Ponticelli C, Zucchelli P, Imbasciati E, Cagnoli L, Pozzi C, Passerini P, Grassi C, Limido D, Pasquali S, Volpini T
N Engl J Med. 1984 Apr 12;310(15):946-50. doi: 10.1056/NEJM198404123101503.
Sixty-seven adults with idiopathic membranous nephropathy and the nephrotic syndrome were randomly assigned to symptomatic treatment only or to a six-month course of methylprednisolone alternated with chlorambucil every other month. Patients were followed for one to seven years. At the end of follow-up (mean of 31.4 +/- 18.2 months for the treated group and 37.0 +/- 22.0 for the control group) 23 of 32 treated patients were in complete or partial remission, as compared with 9 of 30 control patients (P = 0.001). Twelve of the treated patients were in complete remission, as compared with only two of the controls. In the treated group there were no changes in renal function during follow-up, whereas in the control group the reciprocal of the plasma creatinin level, which is proportional to the creatinine clearance, decreased significantly (P = 0.00017) after two years of follow-up. Side effects were minimal in all treated patients except two, who were dropped from the study because of peptic ulcer and gastric intolerance to chlorambucil. We conclude that steroid and chlorambucil treatment for six months favors remission of the nephrotic syndrome in adults with idiopathic membranous nephropathy and can preserve renal function for at least some years.
67例患有特发性膜性肾病和肾病综合征的成年人被随机分配，一组仅接受对症治疗，另一组接受为期6个月的甲基泼尼松龙治疗，每隔一个月交替使用苯丁酸氮芥。对患者进行了1至7年的随访。随访结束时（治疗组平均为31.4±18.2个月，对照组为37.0±22.0个月），32例接受治疗的患者中有23例完全或部分缓解，而30例对照组患者中有9例缓解（P = 0.001）。接受治疗的患者中有12例完全缓解，而对照组中只有2例。在治疗组中，随访期间肾功能无变化，而在对照组中，与肌酐清除率成正比的血浆肌酐水平的倒数在随访两年后显著下降（P = 0.00017）。除两名患者因消化性溃疡和对苯丁酸氮芥的胃部不耐受而退出研究外，所有接受治疗的患者副作用均极小。我们得出结论，对于患有特发性膜性肾病的成年人，使用类固醇和苯丁酸氮芥治疗6个月有利于肾病综合征的缓解，并可在至少几年内保留肾功能。
