes zoster and fungal infections were observed in pulse group as often as control group.
为了确定大剂量静脉注射甲基强的松龙冲击疗法在狼疮性肾炎中的治疗指征，我们根据世界卫生组织的形态学分类，对120例经活检证实的狼疮性肾炎患者口服泼尼松龙与冲击疗法的疗效进行了回顾性评估。在冲击治疗组中，连续三天给予1g甲基强的松龙，然后开始口服类固醇治疗（40 - 30mg）。在治疗III级和IV - b级患者时，多次进行了重复冲击治疗。在口服泼尼松龙对照组中，开始给予中剂量类固醇治疗（50 - 30mg）。在轻度肾小球异常和系膜增生性狼疮性肾炎患者中，通过血清补体水平、抗DNA抗体和抗核抗体评估，冲击治疗组的血清学活性迅速改善。在局灶性狼疮性肾炎患者中，冲击治疗组血清补体水平迅速升高，蛋白尿下降。在伴有活动性坏死性病变的弥漫性增殖性狼疮性肾炎患者中，冲击治疗组血清补体水平和蛋白尿上升更快。在膜性狼疮性肾炎患者中，两组之间无显著差异。与各形态学分类中冲击治疗的效果相比，IV - b级患者血清补体水平升高最慢。IV - b级和V级患者均表现为肾病综合征，与V级相比，IV - b级患者经冲击治疗后尿蛋白下降更快、更显著。在约150次冲击治疗期间，未观察到甲基强的松龙有显著不良反应。冲击治疗组中细菌、病毒感染如带状疱疹和真菌感染的发生率与对照组相同。
