吗替麦考酚酯联合小剂量激素治疗原发性肾病综合征合并慢性乙型病毒性肝炎的观察(2)
参见附件。
笔者研究发现,激素组与MMF组对于原发性肾病综合征合并慢性乙型病毒性肝炎的疗效与病理类型有着密切关系,激素组与MMF组对MCD的治疗反应一致,但复发率,激素组高于MMF组;对于MsPGN的治疗,激素组优于MMF组;对于FSPGN、FSGS、MN的治疗,MMF组优于激素组。同时还观察到对于FSPGN、MsPGN、FSGS病理类型的患者,延长MMF组的治疗时间,逐步缓慢的减少MMF的药量,能增加部分缓解的患者达到完全缓解的可能性,并能有效的降低肾病综合征复发的可能。
本研究由于样本量偏小,随访时间偏短,尚不能完全明确两种治疗方案的优缺点,但能为临床医师提供两种有供参考的临床治疗方案。对于此两种治疗待于进一步的大样本随机对照研究,来具体证实其治疗的优缺点。
参考文献
[1]王吉曜.内科学.第2版.北京;人民卫生出版社,2001:11-474.
[2]钱桐荪.肾脏病学.第3版.北京:华夏出版社,2000:19-473.
[3]Waldman M,Crew RJ,Valefi A. Adult minimalchange disease:clinical characteristics,treatment,and outcomes.Clin J Am Soc Nephrol,2007,72:1165-1166.
[4]Yi N J,Suh KS,Cho jY. Recurrence of hepatitis B is associated with cumulative cortieosteroid dose and chemotherapy against hepatocellular carcinoma recurrence after liver transplantation.Liver Transplantation,2007,2:445-453.
[5]Gong Z J,De Meyer S,Clarysse C. Mycophenolic acid,an immunosuppressive agent,inhibits HBV replication in vitro.Journal of Viral Hepatitis,1999,6:229-236.
[6]Fujimoto S,Yamamoto Y,Hisanaga S. Minimal change nephrotic syndrome in adults:response to corticosteroid therapy and frequency of relapse.American Journal of Kidney Diseases,1991,17:687-692.
[7]Lau SC,Tse KC,Lai WM. Use of prophylactic lamivudine and mycophenolate mofetil i n renal transplant recipients with chronic hepatitis B infection.Pediatric Transplantation,2003,7:376-380.
[8]Mendizahal S, Zamora I, Bebel O, et al. Mycophenolate mofetil in steroid/cyclosporine-dependernt/resistant nephritic syndrome. Pediatr Nephrol,2005,20:914-919.
(收稿日期:2011-05-25)
(本文编辑:车艳)
笔者研究发现,激素组与MMF组对于原发性肾病综合征合并慢性乙型病毒性肝炎的疗效与病理类型有着密切关系,激素组与MMF组对MCD的治疗反应一致,但复发率,激素组高于MMF组;对于MsPGN的治疗,激素组优于MMF组;对于FSPGN、FSGS、MN的治疗,MMF组优于激素组。同时还观察到对于FSPGN、MsPGN、FSGS病理类型的患者,延长MMF组的治疗时间,逐步缓慢的减少MMF的药量,能增加部分缓解的患者达到完全缓解的可能性,并能有效的降低肾病综合征复发的可能。
本研究由于样本量偏小,随访时间偏短,尚不能完全明确两种治疗方案的优缺点,但能为临床医师提供两种有供参考的临床治疗方案。对于此两种治疗待于进一步的大样本随机对照研究,来具体证实其治疗的优缺点。
参考文献
[1]王吉曜.内科学.第2版.北京;人民卫生出版社,2001:11-474.
[2]钱桐荪.肾脏病学.第3版.北京:华夏出版社,2000:19-473.
[3]Waldman M,Crew RJ,Valefi A. Adult minimalchange disease:clinical characteristics,treatment,and outcomes.Clin J Am Soc Nephrol,2007,72:1165-1166.
[4]Yi N J,Suh KS,Cho jY. Recurrence of hepatitis B is associated with cumulative cortieosteroid dose and chemotherapy against hepatocellular carcinoma recurrence after liver transplantation.Liver Transplantation,2007,2:445-453.
[5]Gong Z J,De Meyer S,Clarysse C. Mycophenolic acid,an immunosuppressive agent,inhibits HBV replication in vitro.Journal of Viral Hepatitis,1999,6:229-236.
[6]Fujimoto S,Yamamoto Y,Hisanaga S. Minimal change nephrotic syndrome in adults:response to corticosteroid therapy and frequency of relapse.American Journal of Kidney Diseases,1991,17:687-692.
[7]Lau SC,Tse KC,Lai WM. Use of prophylactic lamivudine and mycophenolate mofetil i n renal transplant recipients with chronic hepatitis B infection.Pediatric Transplantation,2003,7:376-380.
[8]Mendizahal S, Zamora I, Bebel O, et al. Mycophenolate mofetil in steroid/cyclosporine-dependernt/resistant nephritic syndrome. Pediatr Nephrol,2005,20:914-919.
(收稿日期:2011-05-25)
(本文编辑:车艳)
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