肾囊注射甲泼尼龙快速诱导缓解原发性重症肾病综合征临床研究

目的：研究肾囊注射甲泼尼龙在快速诱导缓解原发性重症肾病综合征（nephroticsyndrome,NS）中的疗效与安全性。方法：将原发性重症NS患者32例随机分为肾囊注射组20例及对照组12例,常规行肾脏穿刺病理检查。在共同基础治疗的前提下,肾囊注射组采用甲泼尼松0.5mg·kg-1.d-1口服加肾囊注射40mg/每侧肾囊,每周2次,共5周;对照组采用泼尼松1.0mg·kg-1.d-1,不加肾囊注射,共观察12周。分别于治疗前,研究过程的第3、6、9、12周记录两组的体重、血浆白蛋白、24h尿蛋白定量、血清肌酐的变化及相应并发症。结果：肾囊注射组第3、6、9、12周及对照组第9、12周时体重、血浆白蛋白、24h尿蛋白与治疗前基础数值相比差异均有统计学意义（P〈0.05）;两组血肌酐治疗前后差异均无统计学意义（P〉0.05）;治疗组与对照组在研究的第3、6周时体重、血浆白蛋白、24h尿蛋白相比较存在差异并具有统计学意义（P〈0.05）;两组在研究第9周时血浆白蛋白、24h尿蛋白相比较差异有统计学意义（P〈0.05）;12周时两组间各项观察指标变化的差异不大（P〉0.05）。肾脏病理类型中,微小病变型和系膜增生型对甲泼尼龙注射效果最佳,膜型肾病次之,有慢性化倾向或伴膜增殖者疗效差。结论：肾囊注射甲泼尼龙治疗原发肾病综合征是安全有效的,能够快速诱导肾病综合征临床症状的缓解。

Clinical Study on Inducing Quick Remission in Primary Severe Nephrotic Syndrome by Injecting Methylprednisolone into Renal Adipose Capsule

Objective：To evaluate the efficacy and safety of inducing quick remission in primary severe nephrotic syndrome by injecting Methylprednisolone into renal adipose capsule.Methods：32 patients with primary severe nephrotic syndrome were divided into two groups,renal adipose capsule injection group（20 patients）and the control group（12 patients）.All the patients accepted the routine renal biopsy.In the basis of same basic therapy,the renal adipose capsule injection group was treated with oral methylprednisolone 0.5 mg·kg-1·d-1 and the renal adipose capsule injection by methylprednisolone 40 mg/each renal,two times each week for five weeks;the control group was treated with prednisone 1.0 mg·kg-1·d-1 without renal adipose capsule injection.Recording the value of weight、plasma albumin、urine protein/24 h、serum creatinine and corresponding complications of two group patients five times,before the therapy and after the therapy（the third week、the sixth week、the ninth week and the twelfth week）.Results：Comparison of the weight、plasma albumin and urine protein/24 h in renal adipose capsule injection group before and after the therapy（3w、6w、9w、12w）showed significant difference（P0.05）,and in control group the comparison of weight、plasma albumin and urine protein/24 h before and after the therapy（9w、12w）also showed significant difference（P0.05）.The serum creatinine in two groups showed no significant difference before and after the therapy（P0.05）.The weight、plasma albumin and urine protein/24 h of the patients after the therapy（3w、6w）showed significant difference compared to the same patients after the therapy in two groups（P0.05）.The level of plasma albumin and urine protein/24 h of the patients after the therapy（9w）showed significant difference compared to the same patients before the therapy in two groups（P0.05）.The level of each index after the therapy（12w）showed no significant difference compared to the level before the therapy in two groups.In the renal pathological types,methylprednisolone injection had a best clinical efficacy to minimal change nephropathy type and mesangial proliferative glomerulosclerosis type,and a less clinical efficacy to membranous nephropathy（MN）.To Membranoproliferative GN,the clinical efficacy is worst.Conclusion：It is effective and safe that injecting Methylprednisolone into renal adipose capsule can rapidly induce remission in primary severe nephrotic syndrome.