伴有中等量蛋白尿的IgA肾病的治疗

The treatment of IgA nephropathy with moderate proteinuria

目的探讨糖皮质激素加环磷酰胺在治疗伴有中等量蛋白尿的IgA肾病的价值。方法共选择32例有中等量蛋白尿,并经肾活检证实的原发性IgA肾病患者,随机抽取12例为对照组(采用对症治疗),20例为治疗组(对症治疗+糖皮质激素+环磷酰胺),治疗前两组间24h尿蛋白定量、血肌酐、内生肌酐清除率无明显差异。比较治疗1年前后各项指标的变化,以及治疗1年后两组间上述指标的差异(统计学采用t-test)。结果随访1年后对照组血肌酐升高,内生肌酐清除率降低(P<0.01),24h尿蛋白定量无明显变化(P>0.05);治疗组血肌酐降低,内生肌酐清除率升高,但无统计学意义,24h尿蛋白定量明显减少(P<0.01)。治疗后各组间比较,对照组24h尿蛋白定量、血肌酐均大于治疗组(P<0.01、P<0.05),内生肌酐清除率较治疗组低(P<0.05)。结论糖皮质激素加环磷酰胺对控制伴有中等量蛋白尿的IgA肾病的尿蛋白有明显效果,虽不能进一步改善肾功能,但能延缓肾功能的恶化,延长进入终末期肾衰的时间。

Objective To investigate the treatment value of corticosteroid in IgA nephropathy with moderate proteinuria. Methods Thirty-two patients with moderate proteinuria who were proved IgA nephropathy by biopsy were studied (no patients had crescenteric change).twelve cases were control group (given symptomatic treatment).twenty cases were treatment group(given combination of symptomatic and corticosteroid and cyclophosphamide treatment).24 hours urine total protein,serum creatinine(Scr) and creatinine clearance(CCr) were no obvious diffirence between two groups before therapy.To compare the changes of observable index above-mentioned before and after one year treatment. To compare difference of observable index above-mentioned between the two groups after one year treatment. Results Followed-up one year, the control group had increased in Scr and had decreased in CCr(P <0.01).24 hours urine total protein had no obvious chang(P >0.05).As far as the treatment group were concerned, there was decreased in Scr and increase in CCr,it had no significance in statistics. There was a obvious decrease in 24 hours urine total protein(P <0.01). To compare between the two groups after treatment, 24 hours urine total protein and Scr of control group were more than treatment group (P <0.01, P <0.05 prospectively).CCr of control group was less than treatment group. Conclusions It has obvious effective that corticosteroid control proteinuria for IgA nephropathy with moderate proteinuria, it cannot further improve renal function but it may attenuate the progression of renal failure and prolong the period to end-state renal failure.