吗替麦考酚酯联合小剂量糖皮质激素对IgA肾病患者血清离子及β_2-糖蛋白I/氧化低密度脂蛋白复合物水平的影响

Effect of mycophenolate mofetil combined with small dose of glucocorticoids on the serum ions and β_2-GPI/ox-LDL of patients with IgA nephropathy

目的探讨吗替麦考酚酯联合小剂量糖皮质激素对IgA肾病血清离子及β_2-糖蛋白I/氧化低密度脂蛋白复合物(β_2-GPI/ox-LDL)水平的影响。方法选取IgA肾病患者68例,随机分为2组各34例。对照组在常规治疗基础上予以小剂量糖皮质激素治疗,研究组在常规治疗基础上予以吗替麦考酚酯联合小剂量糖皮质激素治疗。测定血清学指标,记录不良反应状况。结果 2组治疗后血磷及血清β_2-GPI/ox-LDL复合物水平显著降低,血钙水平显著升高,肌酐(Scr)、尿素氮(BUN)、血清胱抑素C(CysC)及24 h尿蛋白水平显著降低,血清转化生长因子β_1(TGF-β_1)、白细胞介素4(IL-4)水平显著降低,γ干扰素(IFN-γ)水平显著升高,血清基质金属蛋白酶-9(MMP-9)、血管内皮细胞生长因子(VEGF)、内皮素-1(ET-1)水平显著降低(P<0.05);与对照组比较,研究组治疗后血磷及β_2-GPI/ox-LDL水平显著较低,血钙水平显著较高,Scr、BUN、CysC及24 h尿蛋白水平显著较低,血清TGF-β_1、IL-4水平显著较低,IFN-γ水平显著较高,血清VEGF、ET-1和MMP-9水平显著较低(P<0.05)。结论吗替麦考酚酯联合小剂量糖皮质激素对IgA肾病疗效确切,能降低血清离子及β_2-GPI/ox-LDL水平。

Objective To investigate the effect of mycophenolate mofetil combined with small dose of glueocorticoids on the serum ions and β2-GPI/ox-LDL of patients with IgA nephropathy. Methods A total of 68 patients with IgA nephropathy were randomly divided into two groups, 34 cases in each group. Control group was treated with small dose of glueocorticoid, while the study group was treated with mycophenolate mofetil on the basis of control group. Serum markers and adverse reactions were recorded during the treatment. Results After treatment, levels of serum phosphorus and β2-GPI/ox-LDL decreased significantly in both groups, levels of serum calcium increased significantly, Scr, BUN, CysC and 24 h urine protein decreased significantly, levels of serum TGF-β2, IL-4 decreased significantly, IFN-γ increased significantly, levels of serum VEGF, ET-1 and MMP-9 decreased significantly （ P 〈 0.05 ）. Compared with the control group, levels of serum phosphorus and β2-GPI/ox-LDL in the study group were significantly lower, levels of blood calcium were significantly higher , levels of Scr , BUN , CysC and 2 4 h urine protein were significantly lower , levels of serum TGF-β1, IL-4 were significantly lower, IFN-γ were significantly higher, and levels of serum VEGF, ET-1 and MMP-9 were significantly lower （ P 〈 0. 05 ）. Conclusion Mycophenolate mofetil combined with small dose of glucocorticoids is effective in the treatment of patients with IgA nephropathy, and it can reduce the levels of serum ions and β2-GPI/ox-LDL.