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目的 探讨静脉滴注人血丙种球蛋白 (IVIG)冲击治疗原发性难治性肾病综合征的疗效及其安全性。方法 8例患者均经肾穿刺活检 ,其中微小病变肾病 2例 ,系膜增生性肾小球肾炎 3例 ,局灶节段性肾小球硬化 1例 ,膜性肾病 2例。 8例原发性难治性肾病综合征均采用激素 (泼尼松、甲基泼尼松龙 )和免疫抑制剂 (雷公藤、骁悉 )正规治疗 8周以上 ,疗效不满意后均加用丙种球蛋白冲击 ,行IVIG治疗前均处于泼尼松减量过程中 ,服雷公藤者 1例。IVIG用量为 0 .3～ 0 .4 g/(kg·d) ,连续 3d。定期随访并记录当时发生的副作用。结果 IVIG联合皮质激素治疗可以降低尿蛋白含量和提高血清白蛋白量、增加尿量、减少心包及胸、腹腔积液、控制感染。完全缓解率 5 0 .0 % (4 /8) ,部分缓解率 37.5 % (3/8) ,无效率 12 .5 % (1/8)。结论 IVIG治疗难治性肾病综合征可取得满意疗效。
Objective To investigate the efficacy and safety of intravenous infusion of human blood gamma globulin (IVIG) in the treatment of primary refractory nephrotic syndrome. Methods Eight patients were examined by renal biopsy, including 2 cases of minimal change nephropathy, 3 cases of mesangial proliferative glomerulonephritis, 1 case of focal segmental glomerulosclerosis and 2 cases of membranous nephropathy. 8 cases of primary refractory nephrotic syndrome were treated with formalin (prednisone, methylprednisolone) and immunosuppressive agents (tripterygium wilfordii) for more than 8 weeks, the effect is not satisfied with both plus Gamma globulin impact, before IVIG treatment were in the process of reducing the amount of prednisone, taking Tripterygium in 1 case. IVIG dosage was 0.3 ~ 0.4 g / (kg · d), continuous 3d. Regular follow-up and record the side effects occurred at the time. Results IVIG combined with corticosteroid treatment can reduce urinary protein and serum albumin, increase urine output, reduce pericardial and thoracic, ascitic fluid, infection control. The complete response rate was 50.0% (4/8), partial response rate was 37.5% (3/8), and inefficiency rate was 12.5% (1/8). Conclusion IVIG treatment of refractory nephrotic syndrome can obtain satisfactory results.