目的 探讨环磷酰胺联合糖皮质激素治疗乙型肝炎病毒相关性肾病的临床疗效。方法 选取2013年3月—2013年10月冀中能源峰峰集团总医院收治的乙肝病毒相关性肾病86例,随机分为对照组和治疗组,每组43例。对照组患者口服甲泼尼龙片,3片/次,2次/d;1周后换用醋酸泼尼松片,2片/次,3次/d,继续维持治疗6周后缓慢减少药量,以保证疗效的同时减少患者对糖皮质激素的依赖性。治疗组口服环磷酰胺片,1片/次,2次/d,糖皮质激素的用法用量同对照组。两组患者均连续治疗6个月。比较两组的临床疗效,同时比较两组治疗前,治疗3、6个月两组患者丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TB)、尿素氮(BUN)、肾小球滤过率(GFR)、尿总蛋白(TP)、白蛋白(ALB)的变化。结果 对照组和治疗组总有效率分别为58.14%、76.74%,两组比较差异有统计学意义(P < 0.05)。治疗后,两组ALT、AST、TB、BUN、TP均较治疗前显著下降,GFR、ALB较治疗前显著升高,同组治疗前后差异有统计学意义(P < 0.05);且治疗组这些观察指标较对照组同期改善更加明显,两组比较差异有统计学意义(P < 0.05)。结论 环磷酰胺联合糖皮质激素治疗乙肝病毒相关性肾病具有较好的临床疗效,可改善患者肝肾功能相关指标,值得临床推广应用。

Objective To investigate the clinical effect of cyclophosphamide combined with glucocorticoid in treatment of hepatitis B virus associated nephropathy. Methods The patients with hepatitis B virus associated nephropathy (86 cases) of the General Hospital of Hebei Central Energy Fengfeng Group Co., Ltd. from March 2013 to October 2013 were randomly divided into control (n= 43) and treatment (n= 43) groups. The patients in the control group were po administered with Methylprednisolone Tablets, 3 tablets/time, twice daily. After 1 week they were po administered with Prednisone Acetate Tablets, 2 tablets/time, three times daily. The patients in the control group maintained the treatment for 6 weeks, and then reduced the dosage slowly to ensure the curative effect and reduced the dependence of glucocorticoid. The patients in treatment group were po administered with Cyclophosphamide Tablets, 1 tablet/time, twice daily, and the usage and dosage of glucocorticoid were the same as the control group. The patients in two groups were treated for 6 months. After treatment, the efficacy was evaluated, and the changes of ALT, AST, TB, BUN, GFR, TP and ALB were compared. Results The efficacies in the control and treatment groups were 58.14% and 76.74%, respectively, and there were differences between two groups (P < 0.05). After treatment, ALT, AST, TB, BUN, and TP in two groups were significantly reduced, while GFR and ALB were significantly higher, and the difference was statistically significant in the same group (P < 0.05). And these indicators in treatment group improved better than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Cyclophosphamide combined with glucocorticoid has the good clinical effect in treatment of hepatitis B virus associated nephropathy, and can improve indicators related with kidney function, which is worth clinical promotion.