MMF联合泼尼松治疗成人特发性膜性肾病的疗效及安全性研究

目的:探究吗替麦考酚酯(MMF)联合泼尼松(Pre)治疗成人特发性膜性肾病(IMN)的疗效及安全性。方法:选取2015.06-2017.06我院收治的102例行IMN患者列为研究对象,将患者按随机数字表法以1:1比例分为对照组与观察组,每组各51例,对照组患者使用Pre进行治疗,观察组患者使用MMF+Pre进行治疗,治疗12个月。比较两组治疗12个月后疗效,治疗前、治疗后6个月及12个月后肾功能相关指标24 h尿蛋白定量(24 h UP)、血清胱抑素C(CysC)、血清尿素氮(BUN)、血清肌酐(Scr)、血清白蛋白(Alb)]、脂代谢指标总胆固醇(TC)、甘油三酯(TG)],并记录用药间期出现的药物不良反应。结果:治疗12个月后,研究组患者总有效率为90.20%,显著高对照组74.51%(P0.05);治疗6个月、12个月后,两组患者24 h UP、Cys C、TC、TG水平较治疗前均依次显著下降而Alb水平显著上升(P0.05),且观察组上述指标与同期对照组对比差异显著(P0.05);而两组BUN和Scr水平较治疗前差异不显著(P0.05),两组对比无统计学意义(P0.05)。治疗期间,观察组患者药物不良反应率为11.76%,显著低于对照组27.45%(P0.05)。结论:应用MMF联合泼尼松治疗成人IMN疗效更佳,可显著改善患者肾功能,并改善患者脂代谢,药物方案安全性较高,具有较高应用价值。

Efficacy and Safety of MMF Combined with Prednisone in the Treatment of Adult Idiopathic Membranous Nephropathy

ABSTRACT Objective: To explore the efficacy and safety of mycophenolate mofetil (MMF) combined with prednisone (Pre) in the treatment of adult idiopathic membranous nephropathy (IMN). Methods: A total of 102 patients with IMN admitted to our hospital from June 2015 to June 2017 were enrolled as the study subjects. The patients were divided into control group and observation group according to the random number table method, with 51 cases in each group. Control group was given Pre while observation group was treated with MMF+Pre, and they were treated for 12 months. The efficacy after 12 months of treatment, and renal function-related indicators 24 h urine protein quantitation (24 h UP), serum cystatin C (CysC), serum urea nitrogen ( BUN), serum creatinine (Scr), serum albumin (Alb)] and lipid metabolism indexes total cholesterol (TC), triglyceride (TG)] before treatment and at 6 months and 12 months after treatment were compared between the two groups, and the adverse drug reactions during medicine were recorded. Results: After 12 months of treatment, the total effective rate in study group was significantly higher than that in control group (90.20% vs 74.51%) (P<0.05). After 6 months and 12 months of treatment, the levels of 24 h UP, CysC, TC and TG in the two groups were decreased significantly in turn compared with those before treatment while the level of Alb was increased significantly(P<0.05), and the above indicators in observation group were significantly different from those in control group at the same time point(P<0.05). The levels of BUN and Scr in the two groups were not significantly different from those before treatment(P>0.05), and there were no significant differences between the two groups(P>0.05). During treatment, the adverse drug reaction rate in observation group was significantly lower than that in control group (11.76% vs 27.45%)(P<0.05). Conclusion: MMF combined with prednisone has better efficacy in the treatment of adult IMN, and it can significantly improve the renal function and promote the lipid metabolism of patients, and the drug regimen has high safety and high application value.