Mycophenolate Mofetile Therapy in Refractory Nephrotic Syndrome-A Preliminary Report

MMF乃一強效免疫抑制劑且已成功地用於腎臟移植病人。然而MMF對於原發及次發性腎絲球腎炎的療效，則有待進一步的探討。本篇報告前瞻性的評估7位以頑抗性腎病候群的表現的腎絲球腎炎病人對MMF治療的反應。病理診斷包括一位微細變化疾病，4位膜性腎絲球腎炎，1位甲型免疫球蛋白腎病變以及1位紅斑性狼瘡腎炎。MMF的劑量是每日1.5克至2克。6位病人併用MMF和類固醇，1位併用MMF和環孢靈。平均治療期間為44 ± 3月（3-11個月）。所有的病人都得到部分緩解同時伴隨明顯的每日尿蛋白下降（11.3 ± 6.7 g/day降至3.9 ± 3.8g/day，P=0.0057）及血清蛋白上升（2.4 ± 0.8g/dl升至3.1 ± 1.1g/dl，p=0.0014）。血清膽固醇由3.4 ± 142mg/dl降至204 ± 58mg/dl，而三酸甘油脂則由227 ±144mg/dl降至100 ± 39mg/dl。雖然此兩者下降的程度尚無統計上的意義，但仍有偏回正常值的趨勢。其他臨床參數諸如血紅素、白血球以及肝酵素皆無明顯的變化。在這7位病人當中有2位因為嚴重的胃腸症狀而在3個月後中止MMF的治療。其他病人則適應良好且無其他副作用。此初始報告顯示MMF對特定的病人是有效的”救援治療”。故當MMF與類固醇或環孢靈併用時，對某此頑抗性腎病症候群是有效的治療。

關鍵字

腎絲球腎炎；膜性腎絲球腎炎

並列摘要

Mycophenolate Mofetile (MMF) is a potent immunosuppressant that has been used successfully in renal transplant recipients. The effect of MMF on primary and secondary glomerulonephritis, however, remains to be tested. In this report, seven patients with glomerulonephritis and refractory nephrotic syndrome were enrolled to prospectively evaluated the effectiveness of MMF. The pathologic diagnoses included minimal change disease (n=1), membranous glomerulonephritis (n=4), IgA nephropathy (n=1), and lupus nephritis (n=1). The dose of MMF ranged from 1.5gm to 2gm per day. MMF was used in combination with steroids in 6 cases and with cyclosporine in one case. The mean duration of treatment was 4.43 months (3 to 11months). In all cases, there was partial remission with significant decrease in daily urine protein from 11.3 ± 6.7gm/day to 3.9 ± 3.8gm/day (p=0.0057) and elevation of serum albumin from 2.4 ± 0.8 gm/dl to 3.1 ± 1.1 gm/dl (p=0.014). The serum cholesterol and triglyceride decreased from 340 ± 142mg/dl to 204 ± 58 mg/dl and from 227 ± 144 to 100 ± 39 mg/dl respectively. Despite no statistical significance, there was a trend toward normalization of the lipid profile. There was no significant change in other clinical parameters such as hemoglobin, leukocyte count or liver enzymes. Two of the 7 patients were withdrawn from the study because of marked gastrointestinal upset. The others tolerated the drug well and showed no significant side effects. This preliminary report suggests that MMF is an effective second-line therapy in selected patients. We conclude that, MMF when combined with steroids or cyclosporine, may serve as an effective drug against refractory nephritic-ranged proteinuria in certain types of glomerulonephritis.

並列關鍵字

mycophenolate mofetil ； glomerulonephritis ； membranous glomerulonephritis

國際替代計量

Mycophenolate Mofetile Therapy in Refractory Nephrotic Syndrome-A Preliminary Report

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