霉酚酸酯在治疗伴肾功能不全IgA肾病中的疗效分析

Investigation on the effectiveness of mycophemolate mofeil(MMF) in severe IgA nephropathy with part of renal function

目的对比研究霉酚酸酯联合强的松在治疗伴肾功能不全IgA肾病中的临床疗效、安全性和耐受性。方法选择经肾脏病理诊断为原发性IgA肾病,尿蛋白≥1.0g/d,有肾功能减退但血肌酐<355μmol/L(4mg/dl)病例30例随机分为治疗组和对照组。治疗组口服霉酚酸酯分散片联合强的松;对照组单用强的松口服。分别于治疗前及治疗后3、6、12个月观察两组患者的24小时尿蛋白、肾小球滤过滤、血浆尿素氮、肌酐、白蛋白及肝功能等多项临床指标。结果1)治疗3个月时,治疗组尿蛋白定量较治疗前明显减少(P<0.01),但对照组尿蛋白定量与治疗前比较差异无显著意义;治疗6、12个月时,两组尿蛋白定量均较治疗前明显降低,但治疗组尿蛋白定量明显低于对照组(P<0.05);2)治疗12个月时,治疗组血肌酐较治疗前明显下降、肾小球滤过率较治疗前明显上升(P<0.05),而对照组血肌酐及肾小球滤过率与治疗前比较差异无显著意义。结论霉酚酸酯联合强的松对治疗伴肾功能不全的IgA肾病在降低蛋白尿、保护肾功能等方面优于单用强的松口服疗法,未见明显毒副作用,耐受性好。

Objective To investigate the effectiveness, safety and the -tolerance of mycophemolate mofeil （MMF） and prednisone orally in severe the IgA nephropathy with part of renal function. Methods 30 patients with IgA nephropathy diagnosed by renal biopsy with urinary protein≥1. 0g/d and part of renal function but serum creatinine〈355μmol/L（4mg/dl） were enrolled randomly in the trial. The study group take mycophemolate mofeil dispersible tablets and prednisone orally. The control group only take prednisone orally. 24h urinary protein, glomerular filtration rate, hepatic and renal function were performed before and 3.6,12 months after treatments in both groups. Results DAfter 3 months treatment, decrease of urinary protein were observed in MMF group （P 〈 0. 01）, while in control group no significant changes were found in urinary protein. After treatment for 6 and 12 months, both groups showed obvious decrease of urinary protein. At the 6th and 12th month, the proteinuria in MMF group was significant improved than that in control group （P 〈 0.05）. 2）After 12 months treatment, decrease of serum creatinine and improvement of renal function were observed in MMF group, while there were no significant changes in control group. Conclusions The therapy of mycopyemolate mofeil and prednisone orally is more effective in reducing proreinuria and protecting renal function than the therapy of prednisone orally in IgA nephropathy with part of renal function. Treatment with MMF associates with less adverse effect and good tolerance.