目的 探討環(huán)磷酰胺聯(lián)合糖皮質(zhì)激素治療乙型肝炎病毒相關(guān)性腎病的臨床療效。方法 選取2013年3月—2013年10月冀中能源峰峰集團總醫(yī)院收治的乙肝病毒相關(guān)性腎病86例,隨機分為對照組和治療組,每組43例。對照組患者口服甲潑尼龍片,3片/次,2次/d;1周后換用醋酸潑尼松片,2片/次,3次/d,繼續(xù)維持治療6周后緩慢減少藥量,以保證療效的同時減少患者對糖皮質(zhì)激素的依賴性。治療組口服環(huán)磷酰胺片,1片/次,2次/d,糖皮質(zhì)激素的用法用量同對照組。兩組患者均連續(xù)治療6個月。比較兩組的臨床療效,同時比較兩組治療前,治療3、6個月兩組患者丙氨酸氨基轉(zhuǎn)移酶(ALT)、天門冬氨酸氨基轉(zhuǎn)移酶(AST)、總膽紅素(TB)、尿素氮(BUN)、腎小球濾過率(GFR)、尿總蛋白(TP)、白蛋白(ALB)的變化。結(jié)果 對照組和治療組總有效率分別為58.14%、76.74%,兩組比較差異有統(tǒng)計學(xué)意義(P < 0.05)。治療后,兩組ALT、AST、TB、BUN、TP均較治療前顯著下降,GFR、ALB較治療前顯著升高,同組治療前后差異有統(tǒng)計學(xué)意義(P < 0.05);且治療組這些觀察指標較對照組同期改善更加明顯,兩組比較差異有統(tǒng)計學(xué)意義(P < 0.05)。結(jié)論 環(huán)磷酰胺聯(lián)合糖皮質(zhì)激素治療乙肝病毒相關(guān)性腎病具有較好的臨床療效,可改善患者肝腎功能相關(guān)指標,值得臨床推廣應(yīng)用。

Objective To investigate the clinical effect of cyclophosphamide combined with glucocorticoid in treatment of hepatitis B virus associated nephropathy. Methods The patients with hepatitis B virus associated nephropathy (86 cases) of the General Hospital of Hebei Central Energy Fengfeng Group Co., Ltd. from March 2013 to October 2013 were randomly divided into control (n= 43) and treatment (n= 43) groups. The patients in the control group were po administered with Methylprednisolone Tablets, 3 tablets/time, twice daily. After 1 week they were po administered with Prednisone Acetate Tablets, 2 tablets/time, three times daily. The patients in the control group maintained the treatment for 6 weeks, and then reduced the dosage slowly to ensure the curative effect and reduced the dependence of glucocorticoid. The patients in treatment group were po administered with Cyclophosphamide Tablets, 1 tablet/time, twice daily, and the usage and dosage of glucocorticoid were the same as the control group. The patients in two groups were treated for 6 months. After treatment, the efficacy was evaluated, and the changes of ALT, AST, TB, BUN, GFR, TP and ALB were compared. Results The efficacies in the control and treatment groups were 58.14% and 76.74%, respectively, and there were differences between two groups (P < 0.05). After treatment, ALT, AST, TB, BUN, and TP in two groups were significantly reduced, while GFR and ALB were significantly higher, and the difference was statistically significant in the same group (P < 0.05). And these indicators in treatment group improved better than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Cyclophosphamide combined with glucocorticoid has the good clinical effect in treatment of hepatitis B virus associated nephropathy, and can improve indicators related with kidney function, which is worth clinical promotion.