初发初治特发性膜性肾病不同治疗方案疗效及累积缓解率比较

张洪川; 朱华夏; 郭凯琦; 许星成; 李小伟

doi:10.16766/j.cnki.issn.1674-4152.004481

初发初治特发性膜性肾病不同治疗方案疗效及累积缓解率比较

doi: 10.16766/j.cnki.issn.1674-4152.004481

安徽医科大学附属阜阳人民医院肾内科，安徽阜阳 236000

基金项目:

安徽省重点研究与开发计划项目 2022e07020057

安徽省卫生健康科研项目 AHWJ2024Aa20394

阜阳市重点研究与开发计划项目临床医学研究转化专项 FYZDYF2023LCYX002

详细信息

通讯作者:
李小伟, E-mail: lllxxxwww2005@aliyun.com

中图分类号: R692
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出版历程
- 收稿日期: 2025-07-11
- 网络出版日期: 2026-10-23

Comparison of therapeutic effects and cumulative remission rates of different treatment regimens for first-episode, treatment IMN

Department of Nephrology, Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui 236000, China

摘要

摘要: 目的本研究旨在比较初发初治特发性膜性肾病患者采用对症治疗、糖皮质激素联合环磷酰胺（GC+CYC）及糖皮质激素联合钙调磷酸酶抑制剂（GC+CNIs）3种初始方案的临床疗效与缓解特点，进一步分析不同亚组方案的疗效差异及治疗切换后的临床结局，为临床个体化治疗提供参考依据。方法回顾性纳入2017年1月—2023年1月安徽医科大学附属阜阳人民医院确诊IMN患者231例，按初始方案分为对症治疗组（45例）、糖皮质激素联合环磷酰胺（GC+CYC）组(77例)、糖皮质激素联合钙调磷酸酶抑制剂（GC+CNIs）组(109例)，比较3组临床缓解率、累积缓解率及不同亚组及治疗切换后的结局。结果 IMN患者总临床缓解率为59.74%（138/231），其中部分缓解率为24.24%(56/231), 完全缓解率为35.50%(82/231)。对症治疗组、GC+CYC组、GC+CNIs组缓解率分别为40.00%（18/45）、59.74%（46/77）、67.89%（74/109）；2组免疫抑制组累积缓解率均显著高于对症治疗组，且GC+CNIs组在随访3、6、9个月时累积缓解率高于GC+CYC组。改良意大利方案与CYC冲击、环孢素与他克莫司等亚组间疗效差异均无统计学意义，由对症治疗切换至CYC或CNIs者缓解率与初始即予免疫抑制者相近。结论 CYC方案与CNIs方案治疗IMN患者临床缓解率无差异，但CNIs方案的起效时间更快，无效患者切换方案后可部分提高缓解率。
- 特发性膜性肾病 /
- 环磷酰胺 /
- 钙调磷酸酶抑制剂 /
- 免疫抑制剂 /
- 疗效
Abstract: Objective This study aimed to compare the clinical efficacy and remission characteristics of three initial therapeutic strategies—symptomatic treatment, glucocorticoid combined with cyclophosphamide (GC+CYC), and glucocorticoid combined with calcineurin inhibitors (GC+CNIs)—and to further analyze subgroup differences and outcomes after treatment switching, thereby providing a reference for individualized clinical management. Methods A total of 231 patients with IMN diagnosed at Fuyang People's Hospital of Anhui Medical University from January 2017 to December 2022 were selected as study subjects. According to the initial treatment regimen, they were divided into three groups: symptomatic treatment group (n=45), GC+CYC group (n=77), and GC+CNIs group (n=109). Clinical efficacy and remission outcomes were compared among groups. Results The overall clinical remission rate of IMN patients was 59.74% (138/231), among which the partial remission rate was 24.24% (56/231) and the complete remission rate was 35.50% (82/231). The overall clinical remission rates in the symptomatic treatment, GC+CYC group, and GC+CNIs group were 40.00% (18/45), 59.74% (46/77), and 67.89% (74/109), respectively, with no significant difference between the latter two groups (P>0.05). At follow-up, cumulative clinical remission rates were significantly higher in the GC+CYC group and the GC+CNIs group than in the symptomatic treatment group (P < 0.05). The GC+CNIs group had significantly higher cumulative clinical remission rates than the GC+CYC group at 3, 6, and 9 months (P < 0.05). No significant differences in efficacy were observed between the modified Italian subgroup and the CYC shock subgroup, or between the cyclosporine A subgroup and the tacrolimus subgroup (P>0.05). There was no significant difference in the efficacy of patients who switched from the symptomatic treatment group to the immunosuppressive group compared with patients receiving initial CYC or CNIs. Conclusion Although no significant difference in efficacy was observed between the CYC regimen and the CNIs-based regimen, CNIs regimen demonstrated a more rapid therapeutic effect. Subgroup analyses showed comparable efficacy across regimens, and treatment switching may partially improve remission outcomes.
- Idiopathic membranous nephropathy /
- Cyclophosphamide /
- Calmodulin phosphatase inhibitors /
- Immunosuppressant /
- Efficacy

HTML全文

图 1 IMN患者筛选流程图

注：AKI为急性肾衰竭(acute kidney injury)；IgA为免疫球蛋白A(immunoglobulin A)。

Figure 1. Flow chart for patient screening in IMN

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图 2 3组IMN患者初始方案临床缓解率比较

注：与GC+CYC组比较，^aP < 0.05；与GC+CNIs组比较，^bP < 0.05。

Figure 2. Comparison of clinical remission rates of initial regimens among three groups of IMN patients

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图 3 不同亚组IMN患者初始方案临床缓解率比较

Figure 3. Comparison of clinical remission rates of initial regimens among different IMN subgroups

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表 1 3组IMN患者基线资料比较

Table 1. Comparison of baseline data in three IMN groups

项目	对症治疗组 (n=45)	GC+CYC组 (n=77)	GC+CNIs组 (n=109)	统计量	P值
性别(男性/女性，例)	24/21	52/25	62/47	3.082^b	0.214
年龄(x±s，岁)	47.49±13.55	52.45±8.60^a	48.54±13.75	3.173^c	0.044
院前病程[M(P₂₅，P₇₅), 月]	1.00(0.50, 4.00)	1.00(0.50, 3.00)	1.00(0.50, 3.00)	2.759^d	0.267
基础疾病[例(%)]
高血压	25(55.56)	50(64.94)	62(56.88)	1.539^b	0.463
糖尿病	6(13.33)	3(3.90)	12(11.01)	4.270^b	0.110
冠心病	0	4(5.19)	4(3.67)	2.046^b	0.371
缺血性脑卒中	0	1(1.30)	3(2.75)	1.006^b	0.675
检验指标[M(P₂₅，P₇₅)]
白蛋白(g/L)	31.00(26.30, 35.05)	21.60(18.85, 24.45)^a	21.60(18.75, 24.50)^a	68.022^d	＜0.001
血肌酐(μmol/L)	51.70(41.45, 62.65)	63.00(48.60, 72.30)^a	58.40(48.00, 70.55)^a	10.708^d	0.005
胱抑素(mg/L)	0.74(0.65, 0.84)	0.87(0.77, 1.01)^a	0.83(0.72, 0.99)^a	15.307^d	＜0.001
总胆固醇(mmol/L)	6.31(5.46, 6.89)	7.59(6.48, 8.66)^a	7.22(5.96, 8.73)^a	20.635^d	＜0.001
UPCR	1.86(1.16, 2.80)	4.52(2.99, 7.03)^a	4.88(3.67, 7.92)^a	35.576^d	＜0.001
eGFR[mL/(min·1.73m²)]	113.60(105.45, 124.10)	106.70(98.20, 112.20)^a	109.30(98.30, 119.25)^a	12.034^d	0.002
注：与对症治疗组比较，^aP < 0.05；^b为χ²值，^c为F值，^d为H值。

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