Kidney Int:微小病变肾病综合征:低剂量糖皮质激素+麦考酚钠是否优于标准方案?

2018-12-18 常路 环球医学

成人微小病变肾病综合征(MCNS)的一线治疗大部分是从儿童研究中推导出来的,包括高剂量口服糖皮质激素。2018年12月,发表在《Kidney Int》的一项研究评估了,低剂量糖皮质激素+麦考酚钠是否优于标准口服糖皮质激素方案。

研究人员从一项在法国32家中心进行的开放标签随机对照试验中纳入了116名微小病变肾病综合征成人患者。58名参与者随机分配至接受低剂量泼尼松(0.5mg/kg/d,最高40mg/d)+肠溶麦考酚钠720mg每天两次共24周的检验组,8周后未实现完全缓解的患者进行二线方案(泼尼松剂量增加至1mg/kg/d,联合或不联合环孢菌素)。58名参与者随机分配至接受常规高剂量泼尼松(1mg/kg/d,最高80mg/d)共24周的对照组。

首要终点指标为治疗4周后完全缓解,109名参与者实现首要终点,检验组和对照组无显着性差异。次要结局指标包括治疗8和24周后缓解,两组无差异。随访52周期间,实现首要结局指标的15名参与者微小病变肾病综合征复发(23.1%)。检验组和对照组复发的中位时间相似(7.1和5.1个月),严重不良事件发生率也相似。5名参与者死于出血(2人)或脓毒性休克(3人),其中检验组2人,对照组3人。

因此,在成年患者中,对于诱导微小病变肾病综合征完全缓解,低剂量泼尼松+肠溶麦考酚钠不优于标准高剂量泼尼松方案。

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    2018-12-20 gwc389
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    2018-12-18 1ddf0692m34(暂无匿称)

    学习了,长知识

    0