厄贝沙坦联合甲基泼尼松龙冲击治疗原发性系膜增生性肾小球肾炎疗效的观察

Effects of irbesartan combined with pulse methylprednisolone on mesangial proliferative primary nephrotic syndrome

目的观察厄贝沙坦联合大剂量甲基泼尼松龙冲击治疗原发性系膜增生性肾小球。肾炎（MsPGN）的早期疗效。方法将43例通过。肾脏活体组织检查确诊为MsPGN患者，分为厄贝沙坦联合大剂量甲基泼尼松龙冲击治疗组（A组）15例；大剂量甲基泼尼松龙冲击治疗组（B组）14例；甲基泼尼松龙片常规剂量治疗组（C组）14例，疗程共4周。检测治疗前及治疗后第1、2、3、4周血清白蛋白（Alb）、24h尿蛋白定量、内生肌酐清除率（Ccr）、尿素氮（BUN）、丙氨酸氨基转氨酶（ALT）、天门冬氨酸氨基转氨酶（AST）及空腹血糖（FBS）。结果A、B组在治疗后第3、4周24h尿蛋白定量减少、Alb升高，与C组比较有统计学差异（P〈0．01）。A组在治疗后第3、4周24h尿蛋白定量减少，与B组比较有统计学差异（P〈0．05）；各组治疗前、后Ccr、BUN、ALT、AST及FBS均无统计学差异（P〉0．05）。结论大剂量甲基泼尼松龙冲击治疗原发性MsPGN能迅速缓解临床症状，起效时间短，降低尿蛋白快。

Objective To observe the clinical effects of irbesartan combined with pulse methylprednisolone （MP） on mesangial proliferative primary nephrotic syndrome. Methods Forty-three patients with mesangial proliferative primary nephrotic syndrome were randomly divided into three groups：irbesartan combined with MP treated group （group A）, single MP treated group （group B）, and single methylprednisolone treated group （group C）. Before and four weeks after therapy, Alb,24-h urine protein excretion, Ccr, BUN, ALT, AST, and FBS were tested. All cases were followed up. Results Compared with group C, both in group A and group B 24-h urine protein excretion was significantly reduced, but Alb was significantly increased（P〈0. 05）. At the third week and the forth week, in group A the 24-h urine protein excretion was reduced as compared with group B（P〈0. 05）. There was no significant difference in Ccr, BUN, ALT, AST and FBS in each group before and after therapy（P〈0. 05）. Conclusion Irbesartan combined with MP can significantly improve the prognosis of mesangial proliferative primary nephrotic syndrome,in particular can reduce the 24-h urine protein excretion.