| Objective: Retrospectively observe the efficacy and adverse reactions of different Immunotherapy for idiopathic membranous nephropathy.Immunotherapy include glucocorticoids combined with cyclophosphamide and glucocorticoids combined with cyclosporine A.At the same time.The correlation between the level of serum anti-phospholipase A2 receptor antibody and therapeutic effect was evaluated.Methods: 105 patients with IMN diagnosed by renal biopsy and clinical data in Peking University Shenzhen Hospital from January 2015 to December 2017 were selected.The 45 patients who received immunosuppressive therapy were divided into two groups according to the treatment plan.Patients in group A and group B took separately glucocorticoid with cyclophosphamide(33 cases)or cyclosporine A(12 cases).The serum albumin,serum creatinine,random urine protein/creatinine,24-hour urine protein quantitation,liver function,blood lipids and adverse reactions were observed.At the same time,according to the patient’s anti-phospholipase A2 receptor antibody on the day of renal biopsy,the patients were further divided into antibody-positive group and negative group,and the remission rate of the two groups after 6 months of treatment was compared.According to whether the patients reached clinical remission after 6 months of treatment,they were divided into the treatment effective group and the ineffective group,and the pre-treatment antibody positive rate and titer were compared between the two groups.Results:(1)The clinical remission rate of cyclophosphamide group and cyclosporine A group was 48.5%,75% at 3 months,and was 69.7%,83.3% at 6 months,respectively.The incidence of adverse reactions was 9.0% and 25.0%.The difference was not statistically significant(P>0.05).Comparison between groups: Serum albumin of cyclosporine A group was higher than cyclophosphamide group at 3months and 6 months(P<0.05),there was no statistically significant with urinary protein(P>0.05).Intra-group comparison: serum albumin increased gradually with the treatment time in the cyclophosphamide group(P<0.05),and urine protein at 3months and 6 months was lower than before(P<0.05).Serum albumin was higher in the cyclosporine A group at 3 months and 6 months than before(P<0.05),urine protein was lower at 6 months than that at 3 months and before(P<0.05).(2)The anti-phospholipase A2 receptor antibody positive group had lower clinical remission rate than the negative group(P<0.05)and the complete remission rate was lower(P>0.05).The positive rate and titer of the therapeutically effective group were lower than those of the treatment-ineffective group(P<0.05).Conclusions: Non-immunosuppressive therapy is the basic treatment for IMN patients with low and moderate risk.For patients with moderate and high risk,glucocorticoid combined with cyclophosphamide or cyclosporine A is effective treatment for IMN with good safety.Glucocorticoid combined with cyclosporine A in IMN patients with clinical manifestations of nephrotic syndrome can increase serum albumin faster than cyclophosphamide,but there is no significant difference between the two regimens in reducing urinary protein.Patients with positive anti-phospholipase A2 receptor antibodies and high titers may have poor response to treatment.The above views need to be confirmed by a large sample study. |
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