关键词: 增殖性狼疮性肾炎, 吗替麦考酚酯, 疗效, 预后

Abstract:

Ｏｂｊｅｃｔｉｖｅ：To retrospectively analyze the efficacy and longterm prognosis of mycophenolate mofetil (MMF) treatment on patients with proliferative lupus nephritis (LN).
Ｍｅｔｈｏｄｏｌｏｇｙ：Two hundred and thirtyfive patients with biopsyproved Class Ⅲ、Ⅳ and Ⅲ/Ⅳ+Ⅴ lupus nephritis were enrolled in this study. All received prednisolone and MMF as induction immunosuppression. According to MMF therapy, they were divided into three groups：longterm MMF maintenance group (group Ⅰ)、shortterm MMF maintenance group (group Ⅱ)、and nonMMF maintenance group (group Ⅲ). According to response to induction immunosuppression, they  were divided into complete remission、partial remission、and no remission. The composite renal endpoint included endstage renal disease (ESRD), creatinine doubling and decrease in eGFR≥50%.
Ｒｅｓｕｌｔｓ：221 patients (940%) responded favorably (complete or partial remission) to induction treatment. The overall (complete and partial remission) response incidences at 6 months and 9 months was 893% and 902%, respectively. The incidence of complete remission at 6 months and 9 months was 476% and 531%, respectively. There were no significant differences in clinical and pathological parameters between the three groups. The median follow-up time was 83（38，106）months. During followup, seventythree patients (330%) relapsed. In group Ⅰ, the relapse rate  was significantly lower than that in group Ⅱ and group Ⅲ（221% vs 444% vs 455%, respectively, P＜0.05）. Multivariate analysis showed that the hazard ratio of relapse for group Ⅱ was 229（95%CI 118～447, P=0015）and 322 for group Ⅲ (95%CI 185～561, P＜0001）when compared with group Ⅰ. 20 patients reached the endpoint, include ESRD (n=2), creatinine doubling increase (n=9) and a decrease in eGFR ≥ 50% (n=9). Group Ⅰ showed lower incidence of composite renal endpoint than group Ⅱ and group Ⅲ(48% vs 106% vs 139%, respectively, P＞0.05).
Ｃｏｎｃｌｕｓｉｏｎ：
Longterm MMF maintenance after remission can achieve better sustained remission rate, longterm MMF treatment can reduce the relapse and the incidence of endevents.

Key words: proliferative lupus nephritis, mycophenolate mofetil, efficacyprognosis