Martinelli R, Pereira L J, Santos E S, Rocha H
Renal Service/Department of Medicine, Medical School-Federal University of Bahia, Salvador, Brazil.
Nephron. 1996;74(2):313-7. doi: 10.1159/000189327.
To evaluate the clinical effectiveness of intermittent intravenous cyclophosphamide in the treatment of severe systemic lupus erythematosus, 20 patients with systemic lupus erythematosus (SLE) and evidence of severe renal involvement or systemic vasculitis, consecutively admitted to the hospital were studied. Cyclophosphamide was administered intravenously at a dosage of 1.0 g/m2 monthly, during 6 months and maintained every 3 months during 12 additional months. Of 10 patients with active lupus nephritis, a reduction or disappearance of proteinuria and maintenance of normal renal function was recorded in 6. Improvement of renal function was observed in 4 out of 7 patients with renal insufficiency at initial evaluation; resolution of renal insufficiency was more frequently observed in patients with recent onset renal failure. At the end of the follow-up (18.0 +/- 14.5 months) disappearance or reduction of nephrotic range proteinuria was recorded in 6 out of 14 patients; there was progression toward renal failure in 4 patients (20%). Response to intravenous cyclophosphamide therapy was observed in 4 of 5 patients with severe extrarenal SLE. Side effects, recorded in 12 patients, were mild and transient and in no patient was the treatment discontinued. Four patients died during the follow-up, although in 2 of them the deaths were not attributable to therapy. Even though this was an open and uncontrolled study, intermittent, intravenous cyclophosphamide was an effective therapy for severe, steroid refractory SLE.
为评估间歇性静脉注射环磷酰胺治疗重症系统性红斑狼疮的临床疗效，对连续入院的20例有严重肾脏受累或系统性血管炎证据的系统性红斑狼疮（SLE）患者进行了研究。环磷酰胺以1.0 g/m²的剂量每月静脉注射一次，持续6个月，随后在接下来的12个月中每3个月维持注射一次。10例活动性狼疮性肾炎患者中，6例蛋白尿减少或消失且肾功能维持正常。初始评估时7例肾功能不全患者中，4例肾功能有改善；近期发生肾衰竭的患者肾功能不全缓解更为常见。随访结束时（18.0±14.5个月），14例患者中有6例肾病范围蛋白尿消失或减少；4例患者（20%）出现肾衰竭进展。5例重症肾外SLE患者中有4例对静脉注射环磷酰胺治疗有反应。12例患者记录到有副作用，均为轻度且短暂，无一例患者中断治疗。随访期间4例患者死亡，其中2例死亡与治疗无关。尽管这是一项开放且无对照的研究，但间歇性静脉注射环磷酰胺是治疗重症、激素难治性SLE的有效疗法。
