泼尼松联合来氟米特治疗IgA肾病的临床疗效及对患者血清VEGF及MMP-9水平的影响

Clinical Efficacy of Prednisone combined with Leflunomide in the Treatment of Patients with IgA Nephropathy and Its Effect on the Serum VEGF and MMP-9 Levels

目的:探讨泼尼松联合来氟米特治疗Ig A肾病的临床疗效及对患者血清内皮生长因子(vascula endothelial growth factor,VEGF)及基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)水平的影响。方法:选择我院肾病内科收治的Ig A肾病患者60例,随机分为对照组与观察组,每组各30例。对照组患者给予尼泼松治疗,观察组在对照组基础上给予来氟米特治疗。比较两组患者治疗后的临床疗效及不良反应发生情况;分别于治疗前后检测和比较两组患者的肾功能、血清VEGF及MMP-9水平。结果:治疗后,对照组患者临床总有效率为73.33%,总不良反应率为10.00%;观察组患者临床总有效率为86.67%,明显高于对照组,而总不良反应率为3.33%,显著低于对照组(P<0.05)。治疗后,两组患者血清血尿氮(blood urine nitrogen,BUN)、血肌酐(creatinine,Cr)、VEGF及MMP-9水平均明显低于本组治疗前,肾小球滤过率(glomerular filtration rate,GFR)水平明显高于本组治疗前;且观察组患者治疗后血清BUN、Cr、VEGF及MMP-9水平明显低于对照组,GFR水平明显高于对照组(P<0.05)。结论:泼尼松联合来氟米特治疗Ig A肾病的临床疗效明显优于单用泼尼松治疗,可更显著改善患者肾脏功能,可能与其降低患者血清VEGF及MMP-9水平有关。

Objective: To investigate the effects of prednisone combined with leflunomide on the curative effect, renal function,VEGF and MMP-9 levels in patients with Ig A nephropathy. Methods: 60 patients with Ig A nephropathy admitted in our hospital were randomly divided into the control group and the observation group, 30 cases in each group. The patients in control group were treated with prednisone, and the patients in observation group were given leflunomide on the basis of control group. The clinical efficacy and incidence of adverse reactions were compared between the two groups after treatment. The renal function, serum VEGF and MMP-9 levels of the two groups were measured and compared before and after treatment. Results: After treatment, the total clinical effective rate of control group was 73.33 % and the total adverse reaction rate was 10.00 %. The total clinical effective rate of observation group was 86.67 %, which was higher than that of the control group, and the total adverse reaction rate was 3.33 %, which was lower than that of the control group(P<0.05). After treatment, the levels of serum BUN, Cr, VEGF and MMP-9 in both groups were significantly lower than those before treatment, and the level of GFR was significantly higher than that before treatment. The levels of serum BUN, Cr, VEGF and MMP-9 of observation group were significantly lower than that of the control group. The level of GFR was significantly higher than that of the control group(P <0.05). Conclusion: The clinical effect of prednisone combined with leflunomide in the treatment of IgA nephropathy is obviously better than that of prednisone alone. It can more significantly improve the renal function of patients, which may be related to the reduction of serum VEGF and MMP-9 levels of patients.