标题：吗替麦考酚酯诱导后长期维持治疗对增生性狼疮性肾炎预后的影响

      作者：雷雪姣，任莉，李栋    (咸阳市核工业215医院肾病科，陕西 咸阳 712000)

      卷次： 2018年29卷10期

      【摘要】 目的 探讨激素联合吗替麦考酚酯(MMF)诱导后长期应用MMF维持治疗增生性狼疮性肾炎(LN)的疗效。方法 回顾性分析2008年1月至2015年1月于咸阳市核工业215医院肾病科接受治疗的182例增生性LN患者的临床资料，所有患者均接受激素联合MMF诱导，获得缓解后，以接受激素、激素联合硫唑嘌呤或雷公藤多苷或来氟米特维持治疗者为C组，接受激素联合MMF维持治疗，且MMF维持时间≥18个月者为A组，接受激素联合MMF维持治疗，且MMF维持时间<18个月者为B组。观察患者诱导疗效，随访观察复发情况及复合肾脏终点事件发生情况。结果 182例患者中169例诱导进入缓解期，包括A组81例、B组58例、C组30例。诱导期MMF治疗6个月时，Ⅲ型、Ⅳ型患者缓解率分别为95.88% (31/32)、96.30% (104/108)，明显好于Ⅳ+Ⅴ型患者的79.41% (27/34)，差异均有统计学意义(P<0.05)；54例患者复发，占31.95%，B、C组累积复发率分别为43.10%、40.00%，明显高于A组的20.99%，差异均有统计学意义(P<0.05)，A组复发风险是C组的0.323倍(95%CI=0.152~0.687，P=0.003)；复合肾脏终点事件共发生17例，B、C组累积肾脏复合事件发生率分别为13.79%、16.67%，明显高于A组的2.47%，差异均有统计学意义(P<0.05)。结论 激素联合MMF诱导进入缓解期后，继续应用激素联合MMF维持治疗，能使LN患者持续获得较可靠的缓解率，且长期应用MMF有助于降低复发及复合肾脏终点时间发生率。
      【关键词】 增生性狼疮性肾炎；吗替麦考酚酯；维持治疗；预后
      【中图分类号】 R692.3 【文献标识码】 A 【文章编号】 1003—6350（2018）10—1372—04

Effect of long-term maintenance therapy after induction immunosuppression by mycophenolate mofetil on theprognosis of patients with proliferative lupus nephritis.
LEI Xue-jiao, REN Li, LI Dong. Department of Nephrology,215 Hospital of Nuclear Industry of Xianyang City, Xianyang 712000, Shaanxi, CHINA
【Abstract】 Objective To investigate the efficacy of long-term maintenance therapy on proliferative lupus ne-phritis (LN) after induction immunosuppression by mycophenolate mofetil (MMF). Methods The clinical data of 182cases of proliferative LN, who admitted to Department of Nephrology of 215 Hospital of Nuclear Industry of XianyangCity from January 2008 to January 2015, were retrospectively analyzed. All cases received prednisolone and MMF as in-duction immunosuppression, then in catabasis. The patients treated with prednisolone, prednisolone combined with aza-thioprine or tripterygium glycosides or leflunomide for maintenance therapy were included into group C; the patientstreated with prednisolone combined with MMF (≥18 months) were enrolled into group A; the patients treated with pred-nisolone combined with MMF (<18 months) were enrolled into group B. The curative effect during induction immuno-suppression, the recurrence and the occurrence of compound renal endpoint events were observed. Results Among the182 patients, 169 cases were induced into remission stage, including 81 cases in group A, 58 cases in group B, and 30cases in group C. At the induction phase, 6 months after MMF treatment, the remission rates of type Ⅲ and Ⅳ patientswere 95.88% (31/32) and 96.30% (104/108), respectively, which were significantly better than 79.41% (27/34) of pa-tients with type Ⅳ and Ⅴ (P<0.05). There were 54 relapses with the recurrence rate of 31.95%. The cumulative recur-rence rates of group B and C were 43.10% and 40.00%, respectively, which were significantly higher than 20.99% of·论 著·doi:10.3969/j.issn.1003-6350.2018.10.012