肾脂肪囊注射甲基泼尼松龙及川芎嗪治疗原发性系膜增殖性肾炎疗效观察

The Effects of Renal Intracapsular Injection of Methyl Prednisolone and Tetramethy Pyrazine on Treating Primary Mesangial Proliferative Glomerulonephritis

目的观察肾脂肪囊注射甲基泼尼松龙及川芎嗪注射液治疗原发性系膜增殖性肾小球肾炎的疗效。方法选择经肾活检病理证实的原发性非IgA系膜增殖性肾炎30例。治疗分3组,即A组12例,每侧肾囊内注射甲基泼尼松龙40mg,每周2次;B组8例,同A组治疗基础上,向每侧肾脂肪囊注射川芎嗪40mg,每周1次;C组10例,口服泼尼松1mg·kg-1·d-1。治疗6周。观察治疗前后24h尿蛋白(UP)、血白蛋白(Alb)、24h尿内皮素排泌量(UEt-1),血压,血糖,水肿变化及糖皮质激素副作用。结果20例(A、B组)肾囊注射治疗后尿蛋白明显减少或转阴,血浆白蛋白升高。而A组与B组比较无明显差别,治疗后UEt-1下降,且未发现明显糖皮质激素的副作用。A组、B组疗效优于C组。结论肾脂肪囊注射甲基泼尼松龙是治疗原发性系膜增殖性肾炎的有效方法,且可降低全身用药的副作用。

Objective： To investigate the effects of renal intracapsular injection of Methylprednisolone and Tetramethy pyrazine on patients with primary mesangial proliferative glomerulonephritis （MsPGN）, Methods： 30 patients with primary MsPGN by renal biopsies were dividided into 3 groups （A,B,C groups）. Under the guide of sonograph,40 mg methylprednisolone were injected into each renal adipose capsule of 12 patients in A group twice a week, and besides Methylprednisolone,40 mg Tetramethyl pyrazine were also injected into each one of 8 patients in B group once a week. 10 patients in C group took 1 mg·kg^-1·d ^-1 prednisone for 6 weeks. Before and after the treatment for 6 weeks, the urinary protein, plasma albumin, serum creatine, urinary endothelin- 1, blood pressure, blood sugar were measured. Results：The excretion of urinary protein in 20 patients among A and B groups had significantly decreased after the treatment for 6 weeks. In addition, the plasma albumin in 20 patients after the treatment was significantly higher than that before the treatment. But these changes were not significantly different between A and B groups. Any obvious side effects of glucocorticoid were not found in 20 patients. The treated effects in A and B groups were better than that in C groups. Conclusion： The therapy of injecting Methylprednislone into renal adipose capsule could be an effective method to treat primary MsPGN with much fewer side effects.