摘要
目的观察小剂量尿激酶联合福辛普利、来氟米特和泼尼松，多靶点治疗中、重型IgA肾病（IgAN）的临床疗效和安全性。方法选择经肾活检并结合临床确诊为原发性IgAN的患者57例，年龄15～55岁，尿蛋白≥1．0g／24h，血肌酐≤265．20μmoL／L，肾活检病理Hass分型Ⅲ型以上，随机分为治疗组（28例）和对照组（29例），治疗组接受尿激酶、泼尼松、来氟米特和福辛普利治疗，对照组给予泼尼松和福辛普利治疗，疗程为6个月。结果（1）临床缓解率：治疗组的完全缓解率和部分缓解率分别为52．0％及40．0％，对照组分别为20．8％及54．2％。两组疗效比较，总缓解率（x2=0．47，P〈0．05）及完全缓解率（x2=5．11，P〈0．05）差异均有统计学意义。（2）治疗前与治疗6个月后比较，治疗组血肌酐明显下降[（115．834-16．78）、（93．294-12．41）μmol／L，P〈0．05]，对照组血肌酐则上升[（112．79±12．79）、（136．99±25．97）μmol／L，P〈0．05]；两组血肌酐治疗后比较差异有统计学意义（P〈0．05）。治疗组及对照组治疗后内生肌酐清除率改善，两组比较差异无统计学意义（P=0．52）；治疗组组内比较差异无统计学意义[（79．34±6．09）、（85．12±12．26）ml／min，P=0．05]，对照组组内比较差异无统计学意义[（80．18±6．51）、（84．22±8．39）ml／min，P=0．67]。治疗组尿蛋白明显下降[（1．93±0．55）、（0．78±0．42）g,／24h，P〈0．05]，对照组治疗后较治疗前亦下降[（1．85±0．51）、（1．30±0．35）g／24h，P〈0．05]，治疗组优于对照组（P=0．04）。结论利用小剂量尿激酶联合福辛普利、来氟米特和泼尼松，多靶点治疗中、重型IgA肾病，能改善肾功能，减少蛋白尿，安全有效。
Objective To investigate the effect and safety of a low-dosed urokinase combined with fosinopri plus leflunomide and prednisone on treatment of moderate and severe IgA nephropathy （IgAN）. Methods Fifty-seven patients with IgAN confirmed by biopsy combining with clinical presentations were enrolled,with their ages ranged from 15 to 55, proteinuria excretion ≥ 1.0 g/24 h, serum creatinine（SCr） ≤ 265.20μmol/L, grade Ⅲ or above in Hass histologic grading systems for renal biopsy. The patients were randomly divided into trial group （n = 28）and control group.（ n = 29）and received treatment for six months. The patients in trial group were treated with a low-dosed urokinase combined with fosinopri plus leflunomide and prednisone,while those in control group were treated with prednisone and fosinopril. Results （1）After 6 months of treatment,the rates of complete remission （CR）and partial remission （PR）were 52. 0% and 40. 0% respectively in trial group,and 20. 8% and 54. 2% respectively in control group. The total remission rate（TR） and CR in trial group were significantly higher than those in control group （ TR X2 = 0. 47, P 〈 0. 05 ; CR x2 = 5. 11 ,P 〈0. 05）. （2） The SCr level was decreased in trial group（ [ 115.83 ± 16. 78] μmol/L v. s. （93.29 ± 12. 41 ） μmol/L, P 〈 0. 05 ）, while increased in control group （ [ 112. 79 ± 12.79 ] μmol/L v.s. （ 136. 99 ± 25.97 ）μmol/L, P 〈 0. 05 ）. The two groups had significant difference on SCr clearance rate after treatment（ P 〈 0. 05）. There was no significant difference between the two groups on the endogenous creatinine clearance rate （Ccr） （ P = 0.52 ）, and no significant difference within trial group （ [ 79. 34 ± 6.09 ] ml/min v. s. [ 85. 12 ± 12. 26 ] ml/min, P = 0. 05 ） and within control group （ [ 80. 18 ± 6. 51 ] mi/min v. s. [ 84. 22 ± 8. 39 ] ml/min, P = 0. 67）. The levels of 24-hour proteinuria excretion after 6 months were decreased in both groups （ trial group ： [ 1.93 ±0. 55] g/24 h v. s. [0. 78±0. 42] g/24 h,P 〈0. 05 ;control group： [ 1.85 ±0. 51 ]g/24 h v. s. [ 1.30 ±0. 35 ] g/24 h, P 〈 0. 05 ）, and the treatment effect was better in trial group （P = 0. 04）. Conclusion Treatment of moderate and severe IgA nephropathy with low-dosed urokinase combined with fosinopri plus leflunomide and prednisone is effective and safe by improving renal function and decreasing proteinuria.
出处
《中国综合临床》
2012年第5期455-458,共4页
Clinical Medicine of China
基金
广东省自然科学基金（8151001002000006）
