Full Text:   <1285>

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CLC number: R692.3

On-line Access: 2015-09-05

Received: 2014-12-07

Revision Accepted: 2015-03-05

Crosschecked: 2015-08-10

Cited: 3

Clicked: 2359

Citations:  Bibtex RefMan EndNote GB/T7714

 ORCID:

Jiang-hua CHEN

http://orcid.org/0000-0002-3282-3998

Fei Han

http://orcid.org/0000-0002-7089-6223

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Journal of Zhejiang University SCIENCE B 2015 Vol.16 No.9 P.772-779

http://doi.org/10.1631/jzus.B1400335


Mycophenolate mofetil plus prednisone for inducing remission of Henoch-Schönlein purpura nephritis: a retrospective study


Author(s):  Fei Han, Liang-liang Chen, Ping-ping Ren, Jing-yun Le, Pei-jing Choong, Hong-ju Wang, Ying Xu, Jiang-hua Chen

Affiliation(s):  Kidney Disease Center, the First Affiliated Hospital, School of Medicine, Zhejiang University / Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province / the Third Grade Laboratory under the National State, Administration of Traditional Chinese Medicine, Hangzhou 310003, China

Corresponding email(s):   chenjianghua@zju.edu.cn

Key Words:  Henoch-Schö, nlein purpura, Nephritis, Mycophenolate mofetil, Remission


Fei Han, Liang-liang Chen, Ping-ping Ren, Jing-yun Le, Pei-jing Choong, Hong-ju Wang, Ying Xu, Jiang-hua Chen. Mycophenolate mofetil plus prednisone for inducing remission of Henoch-Schönlein purpura nephritis: a retrospective study[J]. Journal of Zhejiang University Science B, 2015, 16(9): 772-779.

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author="Fei Han, Liang-liang Chen, Ping-ping Ren, Jing-yun Le, Pei-jing Choong, Hong-ju Wang, Ying Xu, Jiang-hua Chen",
journal="Journal of Zhejiang University Science B",
volume="16",
number="9",
pages="772-779",
year="2015",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1400335"
}

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%T Mycophenolate mofetil plus prednisone for inducing remission of Henoch-Schönlein purpura nephritis: a retrospective study
%A Fei Han
%A Liang-liang Chen
%A Ping-ping Ren
%A Jing-yun Le
%A Pei-jing Choong
%A Hong-ju Wang
%A Ying Xu
%A Jiang-hua Chen
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T1 - Mycophenolate mofetil plus prednisone for inducing remission of Henoch-Schönlein purpura nephritis: a retrospective study
A1 - Fei Han
A1 - Liang-liang Chen
A1 - Ping-ping Ren
A1 - Jing-yun Le
A1 - Pei-jing Choong
A1 - Hong-ju Wang
A1 - Ying Xu
A1 - Jiang-hua Chen
J0 - Journal of Zhejiang University Science B
VL - 16
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PB - Zhejiang University Press & Springer
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DOI - 10.1631/jzus.B1400335


Abstract: 
Objective: The treatment of henoch-Schö;nlein purpura (HSP) with moderate proteinuria remains controversial. We retrospectively analyzed the efficacy of immune suppressants, with a particular emphasis on mycophenolate mofetil (MMF). Methods: Ninety-five HSP patients with moderate proteinuria (1.0–3.5 g/24 h) after at least three months of therapy with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) were divided into three groups: an MMF group (n=33) that received MMF 1.0–1.5 g/d combined with prednisone (0.4–0.5 mg/(kg·d)), a corticosteroid (CS) group (n=31) that received full-dose prednisone (0.8–1.0 mg/(kg·d)), and a control group (n=31). Patients in the MMF and CS groups continued to take ACEI or ARB at the original dose. The patients in the control group continued to take ACEI or ARB but the dose was increased by (1.73±0.58)-fold. The patients were followed up for 6–78 months (median 28 months). Results: The baseline proteinuria was higher in the MMF group ((2.1±0.9) g/24 h) than in the control group ((1.6±0.8) g/24 h) (P=0.039). The proteinuria decreased significantly in all groups during follow-up, but only in the MMF group did it decrease significantly after the first month. At the end of follow-up, the proteinuria was (0.4±0.7) g/24 h in the MMF group and (0.4±0.4) g/24 h in the CS group, significantly lower than that in the control group ((0.9±1.1) g/24 h). The remission rates in the MMF group, CS group, and control group were respectively 72.7%, 71.0%, and 48.4% at six months and 72.7%, 64.5%, and 45.2% at the end of follow-up. The overall number of reported adverse events was 17 in the MMF group, 30 in the CS group, and 6 in the control group (P<0.001). Conclusions: MMF with low-dose prednisone may be as effective as full-dose prednisone and tend to have fewer adverse events. Therefore, it is probably superior to conservative treatments of adult HSP patients with moderate proteinuria.

霉酚酸酯联合糖皮质激素诱导治疗过敏性紫癜性肾炎的回顾性研究

目的:合并中等量蛋白尿的过敏性紫癜性肾炎的诱导治疗尚无确切方案,本研究通过回顾性比较分析了霉酚酸酯联合糖皮质激素的疗效与安全性。
创新点:首次对霉酚酸酯联合糖皮质激素诱导治疗过敏性紫癜性肾炎进行了回顾性研究。
方法:回顾性分析2007年1月至2013年6月间在浙江大学附属第一医院肾脏病中心接受肾穿刺活检,且经过3个月以上血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB)治疗后蛋白尿为1.0~3.5 g/24 h的过敏性紫癜性肾炎患者95例。根据治疗方案分为3组,霉酚酸酯组(33例)在原剂量ACEI/ARB的基础上加用霉酚酸酯联合低剂量糖皮质激素,糖皮质激素组(31例)在原剂量ACEI/ARB的基础上加用全剂量糖皮质激素,对照组(31例)维持单用ACEI/ARB治疗,但可提高其剂量。患者随访观察6~78月(中位观察时间28月),霉酚酸酯组、糖皮质激素组与对照组的蛋白尿缓解率分别为72.7%、64.5%与45.2%(图1),发生副作用分别为17例、30例与6例,糖皮质激素组高脂血症与高血压发生率较高(表3)。
结论:霉酚酸酯联合低剂量糖皮质激素可有效诱导缓解过敏性紫癜性肾炎,其缓解率与全剂量糖皮质激素治疗相当,且副作用较少。

关键词:过敏性紫癜性肾炎;霉酚酸酯;缓解率

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

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