多靶点疗法治疗慢性进展性中重型IgA肾病的临床研究

Clinical Study of Multi Target Therapy in the Treatment of Chronic Progressive Moderate and Severe IgA Nephropathy

目的探讨多靶点疗法治疗慢性进展性中重型IgA肾病的临床疗效。方法选择确诊为慢性进展性中重型IgA肾病患者84例,按随机数字法均分为观察组与对照组。对照组给予贝那普利、缬沙坦及泼尼松治疗,观察组接受尿激酶、霉酚酸酯、泼尼松、贝那普利及缬沙坦等多药联合多靶点治疗,疗程均为12个月。疗程结束后比较两组临床疗效、平均动脉压(MAP)、24 h尿蛋白定量、血清白蛋白(ALB)及内生肌酐清除率(Ccr)等。结果对照组临床疗效总有效率为73.0%,观察组为90.0%,两组临床疗效比较,有显著性差异(Z=2.068,P=0.039)。观察组与对照组治疗前MAP、24 h尿蛋白定量、ALB及Ccr水平之间比较,差异均无统计学意义(P=0.819,P=0.732,P=0.509,P=0.244),治疗后两组之间比较,各指标变化均有显著性差异(P=0.017,P=0.006,P=0.000,P=0.000);对照组及观察组各指标治疗前后自身比较,差异均有统计学意义(均P<0.05)。两组除5例因剧烈咳嗽退出外,无严重不良反应发生。结论多药联合多靶点治疗慢性进展性中重型IgA肾病安全有效。

Objective To investigate the clinical effect of multi target therapy in treatment of chronic moderate and severe IgA nephropathy.Methods 84patientswithchronicprogressivemoderateandsevereIgAnephropathyconfirmedbybiopsywereenrolledand randomly equally divided into observation group and control group.The patients in observation group were treated with urokinase ,prednisone, mycophenolate mofetil , benner pury and valsartan , while those in control group were treated with prednisone , benner pury and valsartan.After 12 months treatment, the clinical efficacy, mean arterial pressure （MAP）, 24h urine protein, serum albumin （ALB） and creatinine clearance rate （ Ccr） were analyzed.Results The total clinical effectiveness of control group was 73.0% and that of observation group was 90.0%.There was significant difference between two groups （Z=2.068, P=0.039）.About the level of MAP , albumin, 24 hour urinary protein and Ccr , there were no significant differences before treatment between two groups （ P =0.819 , P =0.732 , P=0.509 , P=0.244 ） , while after treatment there were significant differences between two groups （ P=0.017 , P=0.006 , P=0.000 , P=0.000 ）.There were all significant differences in each index of the two groups after being compared before and after treatment （ P〈0.05）.Except for severe cough in two groups , there were no serious adverse reactions.Conclusions Multi target therapy of multi drugs combined is effective and safe in treatment of chronic progressive moderate and severe IgA nephropathy .