Imai H, Kodama T, Yasuda T, Nakamoto Y, Miura A B
Third Department of Internal Medicine, Akita University School of Medicine, Japan.
Nephrol Dial Transplant. 1994;9(9):1240-9.
To determine whether serum cholinesterase activity can be a monitoring index of cyclophosphamide therapy in patients with steroid-resistant glomerulopathy, we compared the cholinesterase activity of 37 patients who received a combined therapy that included the use of cyclophosphamide, prednisolone, antiplatelet drugs, and anticoagulant drugs, with the cholinesterase activity of 25 patients who received prednisolone therapy that excluded cyclophosphamide from the combined therapy. In the prednisolone and the combined groups, cholinesterase activity declined as shown in the following formula: Y = 371-26.4 x log(X): (r2 = 0.28), Y = 444-147.7 x log(X): (r2 = 0.95), respectively. (Y: cholinesterase activity, X: the day after treatment). In the combined therapy group, the prevalence of adverse reactions following treatment in the subgroup below 200 U/l of cholinesterase activity was significantly greater (P < 0.01) than that in the subgroup above 200 U/l of cholinesterase activity. However, there was no significant difference (P < 0.25) in the prevalence of adverse reactions between the subgroups with more or less than 184 U/l of cholinesterase activity following treatment. These results suggest the importance of not going below 200 U/l of cholinesterase activity after treatment when the normal cholinesterase activity range is between 300 and 760 U/l (e.g. less than 65% of the lowest value of the normal range of other hospitals) in order to eliminate the hazards of cyclophosphamide to the patients with steroid-resistant glomerulopathy.
为了确定血清胆碱酯酶活性是否可作为激素抵抗性肾小球病患者环磷酰胺治疗的监测指标，我们比较了37例接受包括环磷酰胺、泼尼松龙、抗血小板药物和抗凝药物联合治疗患者的胆碱酯酶活性，以及25例接受不包括环磷酰胺的泼尼松龙治疗患者的胆碱酯酶活性。在泼尼松龙组和联合治疗组中，胆碱酯酶活性下降情况如下列公式所示：Y = 371 - 26.4×log(X)：(r2 = 0.28)，Y = 444 - 147.7×log(X)：(r2 = 0.95)，分别对应。（Y：胆碱酯酶活性，X：治疗后天数）。在联合治疗组中，胆碱酯酶活性低于200 U/l的亚组治疗后不良反应发生率显著高于（P < 0.01）胆碱酯酶活性高于200 U/l的亚组。然而，治疗后胆碱酯酶活性高于或低于184 U/l的亚组之间不良反应发生率无显著差异（P < 0.25）。这些结果表明，对于激素抵抗性肾小球病患者，为消除环磷酰胺的危害，在正常胆碱酯酶活性范围为300至760 U/l（例如低于其他医院正常范围最低值的65%）时，治疗后胆碱酯酶活性不要低于200 U/l非常重要。
