小剂量糖皮质激素与雷公藤多甙联合治疗IgA肾病蛋白尿患者的疗效观察

Clinical significance of low dose glucocorticoid combined with tripterygium glycosides in the treatment of IgA nephropathy with proteinuria

目的观察小剂量糖皮质激素与雷公藤多甙联合治疗对IgA肾病蛋白尿患者的临床疗效。方法选择2010年10月至2012年10月,纳入的IgA肾病继发蛋白尿患者86例,随机将所有观察对象分为研究组和对照组,各43例,两组均给予少盐、低脂、适量优质蛋白饮食,服用氯沙坦钾片1片/(d.次),研究组增加口服雷公藤多甙片(TWP)1mg/kg,3次/d,强的松0.6 mg/kg,清晨顿服,6月后调整药量为TWP 0.5 mg/kg,强的松0.3 mg/kg,3月后复查,调整药量为TWP 10 mg/d,强的松5 mg/d,根据病情可酌情减量至停药。对照组不服用强的松,给予TWP治疗,其疗程与研究组TWP治疗方案相同。比较两组治疗前及治疗后3个月时血常规、肝功能、肾功能、血脂、尿常规、24 h尿蛋白沉淀定量等指标。结果治疗后3个月时,研究组血肌酐、尿素氮、尿酸均明显低于对照组,且研究组治疗后显著低于治疗前(均P<0.01)。研究组24 h尿蛋白沉淀定量及尿红细胞计数均显著低于对照组(均P<0.05)。研究组疗效总有效率明显高于对照组(矫正χ2=9.06,P<0.05)。结论小剂量糖皮质激素与雷公藤多甙联合用药较雷公藤单药具有明显改善IgA肾病患者临床症状、提高疗效、减少不良反应事件等作用。

Objective To investigate the clinical significance of low dose glucocorticoid combined with tripterygium glycosides（TG） in treating IgA nephropathy with proteinuria.Methods A total of 86 IgA nephropathy patients with proteinuria were enrolled in the study and randomly divided into study group（n = 43） and control group（n = 43）.All patients were given low salt,low fat and superior protein diet,and losartan（1 tablet/d）.The patients in study group received TG 1mg/kg,3 times a day and prednisone 0.6 mg/kg.d for 6 months,therapeutic schedule were then adjusted as TG 0.5 mg/Kg,3 times a day and prednisone 0.3 mg/Kg.d for another 3 months.After examination,the patients were then followed the treatment of TG 10mg/d and prednisone 5 mg/d,and dosage reduction until drug withdrawal were also used according to the disease condition of the patients.The patients in control group were only treated with TG and the regimen was the same as in the study group.The blood routine,liver function,renal function,urine routine,24h urinary protein of two groups were detected and analyzed.Results After 3 months treatment,the levels of serum creatinine,urine nitrogen and uric acid in study group were significantly lower than those in control group（all P〈0.05）;and these values were significantly decreased in comparison with the values before treatment in study group（all P〈0.01）.Meanwhile,the 24h urinary protein and RBC-U of study group were obviously lower than those of control group（all P〈0.05）.Moreover,the total effective rate of study group was significantly higher than control group（χ2 = 9.06,P〈0.05）.Conclusion Compared with TG treatment alone,small dose glucocorticoid combined with TG may obviously improve the symptoms,enhance treatment efficiency,and decrease the side reaction for the treatment of IgA nephropathy