关键词:

"> 伴单克隆免疫球蛋白沉积的增生性肾小球肾炎 环磷酰胺?沙利度胺?地塞米松 疗效 不良反应

Abstract: Objective: To  evaluate  the  efficacy  and  safety  of  cyclophosphamide⁃thalidomide⁃dexamethasone (CTD)  therapy  in patients  with proliferative  glomerulonephritis  with monoclonal  immunoglobulin deposits  (PGNMID). Methodology:The clinicopathological data of PGNMID patients who were treated with CTD protocol from January 2018 to January 2024 were retrospectively analyzed.    Results:22 patients were included in the CTD treatment protocol, consisting of 16 patients in the first episode, first⁃treatment group, and 6 patients in the relapsed⁃refractory group. The median follow⁃ up period was 21 months, with a median remission time of approximately 9 months. During the follow⁃up period, 90.9% of patients achieved  renal  remission,  45.5%  complete  remission.  Median  urine  protein  quantification  decreased  from  3.53 (2.10, 6.41)  g/24h to 0.71 (0.41, 2.15)  g/24h  in  all  patients,  and  median  serum  creatinine  decreased  from 122.5 (84.4,150.3) μmol/L to 99.9(70.7,124.0) μmol/L. Of these patients, two relapsed, and one went into end stage kidney disease. The median thalidomide dose  in  the  CTD  group  was  75  (50,  100)  mg/d,  with  an  overall  incidence  of  serious adverse reactions of 9%  (2/22), including one case each of myelosuppression and peripheral neuropathy.    Conclusion: The CTD regimen is effective in treating patients with PGNMID, with a  low incidence  of  serious  adverse  effects  and good tolerability. Further observations are needed regarding the impact on long⁃term efficacy and safety.

Key words: proliferative   glomerulonephritis  , with  , monoclonal   immunoglobulin  , deposits      , cyclophosphamide? thalidomide?dexamethasone    efficacy   , adverse effects