雷公藤多苷联合吗替麦考酚酯多靶点免疫抑制治疗难治性肾病综合症的疗效评估

目的：探讨雷公藤多苷联合吗替麦考~（MMF）多靶点免疫抑制治疗难治性肾病综合症（RNS）的临床疗效及安全性。方法：将76例RNS患者随机分为三组，A组（30例）采用雷公藤多苷联合MMF多靶点免疫抑制疗法，B组（29例）采用环磷酰胺（CTX）冲击疗法，C组（27例）采用MMF疗法，总疗程均为6个月。比较分析三组的临床疗效、肾功能、复发情况及不良反应。结果：A组的总有效率为73_3％，显著高于B组48．3％，c组44．4％（P〈O．05）；治疗后，三组的肾功能指标均有所改善，与B组和c组比较，A组尿蛋白定量、血肌酐（scr）显著降低，血清白蛋白（ALB）显著升高（P〈0．05）；A组的复发率（0％）显著低于B组（21．4％）和c组（15．4％）（P〈0．05）。A组不良反应发生率与B组、C组之间的差异无统计学意义（P〉0．05）。结论：雷公藤多苷联合MMF多靶点治疗RNS安全有效，可减少免疫抑制剂的剂量，提高缓解率，改善肾功能，且不良反应少。

Effect Evaluation on Multi-Target Immunosuppressive Therapy with Tripterygium Glycosides Combined with Mycophenolate Mofetil for Refractory Nephritic Syndrome

Objective： To explore clinical efficacy and safety on multi-target immunosuppressive therapy with tripterygium glycosides combined with mycophenolate mofetil （MMF） for refractory nephritic syndrome （RNS）. Methods： 76 cases of RNS patients were randomly divided into three groups. Group A （N=30） was given multi-target immunosuppressive therapy with tripterygium glycosides combined with MMF, Group B （N=29） was given cyclophosphamide （CTX） pulse therapy, and Group C （N=27） was given MMF, respectively. The clinical effect, renal function, recurrence rate and side effect were observed. Result： The clinical effect in Group A was 73.3%, was significantly higher than that in Group B 48.3% and Group C 44.4% （P〈0.05）. The renal function in all groups was improved after treatment, while the levels of 24 h proteinuria, Scr were lower and ALB was higher significantly in Group A compared with those in Group B and Group C （P〈0.05）. The recurrence rate in Group A （0%） was significantly lower than that in Group B 21.4 % and Group C 15.4 %. There was no significant difference on the side effect among the three groups （P〉0.05）. Conclusion： It is effective and safe of multi-target immunosuppressive therapy with tripterygium glycosides and MMF for RNS, it can contribute to reduce the dosage of immunosuppressant, improve remission rate and renal function, and has a relative lower side effects.