关键词: 狼疮性肾炎, 新月体, 吗替麦考酚酯, 环磷酰胺, 诱导治疗

Abstract:

Objective：To compare the induction efficacy of mycophenolate mofetil (MMF) and intravenous cyclophosphamide (IV-CTX) in Class IV lupus nephritis (LN) patients with ≥15% crescents. Methodology: From 2000 to 2009, the clinical and histological data of all patients with LN in our center was reviewed in this retrospective analysis. Among them, eighty patients biopsy-proven Class IV LN with crescent formation in ≥15% of glomeruli were investigated. According to the induction regimens, they were divided into MMF group (n=39) and IV-CTX group (n=41). Results：There were no differences in baseline clinical and pathological parameters between the two groups. The median ratio of crescents in MMF and IV-CTX group was 34.6% and 31.0% respectively（P=0.836）.The 6-month remission rate was 92.3% in MMF group, significantly higher than that in IV-CTX group (73.1%，P=0.024), while the complete remission (CR) rates of 48.7% in MMF and 34.1% in IV-CTX group respectively were no significant difference (P=0.186). In patients with <50% crescents (n=61), MMF group achieved a much higher remission rates（96.7 % vs 74.2%，P=0.026）and CR（46.7% vs 35.5%, P=0.375） than IV-CTX group. In patients with ≥50% crescents (n=19), remission rates and CR were also higher in MMF group than in IV-CTX group, but without statistical significance. The ratio of patients with normalization of complement C3 after 6-mo induction therapy was significantly higher in MMF group than in IV-CTX group（64.1% vs 35.9%，P=0.013）. Conclusion：Compared to intravenous CTX, MMF had more favorable induction efficacy in Class IV LN with ≥15% crescents. The difference of two induction regimen in LN with different degree of crescent formation needs large samples, and randomized controlled trail.

Key words: lupus nephritis, crescent, mycophenolate mofetil, cyclophosphamide, induction therapy