目的：Ⅴ型狼疮性肾炎(WHO分型LN-V型)主要表现为蛋白尿或肾病综合征，本文分析环孢霉素A(CsA)对LN-V型的疗效。 方法：分析16例经肾活检明确诊断为LN-V型患者CsA治疗的近期及远期的治疗反应。16例患者治疗前均处于肾病综合征状态。治疗方法：CsA 5 mg／(kg·d)诱导治疗3个月，以后每月减1 mg／(kg·d)直至2 mg／(kg·d)维持，CsA治疗同时采用强的松维持。总疗程12～24月，随访时间18月～4年。 结果：诱导期CsA平均血药谷浓度为185±30.8 μg／L。经CsA治疗3个月后，4例(25％)缓解，6例(37.5％)部分缓解。治疗6个月，平均尿蛋白为0.3±0.4 g／24h，血清白蛋白为40.7±4.9 g／L。12例(75％)缓解，3例(18.7％)部分缓解，1例(6.3％)无效，总有效率达93.7％。8例伴有镜下血尿者有6例血尿消失，血清学指标也有所改善。CsA停药两年后有5例(41.7％)复发。CsA治疗1月内81.2％患者(13／16)血尿素氮和肌酐有一过性升高。其它副作用有血压升高(6／16)，少数患者出现多毛及齿龈增生。3例重复肾活检未见条索状间质纤维化或典型CsA导致的小动脉病变。结论：本研究证实CsA治疗降低V型LN蛋白尿短期内疗效肯定，且CsA≤5 mg／(kg·d)用于肾功能正常LN患者未出现严重肾毒性。但停用CsA后复发率高。CsA治疗V型LN的长期疗效及安全性有待严格的临床对照研究和随访。%OBJECTIVE Membranous lupus nephropathy is frequently associated with nephrotic syndrome. Recently, cyclosporine(CsA)has been reported effective in the treatment of nephrotic syndrome associated with primary glomerulonephritis including idio-pathic membranous nephropathy. In this study, we investigated the safety and the efficacy of CsA in membranous lupus nephropa-thy. METHODOILOGY A retrospective analysis was performed in 16 membranous lupus nephropathy who received renalbiopsy before CsA treatment. CsA(5 mg/kg·d-1)combined with low dose prednisone (30 mg/d) was administered for 3 monthsand then decreased 1 mg/( kg·d) every month. The dosage of CsA was tapered to 2 mg/(kg·d) at the sixth month of treatment andmaintained for 12～24 months. Thereafter, The patients were followed-up for an average period of 18～48 months. Clinical andpathological parameters were collected and analyzed. RESULTS The mean trough level of whole blood CsA was 185 + 30.8μg/L. After 3 months of CsA treatment,4 cases experienced complete remission, 6 cases partial remission. After 6 months, 12 casesexperienced complete remission,3 cases partial remission, 1 case turned out ineffective. Hematuria disappemed after CsA treatmentin 6 out of 8 patients who presented with hemamria. After CsA was discontinued, 5 patients relapsed. Side effects were minor exceptfor transient increment of senun creatinine in 13 cases and hypertension in 6 cases. Repeated renal biopsy in 3 patients showed notubulointerstitial lesion associated with CsA renal toxicity. CONCLUSION CsA combined with low dose prednisone was safeand effective in this group of patients with membranous lupus nephropathy. CsA as an alternative treatment for membranous lupusnephropathy should be further evaluated in controlled clinical trials.
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