| Objective:To analyze the therapeutic effects and side effects of different treatments of idiopathic membranous nephropathy(IMN)in the affiliated hospital of Yan'an University: steroid therapy combined with low dose cyclophosphamide(CTX)and low dose cyclosporine(CSA).To understand the clinical efficacy,side effects and differences between the two immunosuppressant regimens and those at home and abroad,to provide a more safe and effective treatment for idiopathic membranous nephropathy(IMN).Method:Analysis of renal biopsy performed in the Department of Nephrology,Affiliated Hospital of Yan'an University between January 2016 and March 2017.Patients with IMN76 who were included and excluded were randomly divided into two groups and treated with P combined with CTX P and CsA for 12 months.The general situation before immunosuppressant therapy,laboratory examination and renal pathology were recorded.The changes of the above indexes in 3 months,6 months and 12 months were observed dynamically,and the remission time of the two immunosuppressant regimens was analyzed and compared.Remission rate,safety and differences with domestic and international.The data of this study are analyzed by spss20.0 statistical software.The measured data accord with normal distribution,and the variance is the same,expressed in ??±s,the difference between the two groups is compared.The percentage difference of counting data was statistically significant by Chi-square test(P < 0.05).Result:1.There was no statistical significance in clinical general situation,laboratory examination,renal pathology and so on in P+CTX combined with CsA group(P>0.05).2.The total remission rate of P combined with CsA in the two groups was higher than that in the P+CTX group at the 3rd month(P< 0.05),the difference was statistically significant(P<0.042),and there was no significant difference in the total remission rate in the P+CTXand P+CsA group in the 6th month after treatment(P<0.05)and in the CsA group(P<0.05).The complete remission rate of P+CTX group was higher than that of P+CTX group.The difference was statistically significant(P<0.05).There was no significant difference in the complete remission rate in 6 months and 12 months after treatment(P>0.05).3.The decrease of urinary protein in 24 hours(P<0.05)and the 24h-Upro of P+CsA +CTX group were 3.57±1.11g/24 h and 2.95±1.42g/24 h respectively at 3 months after treatment(P<0.05).With the increase of treatment time,24h-Upro in both groups decreased gradually.There was no significant difference in 24h-Upro between the two groups in 6 months and 12 months after treatment(P>0.05),and the 24h-Upro of P + CsA group combined with CTX group was 1.63 ±0.90 g/24 h and 1.68 ±0.43 g/24 h after treatment for 12 months,and 1.63 ±0.90g/24 h and 1.68 ±0.43g/24 h,respectively.4.In terms of plasma albumin elevation,the ALB of P group combined with CsA IMN group was higher than that of P group combined with CTX group(P<0.05).The IMN patients in the two groups increased with treatment time.ALB gradually increased;there was no statistical difference between the two groups in the treatment of ALB in June and December(P>0.05).5.The renal function of IMN patients in the two groups remained stable during the follow-up period,and there was no significant difference between the two groups at each time point(P>0.05).At the end of the follow-up(12 months),there was no significant difference between the two groups in renal function and baseline value,(P>0.05).6.Two kinds of immunosuppressant therapy are adverse drug reaction occurred in total number and incidence are: joint CTX group(42.11%),16 P P joint CsA group of 14(43.75%),incidence of adverse reactions between the two groups have no statistical difference(P>0.05).In the two treatment regiments,there was a high proportion of liver enzyme abnormality,bad gastrointestinal tract and lung infection.P combined with CTX group,the main adverse reactions were leukocyte reduction,abnormal liver enzyme,pulmonary infection,gastrointestinal reaction,and menstrual disorders.The main adverse reactions of P combined with CsA group were liver enzyme abnormality,pulmonary infection,gingival hyperplasia,blood glucose disorder,and renal dysfunction.Conclusion:1.P in combination with small dose of CTX,P in combination with small dose of CsA treatment IMN total remission rate no statistical difference(P>0.05),with the international and domestic P al large dose CTX,P combined therapy with large dose of CsA IMN similar curative effect;2.Compared with P combined with CTX,P combined with CsA was effective in treating IMN patients,and early efficacy was better.3.P combined CsA is superior to P combined CTX in raising ALB;4.Low-dose immunosuppression has fewer side effects than international and domestic high-dose IMN treatment. |
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