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首页> 中文期刊> 《肾脏病与透析肾移植杂志》 >沙利度胺联合地塞米松治疗伴单克隆IgG沉积的增生性肾小球肾炎

沙利度胺联合地塞米松治疗伴单克隆IgG沉积的增生性肾小球肾炎

         
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摘要

Objective:To evaluate the efficacy and safety of thalidomide combined with dexamethasone (TD) in patients with proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID).Methodology:Forty four patients diagnosed as PGNMID from December 2011 to November 2017 were enrolled into this retrospective study.According to with or without TD therapy,they were divided into two groups:TD group (n =12),and non-TD group (n =32).Their clinical data,treatment efficacy and safety were analyzed.Chi square test was used to compare the difference between the two remission rates.Results:They were 4 males and 8 females with a median age of 48.5 (27～63) years taking the regimen of TD.With a mean follow-up of 7.5 months,6(50％)patients achieve renal response,includes 2 (16.7％) patients achieving complete response and 4(33.3％) patients achieving partial response,median time of response was 5.5 months.5 (83.3％) patients got hematological response,in which one (16.7％) patients obtained complete response,2 (33.3％)patients obtain very good partial response and 2 (33.3％) patients obtained partial response.After treatment,serum albumin was significantly improved (P =0.002),serum creatinine kept stable (P =0.79),urine protein decreased (P =0.099),and no patient progressed to ESR.D.Compared with the TD group,the mean follow-up time of non-TD group was 19 months.In this group,5 (15.63％)patients achieve renal response,including 3 (9.38％) patients achieving complete response and 2(6.25％) patients achieving partial response.The renal response rate was lower than those in TD group (P=0.045).Three patients got hematological response.Serum creatinine in the last follow-up were worse than the baseline (P =0.046),albumin (P=0.005) and proteinuria (P=0.044) were improved,and 9 (28.1％) patients progressed to ESRD.The common side effects of TD group were mainly numbness (50％),edema (50％),sleepiness (50),and skin lesions (33％),but most of the patients were tolerable through symptomatic treatment and drug reduction.Conclusion:The TD regiment was effective for our patients with PGNMID.Side effects were common but most of the patients could tolerate it.The long-term effect needs further study.%目的:评估沙利度胺联合地塞米松(TD)治疗伴单克隆IgG沉积的增生性肾小球肾炎(PGNMID)的疗效及安全性. 方法:回顾性分析2015年12月至2017年11月在南京总医院国家肾脏疾病临床医学研究中心采用TD方案治疗的12例PGNMID患者的临床资料,与2011年至2016年非TD方案治疗的32例PGNMID患者进行比较.应用卡方检验比较两者缓解率的差别. 结果:本研究TD方案治疗患者12例,男女比例4∶8,中位年龄48.5(27,63)岁,平均随访7.5个月,肾脏缓解率达50％,包括2例(16.7％)肾脏完全缓解,4例(33.3％)部分缓解,中位缓解时间5.5个月;血液学总体缓解率83.3％,完全缓解(CR)1例(16.7％),非常好的部分缓解(VGPR)2例(33.3％),部分缓解(PR)2例(33.3％).末次随访TD组患者血白蛋白较前明显改善(P=0.002),血清肌酐稳定(P=0.79),尿蛋白有一定程下降(P=0.099),无一例患者进入终末期肾病(ESRD).而非TD组肾脏平均随访19个月,肾脏缓解率15.63％,包括3例(9.38％)肾脏CR,2例(6.25％)肾脏PR,肾脏缓解率较TD组低(P=0.045).血液学缓解率33.3％(3/9).血清肌酐水平较基线恶化(P=0.046),白蛋白(P=0.005)及尿蛋白(P=0.044)均有改善,8例(25％)患者进入ESRD.TiD治疗常见的不良反应主要包括麻木(50％)、水肿(50％)、困乏(50％)及皮肤病变(33％),但通过对症处理、药物减量等,患者大多可耐受.非TD组不良反应中感染占40％ (8/20),包括呼吸道感染、消化道感染、皮肤感染等. 结论:TD方案对于PGNMID患者有效,副作用较常见,大部分患者可耐受,长期疗效有待进一步观察.

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  • 来源
    《肾脏病与透析肾移植杂志》 |2018年第2期|101-105,112|共6页
  • 作者

    周伟; 李娟; 黄湘华; 曾彩虹; 胡伟新; 陈朝红; 刘志红; 程震;

  • 作者单位

    南京大学医学院附属金陵医院(南京总医院);

    南京大学医学院附属金陵医院(南京总医院)国家肾脏疾病临床医学研究中心 全军肾脏病研究所 南京,210016;

    南京大学医学院附属金陵医院(南京总医院)国家肾脏疾病临床医学研究中心 全军肾脏病研究所 南京,210016;

    南京大学医学院附属金陵医院(南京总医院)国家肾脏疾病临床医学研究中心 全军肾脏病研究所 南京,210016;

    南京大学医学院附属金陵医院(南京总医院)国家肾脏疾病临床医学研究中心 全军肾脏病研究所 南京,210016;

    南京大学医学院附属金陵医院(南京总医院)国家肾脏疾病临床医学研究中心 全军肾脏病研究所 南京,210016;

    南京大学医学院附属金陵医院(南京总医院)国家肾脏疾病临床医学研究中心 全军肾脏病研究所 南京,210016;

    南京大学医学院附属金陵医院(南京总医院)国家肾脏疾病临床医学研究中心 全军肾脏病研究所 南京,210016;

  • 原文格式 PDF
  • 正文语种 chi
  • 中图分类
  • 关键词

    伴单克隆IgG沉积的增生性肾小球肾炎; 沙利度胺; 地塞米松; 疗效; 副作用;

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