Chu S J, Chang D M, Kuo S Y, Hsu C M, Chen C M, Chang M L
Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1994 Jun;53(6):325-30.
Renal involvement in systemic lupus erythematosus commonly leads to renal failure and death. We conducted a study to evaluate the efficacy and side effects of intermittent intravenous treatment with cyclophosphamide of patients with lupus nephritis.
Twenty-four patients with lupus nephritis were recruited at Tri-Service General Hospital from 1988 to 1992. Cyclophosphamide was administered intravenously monthly for three months, and then every three months. 24-hour urinary protein, creatinine clearance, serum creatinine, blood urea nitrogen, C3 and C4 levels, serum albumin, hemoglobin, and dosage of prednisolone were recorded before each treatment. During treatment, the side effects were monitored.
Two patients progressed to renal failure within one year and one patient after three years. Fifteen patients completed therapy for one year. Among these 15 patients, the levels of hemoglobin, serum albumin, and C3 significantly increased at six months, then became stable; the level of C4 increased at 12 months. In contrast, the dosage of prednisolone decreased significantly at six months. There was no significant difference of creatinine clearance, 24-hour urinary protein, serum creatinine, and blood urea nitrogen before and after treatment. The most common side effects were nausea and vomiting. No severe side effect necessitated discontinuing therapy with cyclophosphamide.
Intermittent intravenous therapy in lupus nephritis with cyclophosphamide can significantly increase levels of hemoglobin, serum albumin, C3 and C4, and keep renal function stable. Poor response was found in a subset of patients. The side effects were mild in the present study.
系统性红斑狼疮累及肾脏常导致肾衰竭和死亡。我们开展了一项研究，以评估环磷酰胺间歇性静脉治疗狼疮性肾炎患者的疗效和副作用。
1988年至1992年期间，三军总医院招募了24例狼疮性肾炎患者。环磷酰胺每月静脉注射一次，共三个月，然后每三个月注射一次。每次治疗前记录24小时尿蛋白、肌酐清除率、血清肌酐、血尿素氮、C3和C4水平、血清白蛋白、血红蛋白以及泼尼松龙的剂量。治疗期间监测副作用。
2例患者在1年内进展为肾衰竭，1例在3年后进展为肾衰竭。15例患者完成了一年的治疗。在这15例患者中，血红蛋白、血清白蛋白和C3水平在6个月时显著升高，然后趋于稳定；C4水平在12个月时升高。相比之下，泼尼松龙的剂量在6个月时显著降低。治疗前后肌酐清除率、24小时尿蛋白、血清肌酐和血尿素氮无显著差异。最常见的副作用是恶心和呕吐。没有严重的副作用需要停止环磷酰胺治疗。
环磷酰胺间歇性静脉治疗狼疮性肾炎可显著提高血红蛋白、血清白蛋白、C3和C4水平，并保持肾功能稳定。部分患者反应不佳。本研究中副作用较轻。
