舒洛地特联合缬沙坦治疗IgA肾病的临床研究

Efficiency of sulodexide combined with valsartan on IgA nephropathy:report of 54 cases

目的观察舒洛地特联合血管紧张素受体拮抗剂（angiotensin receptor blocker,ARB）缬沙坦治疗IgA肾病（IgA nephropathy,IgAN）的效果。方法将54例Lee氏分级在Ⅱ-Ⅳ级之间、尿蛋白定量〈3.5g的IgAN患者,采用完全随机分组方法分为2组：舒洛地特＋ARB组（每日口服缬沙坦80mg＋静脉注射舒洛地特600LSU4周,序贯口服舒洛地特250LSU8周）和ARB组（每日口服缬沙坦80mg共12周）,随访3个月,观察2组尿蛋白定量、血肌酐、血浆纤维蛋白原、凝血酶原时间、活化部分凝血酶时间、甘油三酯、总胆固醇指标的变化。结果治疗3个月后,舒洛地特＋ARB组和ARB组尿蛋白定量下降率分别为48.46%和24.75%,2组差异有统计学意义（P〈0.05）,舒洛地特＋ARB组肾小球积分≥7分者总有效率为88.24%,而ARB组中肾小球积分≥7分者总有效率为45.45%,2组差异有统计学意义（P〈0.05）。②与ARB组比较,舒洛地特＋ARB组血浆纤维蛋白原、甘油三酯、总胆固醇明显下降（P〈0.05）。③ARB组治疗后血肌酐较治疗前明显升高（P〈0.05）,舒洛地特＋ARB组治疗前后血肌酐无显著变化（P〉0.05）。结论舒洛地特联合缬沙坦治疗IgAN安全有效,尤其对Katafuchi IgA肾病积分系统提示活动性病变者作用更显著,疗效优于单用ARB者。

Objective To investigate the effect of sulodexide combined with angiotensin receptor blocker（ARB）,valsartan on IgA nephropathy（IgAN）.Methods Fifty-four cases with pathologically-diagnosed IgAN,whose renal pathologic change were between grade Ⅱ to Ⅳ according to Lee＇s grading and the quantity of urine protein were less than 3.5 g,admitted in our department from June 2009 to January 2010 were randomized equally into 2 groups,Sulodexide ＋ARB group（treated intravenously with a 600 LSU Sulodexide qd for 4 weeks,and then orally with 250 LSU bid for 8 weeks.At the same time,valsartan 80 mg/d,po for 12 weeks）and ARB group（valsartan 80 mg/d,po for 12 weeks）.Therapeutic effect of these 2 treatment in a 3-month follow-up was evaluated by the quantity of urine protein,levels of creatinine,plasma fibrinogen,prothrombin time,activated partial thromboplastin time,triglyceride,and total cholesterol.Results After 3 months of treatment,the quantity of urine protein was reduced by 48.46% and 24.75% respectively in Sulodexide＋ARB group and ARB group.Significant difference was noted in the quantity of urine protein between the 2 groups（P〈0.05）.The effective rate was 88.24% and 45.45% in Sulodexide＋ARB group and ARB group for the patients with glomerular scores more than 7,and significant difference was observed between the 2 groups（P〈0.05）.Compared with ARB group,plasma fibrinogen,triglycerin,and total cholesterol were obviously decreased in Sulodexide＋ARB group after 3 months＇ treatment（P〈0.05）.There was no significant difference in serum creatinine in Sulodexide＋ARB group after treatment,but in ARB group,the value was sigificantly increased than before treatment（P〈0.05）.Conclusion Sulodexide combined ARB is safe and effective in treating IgAN patients,especially for those with whose glomerular scores over 7,and the results are significantly better than those treated with ARB alone.