关键词: 伴单克隆IgG沉积的增生性肾小球肾炎, 沙利度胺, 地塞米松疗, 效副作用

Abstract:

Ｏｂｊｅｃｔｉｖｅ：To evaluate the efficacy and safety of thalidomide combined with dexamethasone (TD) in patients with proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID).
Ｍｅｔｈｏｄｏｌｏｇｙ：Forty four patients diagnosed as PGNMID from December 2011 to November 2017 were enrolled into this retrospective study. According to with or without TD therapy, they were divided into two groups: TD group
(n=12), and nonTD group (n=32). Their clinical data, treatment efficacy and safety were analyzed. Chi square test was used to compare the difference between the two remission rates.
Ｒｅｓｕｌｔｓ：They were 4 males and 8 females with a median age of 485 (27～63) years taking the regimen of TD. With a mean followup of 75 months, 6（50%）patients achieve renal response, includes 2 (167%) patients achieving complete response and 4(333%) patients achieving partial response, median time of response was 55 months. 5 (833%) patients got hematological response, in which one (167%) patients obtained complete response, 2 (333%) patients obtain very good partial response and 2 (333%) patients obtained partial response. After treatment, serum albumin was significantly improved (P=0002), serum creatinine kept stable (P=079), urine protein decreased (P=0099), and no patient progressed to ESRD. Compared with the TD group, the mean followup time of nonTD group was 19 months. In this group, 5（1563%）patients achieve renal response, including 3 (938%) patients achieving complete response and 2(625%) patients achieving partial response. The renal response rate was lower than those in TD group (P=0045). Three patients got hematological response. Serum creatinine in the last followup were worse than the baseline (P=0046), albumin (P=0005) and proteinuria (P=0044) were improved, and 9 (281%) patients progressed to ESRD. The common side effects of TD group were mainly numbness (50%), edema (50%), sleepiness (50), and skin lesions (33%), but most of the patients were tolerable through symptomatic treatment and drug reduction.
Ｃｏｎｃｌｕｓｉｏｎ：
The TD regiment was effective for our patients with PGNMID. Side effects were common but most of the patients could tolerate it. The longterm effect needs further study.