强化控制舒张压在IgA肾病治疗中的作用

The Effect of Strengthening Control of Diastolic Blood Pressure in the Treatment of IgA Nephropathy

目的:观察强化控制舒张压(DBP)对Ig A肾病(Ig AN)患者尿蛋白及肾功能的影响。方法:回顾性分析使用雷公藤多苷联合肾素-血管紧张素系统(RAS)阻断剂治疗并随访≥1年的Ig AN患者,依据治疗6月时尿蛋白情况分为缓解组及无缓解组,评估影响尿蛋白控制的相关危险因素,并依据是否强化控制舒张压分为强化组与未强化组。结果:共279例患者纳入研究,其中缓解组167例,无缓解组112例。尿蛋白是否缓解与基线肾功能、肾脏病理Lee氏分级相关,且两组随访6月时诊室舒张压差异具有统计学意义[(73.63±5.95)比(80.03±7.76)mm Hg,P<0.05]。Logistic回归分析提示舒张压是影响尿蛋白缓解的独立危险因素。无缓解组83例舒张压≥80 mm Hg的患者中,39例强化控制舒张压(强化组),44例维持原方案(未强化组),继续随访至1年,在第9、12月时,强化组舒张压、尿蛋白显著低于未强化组(均P<0.05)。随访期间两组肾功能均稳定。结论:舒张压水平可影响Ig AN尿蛋白的缓解,强化控制舒张压可减少尿蛋白,延缓肾功能进展。

Objective：To observe the influence of strengthening control of diastolic blood pressure（DBP） on the proteinuria and renal function of IgA nephropathy （IgAN） patients. Methods：IgAN patients who had taken Tripterygium wilfordii Hook F with re- ninangiotensinsystem（RAS） blockers and with followup time at least 1 -year, were enrolled in this retrospective study. After 6 months of treatment, patients were divided into remission group and non - remission group based on their proteinuria and relevant risk factors which influenced proteinuria＇ s control were evaluated. Patients were further divided into strengthen group and non - strengthen group based on whether accepted a strengthening control of DBP. Results ：279 patients were analyzed, wherein 167 patients were in the remission group and 112 in the non - remission group. Whether there was a remission of proteinuria was related to baseline renal function, Lee＇s pathological grades and the clinical DBP after 6 months of followup [ （73.63±5.95） vs （80.03 ± 7.76）mmHg, P 〈 0.05 ]. DBP was an independent risk factor for the remission of proteinuria by Logistic analysis. Among the non - remission group＇s 83 patients whose DBP was at least 80 mmHg, 39 accepted strengthening control of DBP（ strengthen group）, and 44 maintained original plan（ non - strengthen group） and all of them were followed - up to 1 year. At 9,12 months, the DBP and proteinuria were significantly lower in the strengthen group （ P 〈 0.05 ）. Renal function of both groups were stable during the follow - up. Conelusion ： The level of DBP can affect the remission of proteinuria, and a strengthening control of DBP can reduce proteinuria while slowing renal deterioration in patients of IgAN.