泼尼松联合咪唑立宾对高蛋白尿IgA肾病患者肾功能的影响

Effect of Prednisone Combined with Mizoribine on Renal Function in Patients with High Proteinuria Type of IgA Nephropathy

目的探讨不同剂量糖皮质激素联合咪唑立宾对高蛋白尿IgA肾病患者肾功能的影响。方法将医院收治的120例高蛋白尿IgA肾病患者采用随机数字表法分为中小剂量组和大剂量组,各60例。患者均给予优质蛋白质、低盐低脂饮食,并予降压、抗凝、调脂等药物和咪唑立宾,中小剂量组加用泼尼松[起始剂量为0.4~0.8 mg/(kg·d),8周后逐渐减量],大剂量组起始剂量为1 mg/(kg·d),8周后逐渐减量。两组均治疗6个月,治疗期间根据病情变化酌情减量至停药。结果中小剂量组总有效率为86.67%,显著高于大剂量组的71.67%(P<0.05);治疗2周及6周时,中小剂量组24 h尿蛋白定量及血肌酐水平显著高于大剂量组,白蛋白水平显著低于大剂量组(P<0.05);治疗6个月时,中小剂量组24 h尿蛋白定量及血肌酐水平显著低于大剂量组(P<0.05);治疗后,中小剂量组天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)分别为(46.01±5.97)U/L和(35.61±5.43)U/L,显著低于大剂量组的(58.73±8.28)U/L和(42.5±6.37)U/L(P<0.05);两组碱性磷酸酶(ALP)水平比较无显著差异(P>0.05);中小剂量组面红症状、皮肤瘙痒、肝损伤等不良反应发生率分别为53.33%,50.00%和56.67%,显著低于大剂量组的76.67%,68.33%和75.00%(P<0.05)。结论中小剂量的糖皮质激素联合咪唑立宾治疗高蛋白尿IgA肾病的临床疗效优于大剂量激素治疗,可有效改善肾功能,并减少肝损伤。

Objective To investigate the effects of different doses of glucocorticoid combined with mizoribine on renal function in patients with high proteinuria type of IgA nephropathy.Methods Totally 120 patients with high proteinuria type of IgA nephropathy admitted to our hospital were selected and divided into the low-and-medium dose group and the high dose group,60 cases in each group.The patients were given the high-quality protein,low-salt and low-fat diet,and drugs for anti-hypertension,anti-coagulation,lipid-lowering and mizoribine,on this basis,and the low-and-medium dose group was additionally given prednisone：initial dose with 0.4-0.8 mg/（ kg·d） and gradual dose reduction after 8 weeks,and the high dose group was given with initial dose of 1 mg/（ kg·d） and gradual dose reduction after 8 weeks,and the two groups were treated for 6 months.The reduction to the withdrawal was given according to the disease condition during treatment.Results The total effective rate of the low-and-medium dose group was 86.67%,which was significantly higher than 71.67% of the high dose group（ P〈0.05）.After 2,6 weeks of treatment,the levels of 24 h urinary protein quantity and serum creatinine（ SCr） in the low-and-medium dose group were significantly higher than those in the high dose group,and the level of albumin in the low-and-medium dose group was significantly lower than that in the high dose group（ P〈0.05）.After 6 months of treatment,the levels of 24 h urinary protein quantity and SCr in the low-and-medium dose group were significantly lower than those in the high dose group（ P〈0.05）.After treatment,the levels of AST and ALT were in the low-and-medium dose group were（ 46.01 ± 5.97） U/L and（ 35.61 ± 5.43） U/L,which were significantly lower than（ 58.73 ± 8.28） U/L and（ 42.5 ± 6.37） U/L in the high dose group（ P〈0.05）.There was no significant difference in the ALP level between the two groups（ P〈0.05）.The incidence rates of adverse reactions such as facial redness,skin itching and liver injury in the low-and-medium dose group were 53.33%,50.00% and 56.67%,respectively,which were significantly lower than 76.67%,68.33%,75.00% in the high dose group（ P〈0.05）.Conclusion Low-and-medium dose of glucocorticoid combined with mizoribine has better effect than the high dose hormonotherapy for patients with high proteinuria type of IgA nephropathy,and it can effectively improve renal function and reduce liver injury.