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【文摘发布】一项多中心研究：霉酚酸酯用于难
Author: Segarra A, Amoedo ML, Garcia JM, Pons S,Praga M, Garcia EI, Alonso JC, Gasco JM, Pou L, Piera L.
Resource:Nephrol Dial Transplant. 2007 Feb20
BACKGROUND: Studies of mycophenolate mofetil (MMF) in primary glomerulonephritis have varied in their inclusion criteria, regimen and follow-up compromising assessments of efficacy and optimal dose. Method. This multicentre study analysed the safety and efficacy of MMF monotherapy in a large cohort with primary glomerulonephritis that was resistant to other conventional therapies. A total of 98 patients with biopsy-proven primary glomerulonephritis resistant to other drugs received MMF monotherapy for 1 year. Primary outcome measures were urinary protein excretion and the number of patients with complete or partial remission of proteinuria. Secondary analyses were time to remission and changes in the slope of creatinine clearance. RESULTS: Fifty-four percent of the patients achieved either complete or partial remission of proteinuria with no significant differences between glomerulonephritis types. Median (range) dose of MMF was 2 g/day (1.5-2 g/day) Mean (SD) treatment time to remission was 141.5 (+/-61.1) days with no significant differences between glomerulonephritis types. Serum albumin increased (P < 0.01), whereas proteinuria (P < 0.01) serum LDL-cholesterol (P < 0.01) and mean blood pressure (P < 0.05) decreased post-treatment. No significant changes were observed in glomerular filtration rate (GFR), serum creatinine or slopes of GFR. The reduction of urinary protein excretion was significantly higher in patients with basal nephrotic proteinuria and preserved renal function; it did not arise from an increased dose of angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists, since, among responders, mean blood pressure significantly decreased and the number of anti-hypertensive drugs could be reduced. CONCLUSIONS: MMF monotherapy causes a moderate decrease in proteinuria in >50% of the patients who do not have other treatment options. The response to therapy is largely influenced by a preserved renal function and requires sustained MMF treatment.
PMID: 17311833 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 题目: 一项多中心研究：霉酚酸酯用于难治性原发性肾小球肾炎“救援性疗法”的疗效和安全性
作者: Segarra A, Amoedo ML, Garcia JM, Pons S,Praga M, Garcia EI, Alonso JC, Gasco JM, Pou L, Piera L.
来源: Nephrol Dial Transplant. 2007 Feb20
背景: 霉酚酸酯用于原发性肾小球肾炎的许多研究中,其选用的标准,用法和随访其疗效,最适剂量折中的评估报道都各不相同.
方法: 这一项多中心研究主要分析霉酚酸酯单一疗法对一大群难治性原发性肾小球肾炎患者的安全性和疗效.总共98例肾活检证实为原发性肾小球肾炎且为难治性的患者接受霉酚酸酯单一疗法1年.起初检测尿蛋白的排泄和统计尿蛋白完全或部分缓解的患者人数.接着分析肌酐清除率缓解和变化的时间.
结果: 54%患者的蛋白尿完全或部分缓解与肾小球肾炎各型相比并无明显差别.霉酚酸酯适中剂量是2克/天(1.5-2克/天),蛋白尿缓解所需平均治疗时间是141.5±61.1天,这也与肾小球肾炎各型无统计学意义的差别.治疗后,血浆白蛋白增加(P<0.01),蛋白尿降低(P<0.01),血浆低密度脂蛋白-胆固醇下降(P<0.01)和平均动脉血压降低(P<0.05).肾小球滤过率,血浆肌酐或肾小球滤过率的斜率没有明显改变.在基础肾病蛋白尿和肾功能尚保存的患者,尿蛋白排泄率下降程度较好些,既然在一些患者中,平均动脉血压明显下降,抗高血压药物数目也在减少,因此这并不归因于血管紧张素转换酶抑制剂或血管紧张素受体阻断剂剂量的增加.
结论: 霉酚酸酯单药治疗可以使50％以上的对其它疗法无效的患者蛋白尿中等程度地降低。治疗效果很大程度上受到现存肾功能的影响,并且需霉酚酸酯维持治疗. slopes of GFR ?
还请confusing组长多多指教!!! slopes of GFR
肾小球滤过率斜率
Studies of mycophenolate mofetil (MMF) in primary glomerulonephritis have varied in their inclusion criteria, regimen and follow-up compromising assessments of efficacy and optimal dose
关于MMF治疗原发性肾小球肾炎的研究在入选标准、治疗方案以及随访等方面都各不相同，影响了对其有效性和最佳剂量的评估。
MMF monotherapy causes a moderate decrease in proteinuria in >50% of the patients who do not have other treatment options.
MMF单药治疗可以使50％以上的对其它疗法无效的患者蛋白尿中等程度地降低。
此处的other treatment options 并非指没有采取其它疗法，而是着重强调这些患者没有其它选择，只有用MMF才可以取得一定的疗效，否则难治性从何而言。 谢谢confusing组长的点评!
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作者:admin@医学,生命科学 2010-11-17 17:11
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