霉酚酸与环磷酰胺治疗儿童狼疮性肾炎的比较：来自台湾一家三级中心医院的回顾性研究。

Comparison of mycophenolic acid with cyclophosphamide for the treatment of pediatric lupus nephritis: A retrospective study from a tertiary center hospital in Taiwan.

作者信息

Chen Huei-Geng, Chen Jin-Shuen, Chen Yao-Shen, Yin Chun-Hao, Chen Hsiao-Ching, Chiou Yee-Hsuan

机构信息

Division of Pediatric Allergy Immunology and Rheumatology, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Pediatrics, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan.

Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.

出版信息

J Microbiol Immunol Infect. 2023 Oct;56(5):1105-1113. doi: 10.1016/j.jmii.2023.08.003. Epub 2023 Aug 9.

DOI:10.1016/j.jmii.2023.08.003

PMID:37586916

Abstract

BACKGROUND

This study aimed to compare the efficacy of mycophenolic acid (MPA) and cyclophosphamide (CYC) for treating pediatric lupus nephritis (pLN).

METHODS

Data on patients with pLN class III, IV, and V, diagnosed by renal biopsy, were collected from the Databank of Kaohsiung Veterans General Hospital between February 2005 and December 2020. The study included 31 pLN patients. Of these, 15 received MPA (MPA group) and 16 received CYC (CYC group). Systemic lupus erythematosus disease activity index score, laboratory findings, complete remission (CR), and partial remission (PR) were assessed at 6, 12, and 24 months.

RESULTS

In the MPA group, CR occurred in 7/15 (47%) patients at month 6 and in 11/15 (73%) at months 12 and 24. In the CYC group, CR was reached in 5/16 (31%) patients at month 6, in 8/16 (50%) at month 12, and in 9/16 (56%) at month 24. PR was seen in 3/15 (20%) patients in the MPA group and in 3/16 (19%) in the CYC group at month 24. The cumulative probability of CR and PR showed no statistically significant difference between the two groups. However, the estimated glomerular filtration rate (eGFR) improved significantly in the MPA group at months 6, 12 and 24 compared to that in the CYC group (p < 0.05).

CONCLUSION

The efficacy of MPA is similar to that of CYC for pLN treatment, with MPA providing a significant improvement in eGFR after pLN induction therapy at months 6,12 and 24.

摘要

背景

本研究旨在比较霉酚酸（MPA）和环磷酰胺（CYC）治疗儿童狼疮性肾炎（pLN）的疗效。

方法

收集2005年2月至2020年12月期间高雄荣民总医院数据库中经肾活检确诊为III、IV和V级pLN患者的数据。该研究纳入了31例pLN患者。其中，15例接受MPA治疗（MPA组），16例接受CYC治疗（CYC组）。在6个月、12个月和24个月时评估系统性红斑狼疮疾病活动指数评分、实验室检查结果、完全缓解（CR）和部分缓解（PR）情况。

结果

在MPA组中，6个月时7/15（47%）的患者达到CR，12个月和24个月时为11/15（73%）。在CYC组中，6个月时5/16（31%）的患者达到CR，12个月时为8/16（50%），24个月时为9/16（56%）。24个月时，MPA组3/15（20%）的患者出现PR，CYC组为3/16（19%）。两组CR和PR的累积概率无统计学显著差异。然而，与CYC组相比，MPA组在6个月、12个月和24个月时的估计肾小球滤过率（eGFR）显著改善（p<0.05）。