IgA肾病的激素治疗及对肾素-血管紧张素系统的影响

Validation of the corticosteroids therapy in patients with IgA nephropathy and the effect on renin-angiotensin system

目的观察激素对于IgA肾病的疗效及对肾素-血管紧张素系统(RAS)的影响。方法 2016年10月至2017年4月期间经肾活检确诊的IgA肾病90例,分为激素治疗组和非激素治疗组,随访观察1年,以患者eGFR下降>15%为终点。结果 38例(42.2%)IgA肾病患者使用了激素,其治疗前的尿蛋白、血肌酐、尿AGT及尿IL-6水平显著高于非激素治疗组,且肾脏病理的肾小管萎缩/间质纤维化、新月体比例高于非激素治疗组(P <0.01)。随访期间,激素治疗组患者的尿蛋白量、血管紧张素Ⅱ和IgA水平显著下降(P <0.05),而血肌酐无显著性变化,其尿蛋白在第12个月时与非激素治疗组比较差异无统计学意义(P> 0.05)。18例(20.0%)患者的eGFR较基线下降超过15%,激素治疗组与非激素治疗组比较差异无统计学意义。结论 IgA肾病使用激素治疗,能在短期内有效地抑制炎症及减少蛋白尿、降低RAS活性,从而有利肾功能维持稳定。

Objective To observe the efficacy of the corticosteroids therapy in patients with IgA nephropa thy(IgAN)and its effect on renin angiotensin system(RAS).Methods A total of 90 patients with IgAN biop sied from October 2016 to April 2017 were divided into corticosteroids therapy group and non-corticosteroids treat ment group who were observed during one year follow-up.The end point was the 15%reduction of baseline eGFR.Results 38(42.2%)patients with IgAN were treated with corticosteroid,whose proteinuria,creatinine,urinary angiotensinogen(AGT)and urinary IL-6 at renal biopsy were significantly higher that of non-corticosteroids treat ment group,as well as the ratio of tubule atrophy/interstitial fibrosis and crescents(P<0.01).During the follow up period,the level of proteinuria serum angiotensinⅡand IgA in corticosteroids treatment group decreased signif icantly(P<0.05)with no significant change in serum creatinine,and no significant difference of proteinuria be tween two groups after 12 months(P >0.05).18 cases(20.0%)developed >15%decline of eGFR during one year follow-up,while there was no significant difference between the corticosteroid/non-corticosteroid treatment groups.Conclusion Corticosteroid therapy in patients with IgAN can inhibit inflammation and RAS activity,con trol proteinuria effectively,and then protect renal function.