治肾最有效的药，重症和顽固肾病不可或缺！防止慢性肾功能衰竭
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q3.itc.cn/q_70/images03/20240423/2338442b7caf48c993506befcc193d2f.png" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">先来看一个临床案例：一位老年女性感冒后自觉不适，查血肌酐高达<span style="color: black;"><strong style="color: blue;">456</strong></span>umol/l（<span style="color: black;">通常</span>女性肌酐40-80umol/l<span style="color: black;">上下</span>，短期快速<span style="color: black;">上升</span>提示急性肾衰竭），<span style="color: black;">立即做</span>肾穿刺活检，确诊新月体型肾小球肾炎，ANCA<span style="color: black;">关联</span>小血管炎<span style="color: black;">［1］</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">大夫</span>给她</span><span style="color: black;"><strong style="color: blue;">环磷酰胺</strong></span><span style="color: black;">冲击治疗后，她的肾功能恢复较好，4个月后血肌酐下降至147umol/l。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">经过</span>上面的病例，<span style="color: black;">跟随肾上线<span style="color: black;">一块</span>来<span style="color: black;">认识</span>，</span>在急<span style="color: black;">严重</span>症肾脏<span style="color: black;">疾患</span>的救治中，一个响当当的名号---</span><span style="color: black;"><strong style="color: blue;"><span style="color: black;">环磷酰胺（<span style="color: black;">简<span style="color: black;">叫作</span>CTX</span>）</span><span style="color: black;">，</span></strong></span><span style="color: black;"><strong style="color: blue;"><span style="color: black;">它是现有最有效的免疫<span style="color: black;">控制</span>疗法之一</span></strong></span><span style="color: black;">。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">针对</span>许多重症的或反复复发的顽固性肾病<span style="color: black;">病人</span>，环磷酰胺<span style="color: black;">能够</span>在<span style="color: black;">很强</span>程度上逆转或阻止肾脏硬化和纤维化的发展，诱导肾病<span style="color: black;">长时间</span>缓解，防止<span style="color: black;">严重</span><span style="color: black;">病人</span>的慢性肾脏功能衰竭。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">环磷酰胺，严重肾病的救命良药</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">环磷酰胺的合成与一战<span style="color: black;">运用</span>的剧毒化学武器-芥子气<span style="color: black;">相关</span>，<span style="color: black;">科研</span>人员<span style="color: black;">发掘</span>芥子气<span style="color: black;">能够</span>破坏淋巴组织和骨髓，受此启发，化学家于1958年<span style="color: black;">科研</span>出了芥子气的衍生化学物：环磷酰胺<span style="color: black;">［1、10］</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">环磷酰胺最初是<span style="color: black;">做为</span>治疗<span style="color: black;"><strong style="color: blue;">癌症的化疗药</strong></span>而上市的，是肿瘤治疗<span style="color: black;">行业</span>的一个里程碑。</span><span style="color: black;">它</span><span style="color: black;">之<span style="color: black;">因此</span>能治疗肿瘤，是<span style="color: black;">由于</span>它在<span style="color: black;">身体</span>的代谢产物<span style="color: black;">能够</span>与肿瘤细胞内的DNA<span style="color: black;">出现</span>交联，<span style="color: black;">控制</span>DNA合成、转录，<span style="color: black;">从而</span><span style="color: black;">引起</span>细胞死亡，<span style="color: black;">因此呢</span>它<span style="color: black;">亦</span>被归类为“</span><span style="color: black;"><strong style="color: blue;">细胞毒<span style="color: black;">药品</span></strong></span><span style="color: black;">”。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">然而不只是肿瘤细胞会受到影响，<span style="color: black;">身体</span>的快速增殖细胞大多都对环磷酰胺<span style="color: black;">敏锐</span>。</span><span style="color: black;"><span style="color: black;">因此呢</span>它还<span style="color: black;">能够</span>非特异性地杀伤淋巴细胞，从而发挥强大地<span style="color: black;">控制</span>免疫的<span style="color: black;">功效</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">自从上世纪60、70年代<span style="color: black;">起始</span>，国内外就<span style="color: black;">起始</span>尝试用环磷酰胺治疗<span style="color: black;">各样</span>免疫病。</span><span style="color: black;">在肾病<span style="color: black;">行业</span>，病情严重的狼疮肾炎、膜性肾病、频繁复发的微小病变、IgA肾病伴急进性肾小球肾炎（新月体肾炎）、ANCA血管炎肾炎、抗GBM病肾病，环磷酰胺的疗效都是傲视群雄的。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">环磷酰胺可口服或静脉给药。口服<span style="color: black;">一般</span>每日吃药，而静脉则间歇给药(例如，每2-4周打1次)。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">1.狼疮肾炎</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">环磷酰胺可<span style="color: black;">做为</span>局灶性、弥漫性狼疮肾炎的一线治疗<span style="color: black;">药品</span>，<span style="color: black;">倘若</span>狼疮累及神经系统、血液系统，<span style="color: black;">亦</span><span style="color: black;">必须</span><span style="color: black;">运用</span>环磷酰胺<span style="color: black;">［2］</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">口服环磷酰胺<span style="color: black;">通常</span>用法是1-1.5mg/<span style="color: black;">公斤</span>/天，<span style="color: black;">连续</span>2-4个月。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">倘若</span>是静脉给药，可每隔2周注射一次，一次500mg，用6次；<span style="color: black;">亦</span><span style="color: black;">能够</span>每隔1个月注射一次，一次0.5-1.0g/m2，用6次。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">2.膜性肾病</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">针对</span>因膜性肾病<span style="color: black;">引起</span>肾功能下降的高危、极高危<span style="color: black;">病人</span>，<span style="color: black;">首要</span><span style="color: black;">举荐</span><span style="color: black;">运用</span>环磷酰胺+激素。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">针对</span>中危<span style="color: black;">病人</span>，<span style="color: black;">倘若</span><span style="color: black;">无</span><span style="color: black;">前提</span><span style="color: black;">运用</span>利妥昔单抗，<span style="color: black;">亦</span><span style="color: black;">能够</span><span style="color: black;">选取</span>环磷酰胺+激素<span style="color: black;">［3］</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">口服环磷酰胺的<span style="color: black;">通常</span>用法为1.5-2mg/<span style="color: black;">公斤</span>/天，联合激素<span style="color: black;">一块</span><span style="color: black;">运用</span>，疗程6个月。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">3.微小病变</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">针对</span>频繁复发、激素依赖的微小病变，环磷酰胺、利妥昔单抗<span style="color: black;">或</span>他克莫司/环孢素，均可<span style="color: black;">做为</span>治疗<span style="color: black;">方法</span><span style="color: black;">［4］</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">口服环磷酰胺的<span style="color: black;">通常</span>用法是，2mg/<span style="color: black;">公斤</span>/天，疗程12周。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">4.其他肾病</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">ANCA血管炎肾炎，一线诱导<span style="color: black;">方法</span>中<span style="color: black;">能够</span><span style="color: black;">选取</span>环磷酰胺+激素，口服环磷酰胺用法为1.5-2mg/<span style="color: black;">公斤</span>/天，疗程3-6个月<span style="color: black;">［5］</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">抗GBM病肾病，治疗<span style="color: black;">包含</span><span style="color: black;">血液</span>置换和免疫<span style="color: black;">控制</span>剂，环磷酰胺+激素是一线<span style="color: black;">方法</span>，口服环磷酰胺用法为2mg/<span style="color: black;">公斤</span>/天，疗程3-6个月</span><span style="color: black;">［6］</span><span style="color: black;">。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">IgA肾病伴急进性肾小球肾炎（新月体肾炎），一线<span style="color: black;">方法</span>是环磷酰胺+激素<span style="color: black;">［7］</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">应对环磷酰胺的毒副<span style="color: black;">功效</span>！</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">刚才</span><span style="color: black;">咱们</span><span style="color: black;">说到</span>环磷酰胺属于细胞毒<span style="color: black;">药品</span>，从字面上<span style="color: black;">亦</span><span style="color: black;">能够</span>看出，用得时间太长、累积剂量过大的话它的毒副<span style="color: black;">功效</span><span style="color: black;">亦</span>是比<span style="color: black;">很强</span>的，这<span style="color: black;">亦</span>是<span style="color: black;">为何</span>环磷酰胺治肾很强，但只给<span style="color: black;">有些</span>病情严重<span style="color: black;">，以及不耐受/<span style="color: black;">不可</span><span style="color: black;">保持</span><span style="color: black;">运用</span>毒性较小的免疫<span style="color: black;">控制</span><span style="color: black;">药品</span></span><span style="color: black;">病人</span>才去<span style="color: black;">运用</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">医患互相<span style="color: black;">协同</span><span style="color: black;">最后</span>达到既<span style="color: black;">能够</span>用环磷酰胺压住<span style="color: black;">肾病活动，<span style="color: black;">以快速限制肾<span style="color: black;">损害</span>的范围和严重性，</span>保住<span style="color: black;">病人</span>的肾功能；又<span style="color: black;">能够</span>在病情稳定后尽快停用环磷酰胺并更换为毒性较低的<span style="color: black;">药品</span>，以<span style="color: black;">尽可能</span>减少该药本身常<span style="color: black;">引起</span>的短期和长期并发症。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">那样</span>，<span style="color: black;">咱们</span>接下来就来介绍下它的<span style="color: black;">重视</span>事项，<span style="color: black;">显现</span>以下<span style="color: black;">状况</span>应<span style="color: black;">即时</span>与<span style="color: black;">大夫</span>沟通联系。<span style="color: black;">因为</span>环磷酰胺在<span style="color: black;">身体</span>的代谢产物是<span style="color: black;">功效</span>于DNA干扰其复制，<span style="color: black;">因此呢</span>它<span style="color: black;">重点</span>影响的是<span style="color: black;">身体</span>增殖旺盛的细胞。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">1）<span style="color: black;"><span style="color: black;">必须</span>监测血常规</span></span></strong><span style="color: black;">：环磷酰胺可<span style="color: black;">引起</span>骨髓<span style="color: black;">控制</span>，<span style="color: black;">导致</span>白细胞、血小板减少</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">2）对感染小心小心再小心</span></strong><span style="color: black;">：环磷酰胺会<span style="color: black;">增多</span>感染的<span style="color: black;">危害</span>，<span style="color: black;">吃下</span>期间需做好个人防护，减少接触已感染人群。</span><span style="color: black;">尤其<span style="color: black;">必须</span><span style="color: black;">注意</span>的是机会性感染，例如卡式肺<span style="color: black;">胞子</span>菌肺炎，这种感染可能是致命的，<span style="color: black;">能够</span>口服复方磺胺甲噁唑预防。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">3）<span style="color: black;">海量</span>喝水：</span></strong><span style="color: black;">环磷酰胺的代谢产物有丙烯醛，有些<span style="color: black;">病人</span>可能会<span style="color: black;">显现</span><span style="color: black;">流血</span>性膀胱炎，肉眼血尿、尿频尿急尿痛。</span><span style="color: black;">用药<span style="color: black;">时期</span><span style="color: black;">海量</span>喝水、补液、<span style="color: black;">即时</span>排空膀胱有助于预防。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">4）性腺毒性</span></strong><span style="color: black;">，环磷酰胺有可能<span style="color: black;">引起</span>女性<span style="color: black;">不育</span>、卵巢早衰，男性精子减少、<span style="color: black;">没</span>精，这种性腺毒性，与年龄、性别、累积剂量<span style="color: black;">相关</span>。</span><span style="color: black;">对女性<span style="color: black;">来讲</span>，年长的女性<span style="color: black;">出现</span><span style="color: black;">不育</span>和闭经的<span style="color: black;">危害</span>比<span style="color: black;">青年</span>的要高，累积剂量＜5g时，不太可能<span style="color: black;">出现</span><span style="color: black;">连续</span>性闭经。对男性<span style="color: black;">来讲</span>，青春期前的男性<span style="color: black;">显现</span>性腺毒性的最低剂量是</span><span style="color: black;">200-300mg/<span style="color: black;">公斤</span>，而性成熟的男性，最低毒性剂量是100mg/<span style="color: black;">公斤</span>。累积剂量达到6-10g，可能<span style="color: black;">引起</span><span style="color: black;">没</span>精。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">5）致畸</span></strong><span style="color: black;">，环磷酰胺有致畸性，用药<span style="color: black;">时期</span>需严格避孕，怀孕、哺乳的女性<span style="color: black;">不可</span>用，备孕中的男女<span style="color: black;">亦</span>均<span style="color: black;">不可</span>用，备孕<span style="color: black;">最少</span><span style="color: black;">必须</span>停药3个月以上。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">6）服药<span style="color: black;">时期</span>不要接种活疫苗<span style="color: black;">包含</span>：</strong></span><span style="color: black;">麻疹疫苗，腮腺炎疫苗，风疹（MMR）疫苗，卡介苗（BCG），口服小儿麻痹症疫苗，轮状病毒疫苗，天花疫苗，黄热病疫苗，水痘疫苗，带状疱疹（带状疱疹）疫苗，口服伤寒疫苗和鼻流感疫苗。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">7）遵医嘱服药，不<span style="color: black;">自动</span>延长疗程：</span></strong></span><span style="color: black;">不同于<span style="color: black;">通常</span><span style="color: black;">药品</span>，<span style="color: black;">大众</span>要格外<span style="color: black;">注意</span>环磷酰胺的<span style="color: black;">运用</span>，不要漏服、多服，要记录清楚自己的用药史，<span style="color: black;">尤其</span>是累积剂量。</span><span style="color: black;">口服环磷酰胺的最大日剂量<span style="color: black;">通常</span>不超过200mg/天，还<span style="color: black;">必须</span><span style="color: black;">大夫</span><span style="color: black;">按照</span>肾功能水平<span style="color: black;">调节</span>剂量。</span><span style="color: black;">如</span><span style="color: black;">果环磷酰</span><span style="color: black;">胺累积剂量大于3</span><span style="color: black;">6g，可能诱发淋巴瘤</span><span style="color: black;">和白血病。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">其他副<span style="color: black;">功效</span>，例如低钠血症、恶心呕吐、脱发、口腔溃疡等<span style="color: black;">［8］</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">以上这些副<span style="color: black;">功效</span>是潜在的，并不是所有人都会一一<span style="color: black;">出现</span>，短期副<span style="color: black;">功效</span>可监测、可处理，<span style="color: black;">长时间</span>副<span style="color: black;">功效</span><span style="color: black;">能够</span><span style="color: black;">经过</span><span style="color: black;">掌控</span>好累积剂量降低其<span style="color: black;">出现</span>率。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">期盼</span>咱们医患互相<span style="color: black;">协同</span>好，达到效果棒棒棒，副<span style="color: black;">功效</span>小小小！</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">参考文献：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">1.占永立,王丽,赵宇,柳丛,李秀英,.Ⅱ～Ⅲ期膜性肾病合并Ⅲ型新月体肾炎1例【J】.中国中西医结合肾病杂志,2006,(11):665-666.</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2.环磷酰胺治疗肾炎<span style="color: black;">综合症</span>4例疗效报告【J】.新医药通讯,1974,(05):15-17.</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3.<span style="color: black;">UpToDate.</span><span style="color: black;">Lupus nephritis: Initial and subsequent therapy for focal or diffuse lupus nephritis.</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4.<span style="color: black;">UpToDate.</span></span><span style="color: black;">Membranous nephropathy: Treatment and prognosis.</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">5.<span style="color: black;">UpToDate.Minimal change disease: Treatment in adults.</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">6.<span style="color: black;">UpToDate.</span>Granulomatosis with polyangiitis and microscopic polyangiitis: Induction and maintenance therapy.</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">7.<span style="color: black;">UpToDate.</span><span style="color: black;">Anti-GBM (Goodpasture) disease: Treatment and prognosis.</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">8.<span style="color: black;">UpToDate.</span></span><span style="color: black;">IgA nephropathy: Treatment and prognosis.</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">9.<span style="color: black;">UpToDate.</span><span style="color: black;">General toxicity of cyclophosphamide in rheumatic diseases.</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">10.环磷酰胺<span style="color: black;">药物</span>说明书.</span></p>
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