Yan D C, Chou C C, Tsai M J, Chiang B L, Tsau Y K, Hsieh K H
Department of Pediatrics, National Taiwan University Hospital, Taipei, R.O.C.
Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1995 May-Jun;36(3):203-9.
We conducted a preliminary study of monthly intravenous cyclophosphamide (IVCY) therapy on children with active lupus nephritis to evaluate the clinical efficacy and safety of IVCY pulse therapy. From June 1993 to May 1994, 13 patients (mean age: 14 +/- 0.9 years old; female: male = 11:2) with active lupus nephritis were treated with intermittent IVCY in addition to their regular corticosteroid therapy. Criteria for patients who received intermittent IVCY therapy were associated with any one of the following conditions: 1) with renal biopsy-proved diffuse proliferative glomerulonephritis; 2) with nephrotic syndrome and are inert to high dose of prednisolone therapy; and 3) with severe side effect of steroid therapy. Cyclophosphamide (CY) was administrated monthly for the first 6 doses, and at 2 to 3-month interval afterward for 2 years. The mean IVCY pulses per patient was 6.5 +/- 0.5 times. The initial dose of CY was 0.5 gm/mm2, then gradually increased to 1 gm/mm2 with a monthly increment of 0.25 gm/mm2. After 6 months, cyclophosphamide treatment was associated with significant improvement in mean levels of serum C3 (41.6 +/- 5.1 vs. 96.7 +/- 11.3 mg/dl), C4 (11.7 +/- 1.1 vs. 35.3 +/- 5.0 mg/dl) and anti-DNA titer (65.4 +/- 17.1 vs. 9.1 +/- 2.8 IU/ml) (all p < 0.01), despite a significant reduction in mean prednisolone dosage (48.5 +/- 4.8 vs. 15.6 +/- 3.2 mg/day; p < 0.01). The mean creatinine clearance also improved significantly from 44.7 +/- 5.7 to 81.9 +/- 2.7 ml/min/1.73 mm2 (p < 0.01) after 6 months of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
我们对活动性狼疮性肾炎患儿进行了每月一次静脉注射环磷酰胺（IVCY）治疗的初步研究，以评估IVCY脉冲疗法的临床疗效和安全性。1993年6月至1994年5月，13例活动性狼疮性肾炎患者（平均年龄：14±0.9岁；女∶男 = 11∶2）在接受常规皮质类固醇治疗的基础上，接受了间歇性IVCY治疗。接受间歇性IVCY治疗的患者标准与以下任何一种情况相关：1）经肾活检证实为弥漫性增殖性肾小球肾炎；2）患有肾病综合征且对高剂量泼尼松龙治疗无反应；3）有严重的类固醇治疗副作用。环磷酰胺（CY）在前6剂时每月给药一次，此后每2至3个月给药一次，持续2年。每位患者的平均IVCY脉冲次数为6.5±0.5次。CY的初始剂量为0.5 gm/mm2，然后逐渐增加至1 gm/mm2，每月增加0.25 gm/mm2。6个月后，环磷酰胺治疗使血清C3平均水平（41.6±5.1 vs. 96.7±11.3 mg/dl）、C4平均水平（11.7±1.1 vs. 35.3±5.0 mg/dl）和抗DNA滴度（�5.4±17.1 vs. 9.1±2.8 IU/ml）均有显著改善（均p<0.01），尽管泼尼松龙平均剂量显著降低（48.5±4.8 vs. 15.6±3.2 mg/天；p<0.01）。治疗6个月后，平均肌酐清除率也从44.7±5.7显著提高至81.9±2.7 ml/min/1.73 mm2（p<0.01）。（摘要截选至250词）
