霉酚酸酯联合皮质类固醇诱导过敏性紫癜肾炎缓解。

The combination of mycophenolate mofetil with corticosteroids induces remission of Henoch-Schönlein purpura nephritis.

机构信息

Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China.

出版信息

Am J Nephrol. 2012;36(3):271-7. doi: 10.1159/000341914. Epub 2012 Sep 7.

DOI:10.1159/000341914

PMID:22965140

Abstract

BACKGROUND

Henoch-Schönlein purpura (HSP) is a form of systemic vasculitis that can progress to Henoch-Schönlein purpura nephritis (HSPN), and the most effective treatment remains controversial. Our aim was to compare the effects of oral mycophenolate mofetil (MMF) with low-dose prednisone and the full-dose corticosteroids (CS; prednisone) for the induction therapy of HSPN with large proteinuria.

METHODS

Fifty-three patients with biopsy-proved HSPN with large proteinuria (>2.0 g/24 h) were divided into two groups: the MMF group (n = 27) who received oral MMF 1.0 g/day (1.5 g/day for patients with a body weight >70 kg) combined with low-dose prednisone (0.4-0.5 mg/kg/day), and the CS group (n = 26) who received the full-dose prednisone (0.8-1.0 mg/kg/day). We compared the effects of inducing remission at 6-month follow-up and the overall remission rate at the end of the follow-up between the two groups.

RESULTS

At 6 months, the estimated glomerular filtration rate level remained stable, while the urine protein decreased significantly in both groups, and the remission rate was 76.9% in the CS group and 55.5% in the MMF group (p = 0.101). With a median follow-up of 28.8 months in the CS group and 28.2 months in the MMF group, the overall remission rate was 80.8% in the CS group and 77.8% in the MMF group (p = 0.788). The MMF group had less side effects than the CS group (48.1 vs. 76.9%, p = 0.031). The relapse was 4/21 (19.0%) in the CS group and 0/21 in the MMF group (p = 0.115).

CONCLUSION

MMF is useful for inducing remission and maintaining remission in Chinese HSPN, and may be used as a steroid-sparing agent in the treatment of HSPN.

摘要

背景

过敏性紫癜（HSP）是一种全身性血管炎，可发展为过敏性紫癜肾炎（HSPN），最有效的治疗方法仍存在争议。我们的目的是比较吗替麦考酚酯（MMF）与小剂量泼尼松和大剂量皮质类固醇（CS；泼尼松）治疗伴有大量蛋白尿的 HSPN 的诱导治疗效果。

方法

53 例经活检证实的 HSPN 伴大量蛋白尿（>2.0 g/24 h）患者分为两组：MMF 组（n=27）接受口服 MMF 1.0 g/天（体重>70 kg 的患者为 1.5 g/天）联合小剂量泼尼松（0.4-0.5 mg/kg/天），CS 组（n=26）接受大剂量泼尼松（0.8-1.0 mg/kg/天）。我们比较了两组在 6 个月随访时诱导缓解的效果和随访结束时的总缓解率。

结果

6 个月时，估计肾小球滤过率水平保持稳定，两组尿蛋白均显著下降，CS 组缓解率为 76.9%，MMF 组为 55.5%（p=0.101）。CS 组中位随访时间为 28.8 个月，MMF 组为 28.2 个月，CS 组总缓解率为 80.8%，MMF 组为 77.8%（p=0.788）。MMF 组的不良反应发生率低于 CS 组（48.1%比 76.9%，p=0.031）。CS 组复发 4/21（19.0%），MMF 组无复发（p=0.115）。