低剂量糖皮质激素对重度马兜铃酸肾病患者病情进展的作用

Effect of Low-dosage Steroid Therapy in Patients with Severe Aristolochic Acid Nephropathy:A Single Center Study

目的:观察低剂量糖皮质激素对重度慢性马兜铃酸肾病患者病情进展的影响。方法:选择北京协和医院肾内科重度慢性马兜铃酸肾病患者37例,根据治疗方案分为两组:激素治疗组(非透析治疗+低剂量糖皮质激素治疗,23例)和对照组(单纯非透析治疗,14例),两组患者一般资料及血生化指标差异无统计学意义。分别观察患者初始、3月、6月、9月、12月的血肌酐水平及其变化程度,及随诊过程中血压、血红蛋白、血生化指标的变化,同时观察治疗的不良反应。结果:对照组患者随诊过程中血肌酐逐渐升高,6月、9月、12月的血肌酐值较基础水平差异有统计学意义(P<0.05);而激素治疗组血肌酐水平在随诊3～6月持续下降,较基础水平差异有统计学意义(P<0.05),9月、12月略有回升,但和治疗前相比差异无统计学意义(P>0.05)。对照组患者在随诊至1年时,绝大多数肾功能恶化明显,而激素治疗组则绝大多数维持稳定或好转。两组患者在随诊过程中绝大多数无明显不适主诉,血生化指标、血压、血红蛋白等基本维持稳定。该治疗方法安全性较好,多数患者可耐受。结论:低剂量糖皮质激素可延缓重度慢性马兜铃酸肾病患者肾功能的进展。

Objective：To test the effect of low-dose steroid on progression of renal damage in patients with severe aristolochic acid nephropathy（AAN）.Methods：37 cases of chronic AAN patients were included in this study,they were divided into two groups,steroid-treated group（SG,n=23） and control group（CG,n=14）.The SG patients were given prednisone at 0.5 mg·kg-1·d-1 for 1～3 month,tapered off 0.05 mg/kg every month while the CG patients were not given prednisone.Antihypertensive,antianemia,antiacidosis,lipid-lowering,and calcium carbonate as phosphorus-binder were given in patients of each group.There were no obvious statistical differences in serum biochemical parameters at basement in two groups.The levels of serum creatinine（Scr） at month 0,3,6,9 and 12 were checked respectively,and blood pressure,hemoglobin,serum biochemical parameters and the adverse effects of steroid were also observed.Results：Scr levels in CG group were gradually elevated during follow-up and the levels at month 6,9 and 12 were significantly increased when compared to the basement level.The levels of Scr in SG group at month 3 and 6 decreased significantly when compared to the basement level.In spite of the levels of Scr at month 9 and 12 were slightly re-increased,no obvious differences were found compared to the basement level.The Scr levels at month 12 deteriorated obviously in most patients of CG group,but maintained stable or improved in patients of SG group.There were no obvious complaints of most patients in each group during follow-up,the serum biochemical parameters,blood pressure and hemoglobin maintained stable.The adverse effects of low-dosage steroid therapy were not severe and could be tolerated to the AAN patients.Conclusion：Low-dosage steroid therapy may reverse or delay progression of renal failure in severe chronic AAN patients.