摘要目的采用前瞻对照性研究，探讨环孢素A （CYA）治疗成年人特发性膜性肾病(IMN)的疗效。方法本研究纳入30例IMN患者，15例采用CSA治疗，另15例采用开博通(CAP)治疗。全部患者在诊断上排除了继发性膜性肾病，且在正式进入研究治疗前未用或已停用类固醇激素和细胞毒药物达半年以上。CSA组应用CSA的起始剂量为5mg/kg/day，一月后逐月减量，三月后按2mg/kg/day维持一年。CAP组长期按37.5mg/day剂量服用CAP。结果在前三个月的诱导期末，CSA组中6(6/15)例患者发生完全缓解，2(2/15)例患者发生部分缓解，而在CAP组仅2(2/15)例患者发生部分缓解。观察15月后，CSA组有8例患者发生过完全缓解(其中1例于减药过程中复发)，4例患者部分缓解，而CAP组无更多病例发生完全或部分缓解。在平均随访44月后，CSA组已完全缓解的病例中2例复发，1例转成部分缓解，而在长期应用CAP治疗的患者中，3例患者在随访15月以后出现自然缓解。两组患者治疗前的血清肌酐水平无显著性差异，临床观察中未发现CSA相关的严重副反应。3例CSA治疗患者的重复肾活检资料表现肾小球基膜病变在CSA治疗后(包括持续缓解中的病例)未发生显著改变，1例患者在复发且出现血清肌酐升高后，肾小管间质出现纤维化改变，而另两例缓解患者的肾小管间质未出现明显变化。结论剂量为5 mg/kg/day的 CSA治疗方案对IMN具有诱导缓解作用，有效率可达78%，但停用CSA 6-9月(或减量过程)后，肾病综合征的复发率较高(50%)。

abstractsObjective To evaluate the efficacy of cyclosporin A (CSA) in the treatment of idiopathic membranous nephropathy (IMN), a prospective controlled clinical study was performed. Methods This study included a group of 30 IMN patients, among them 15 were treated with CSA and 15 with captopril (CAP). The diagnosis of IMN was made with exclusion of secondary forms of membranous nephropathy by extensive clinical and pathological studies. No patients received steroids or cytotoxic agents for six months prior to enrollment. In the CSA group, CSA was given at an initial dosage of 5mg*kg-1*d-1, gradually tailed off over the first three months and maintained at 2mg*kg-1*d-1 for 12 months. In the CAP group, CAP was given at a dosage of 37.5mg/day. Results In the first three months, 6 (6/15)complete remissions (CR) and 2 (2/15) partial remissions (PR) were observed in the CSA group while only 2 (2/15) PRs were observed in the CAP group. Before the end of the 15-months, 8 patients in the CSA group experienced CR and 4 patients experienced PR. One CR patient relapsed as the dosage of CSA was reduced, so 7 patients remained in CR at the end of the first 15-months. No additional CR or PR was observed in the CAP group during late follow-up. At the last visit (an average follow-up time of 44 months) in the CSA-group, another 2 CR patients had relapsed and 1 CR patient shifted to PR after stopping the CSA treatment, so 4 CR and 5 PR remained in the CSA group. In the CAP group, 3 spontaneous CRs occurred beyond 1.5 year's follow-up, with 3 CR and 2 PR at the last visit. No difference was found between the averages of the initial and the last serum creatinine levels in either group. No serious adverse effects were found during CSA treatment. Re-biopsy data of three patients responsive to CSA treatment showed that no pathological improvement of glomerular basement membrane was observed, even in cases at remission. Tubulointerstitial fibrosis was found in 1 relapsed CR patient, whoseserum creatinine increased above the normal range, but not in the other 2 patients whose serum creatinine remained in the normal range. Conclusions CSA therapy at a dosage of 5mg*kg-1*d-1 is effective in inducing remission of nephrotic syndrome in adult IMN patients within three months, with a response rate of 80%. A relatively high rate of relapse (50%) was observed within 2 years after the withdrawal of CSA treatment.