Mathieson P W, Turner A N, Maidment C G, Evans D J, Rees A J
Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London.
Lancet. 1988 Oct 15;2(8616):869-72. doi: 10.1016/s0140-6736(88)92470-1.
Eight patients with idiopathic membranous nephropathy whose renal function was deteriorating were given a 6-month course of alternating monthly cycles of prednisolone and chlorambucil. Proteinuria was reduced in all eight, from a mean (SD) of 15.3 (5.9) g/24 h at the start of treatment to 2.1 (1.5) g/24 h at follow-up (p less than 0.05). Creatinine clearance increased in six, and the rate of decline was reduced in the other two (group mean 51.6 [17.8] ml/min at the start of treatment and 81.4 [36.8] ml/min at follow-up; p less than 0.05). Adverse effects of chlorambucil were severe, and the daily dose had to be reduced. Prednisolone and chlorambucil treatment can change the natural course of membranous nephropathy even when renal function has started to deteriorate, so treatment can be reserved for high-risk patients.
八名肾功能正在恶化的特发性膜性肾病患者接受了为期6个月的泼尼松龙和苯丁酸氮芥交替每月疗程治疗。所有八名患者的蛋白尿均有所减少，从治疗开始时的平均（标准差）15.3（5.9）g/24小时降至随访时的2.1（1.5）g/24小时（p<0.05）。六名患者的肌酐清除率增加，另外两名患者的下降速率降低（治疗开始时组平均为51.6[17.8]ml/分钟，随访时为81.4[36.8]ml/分钟；p<0.05）。苯丁酸氮芥的不良反应严重，每日剂量不得不减少。即使肾功能已开始恶化，泼尼松龙和苯丁酸氮芥治疗仍可改变膜性肾病的自然病程，因此该治疗可保留给高危患者。
