吗替麦考酚酯联合雷公藤多苷及糖皮质激素治疗对IgA肾病患者肾功能、炎症因子和氧化应激的影响

Effects of mycophenolate mofetil combined with tripterygium glycosides and glucocorticoid on renal function,inflammatory factors,and oxidative stress in patients with IgA nephropathy

目的探讨雷公藤多苷联合吗替麦考酚酯对免疫球蛋白A(IgA)肾病的治疗效果,并探讨可能的作用机制。方法将河北医科大学第二医院2020年5月至2022年6月收治的150例IgA肾病患者作为研究对象,随机数字表法分为对照组(n=75)与试验组(n=75)。两组均予以糖皮质激素治疗,此外,对照组予以雷公藤多苷治疗,试验组予以吗替麦考酚酯联合雷公藤多苷治疗,两组均连续治疗6个月。于治疗前后,检测患者肾功能指标[24 h尿蛋白定量、血肌酐(Scr)、尿素氮(BUN)]、体液免疫指标[IgA、免疫球蛋白G(IgG)]、炎症因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]和氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)],比较两组疗效和各项检测指标差异,并统计比较两组不良反应发生情况。结果最终试验组共70例和对照组共71例进入研究,年龄分别为(42.2±6.2)岁和(41.9±5.8)岁。试验组总有效率为95.71%(67/70),显著高于对照组的70.28%(57/71),差异有统计学意义(P<0.05)。治疗后,相比对照组,试验组24 h尿蛋白定量、Scr、BUN水平更低,差异均有统计学意义(均P<0.05)。治疗后,试验组血清IL-6、TNF-α和MDA水平显著低于对照组,差异均有统计学意义(均P<0.05),SOD水平显著高于对照组(P<0.05)。试验组不良反应发生率为18.57%,对照组为12.68%,组间差异无统计学意义(P>0.05)结论雷公藤多苷基础上联用吗替麦考酚酯治疗IgA肾病有较好效果,能够减轻炎症反应和调节氧化应激失衡,从而改善患者肾功能。

Objective To investigate the therapeutic effects of tripterygium glycosides combined with mycophenolate mofetil and glucocorticoid on immunoglobulin A(IgA)nephropathy,and to explore the possible mechanism of action involved.Methods A total of 150 patients with IgA nephropathy admitted to the Second Hospital of Hebei Medical University from May 2020 to June 2022 were enrolled and divided into either a control group(n=75)or an experimental group(n=75)using the random number table methods.Both groups were treated with glucocorticoid.In addition,the control group was treated with tripterygium glycosides,and the experimental group was treated with mycophenolate mofetil combined with tripterygium glycosides.Both groups were treated continuously for 6 months.Before and after treatment,renal function indexes[24-hour urinary protein quantification,serum creatinine(Scr),and urea nitrogen(BUN)],humoral immune indexes[IgA and immunoglobulin G(IgG)],inflammatory factors[interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)],and oxidative stress indexes[superoxide dismutase(SOD)and malondialdehyde(MDA)]were detected.The efficacy and each detected index were compared between the two groups,and the adverse reactions were recorded.Results In the final study,there were 70 patients in the experimental group and 71 in the control group.The mean age of patients in the experimental group was(42.2±6.2)years,while it was(41.9±5.8)years in the control group.The total effective rate of the experimental group was 95.71%,which was significantly higher than that of the control group(70.28%;P<0.05).After treatment,the levels of 24 h urinary protein,Scr,and BUN were all lower in the experimental group than in the control group(P<0.05 for all).After treatment,the levels of serum IL-6,TNF-α,and MDA in the experimental group were all significantly lower than those in the control group(P<0.05 for all),and the level of SOD was significantly higher than that of the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(18.57%vs 12.68%,P>0.05).Conclusion The combination of tripterygium glycosides and mycophenolate mofetil in the treatment of IgA nephropathy has a good effect,which can reduce the inflammatory response and regulate the imbalance of oxidative stress,thereby improving the renal function of patients.