| Objective:With MP+cyclophosphamide (CTX) shock therapy as control group, observe the efficacy and safety of muti-target(MP + mycophenolate mofetil (MMF) + Tacrolimus(FK506))for the treatment of lupus nephritis.Methods : Among September 2009 to November 2010 In our hospital ,they were diagnosed with systemic lupus erythematosus, accord with 1997 American rheumatism learn revised SLE diagnosis criteria, on the base of SLE have diagnosised, it has renal involvement, such as continuous albuminuria than 500mg/d (or dipstick methods protein qualitative check for 3 +) or existence cells tube type (including red, hemoglobin, granules, renal tubular or mixing tube type), then they were diagnosised the lupus nephritis.The diagnosis of renal biopsyⅢtype,Ⅳtype,Ⅴtype,Ⅴ+Ⅲtype,Ⅴ+Ⅳtype of patients with lupus nephritis were 8 cases, at the age of 23 ~ 47 years old, male female ratio is 1:7, randomly divided into two groups of 4 cases, respectively using multi-targets treatment group (induction therapy period give FK506 dose for 3 ~ 4 mg/d, MMF dose 0.75 ~ 1.0 g/d) and intermittent cyclophosphamide (CTX) Shock therapy group (monthly dose for 0.5-1.0 g/m2BSA). Two groups of patients all adopt vein methyl-prednisone shock therapy (0.5 g/d x 3 days), then oral prednisone in the morning, began with 0.6 mg/kg /d (maximum dose 60mg/d), four weeks after, every 2 weeks in reducing the speed of 5mg to 20mg/d, then every 2 weeks minus 2.5 mg to 10mg/d as maintain,all observed 24weeks. To compare and analyze the effective of two groups, such as albumin, 24-hour urinary protein quantitative , Serum complement C3, creatinine, complete response rate (CR, defined as a urinary protein quantitative < 0.4 g / 24h ,urine red cell < 100,000 / ml, no tube type urine and leucocyte urine, albumin≥35 g/L, SCr normal or rise no more than 15% of the basic values). Partial remission rate (PR, urinary protein quantitative fell by more than 50 percent of basic value ,urinary protein quantitative < 3.5 g / 24h ,urine RBC count fell by more than 50% of basic value, serum creatinine normal or not more than 30%of basic value;) treatment no reaction (NR,after24 weeks induction therpy ,did not reach the PR standard) and in the induction therapy end, patients achieved complete remission's time. And compared the adverse reactions of the two groups patients after induction therapy,such as infection, liver damage, bone marrow suppression, gastrointestinal reaction and hemorrhagic cystitis, hair loss, gonad suppression.Results:1 General situation compared,in the group of 8 cases, including multi- target treatment group 4 cases, cyclophosphamide group 4 cases. Two groups of patients in gender, age, kidney duration, SLE - DA I score, urinary protein, albumin, creatinine, low complement ratio was no statistically significant differences (table 1). Two groups of pathological type distribution (table 2).2 After treatment ,to observe the remission rates of two groups in4, 12, 24 weeks,we found that at 24 weeks the remission rates of two groups were same 100%, but the complete remission rate of multi-target group were more than cyclophosphamide group (50%vs25%), and compared with cyclophosphamide group,multi-target group into the complete remission time is early, in 4 weeks the complete remission rate of two groups (25% vs0 %), in the first 12 weeks all the patients of multi-target group have achieved remission (100%vs75 %) (table 3).3 After treatment ,multi-target group and cyclophosphamide group were all significant reduction in 24 h urinary protein quantitative (P < 0.05), but the differences between the two groups were no significant in statistically (P > 0.05).4 After treatment, two groups were all relatively elevated in serum complement C3, but the effect is not apparent, was not statistically significant (P > 0.05). And the two group's differences was also not statistically significant (P > 0.05). 5 After treatment, two groups were all relatively elevated in serum albumin, and the effect is obvious, it was statistically significant (P < 0.05). But the two group's differences was no statistically significant (P > 0.05).6 After treatment, serum creatinine of two groups were without opparent change (P > 0.05), without obvious rise, also without significantly reduced, and the two groups's differences were also not statistically significant (P > 0.05).7 multi- target group appear 1 case with leukocytes reduce ,1 case with severe infected,but only one patient in cyclophosphamide group occurs leukocytes mild decrease, but all the patients of he two groups did not appear liver damage, bone marrow suppression, gastrointestinal reaction and hemorrhagic cystitis, hair loss, gonad suppression adverse reactions. The differences between two groups of adverse reaction were also not statistically significant (P > 0.05).Conclusion:1 Multi-target group and cyclophosphamide group of both groups can effectively treatment with lupus nephritis, improve patients's with lupus nephritis laboratory indicators such as serum albumin, 24-hour urinary protein quantitative, serum C3 etc.2 compared with cyclophosphamide group, Multi-target group's complete remission rate was high, and enter complete remission time was quickly.3 compared with cyclophosphamide group, multi-target treatment group appear immunosuppressive side efforts were also much more obvious . |
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