布累迪宁联合中等剂量糖皮质激素治疗IgA肾病的效果研究

Effect of Bredinine Combined with Middle Dose Glucocorticoid in the Treatment of Ig A Nephropathy

背景IgA肾病是目前我国最常见的原发性肾小球疾病,对患者的身体健康以及生活质量造成严重的影响。糖皮质激素、布累迪宁是临床较为常用的治疗IgA肾病的药物,但关于二者联合应用的研究还相对较少。目的研究布累迪宁联合中等剂量糖皮质激素治疗IgA肾病的临床疗效,以期为临床治疗提供依据。方法选取2015年4月-2017年4月武汉市第四医院IgA肾病患者45例为研究对象。采用随机数字表法将患者分为布累迪宁组、中等剂量糖皮质激素组和布累迪宁联合中等剂量糖皮质激素组,各15例。布累迪宁组患者使用布累迪宁片进行治疗,150mg/次,1次/d。中等剂量糖皮质激素组患者使用口服醋酸泼尼松片进行治疗,40 mg·kg-1·d-1。布累迪宁联合中等剂量糖皮质激素组在口服醋酸泼尼松片治疗的基础上加用布累迪宁片,剂量及用法和布累迪宁组相同。三组患者的治疗时间均为6个月。记录三组总有效率,检测三组治疗前及治疗后血清肌酐、尿微量白蛋白、尿素氮水平和24 h尿蛋白定量及IgA、转化生长因子(TGF)-β1水平,统计不良反应情况。结果布累迪宁联合中等剂量糖皮质激素组总有效率高于布累迪宁组、中等剂量糖皮质激素组(P<0.05)。布累迪宁联合中等剂量糖皮质激素组治疗后血清肌酐、尿素氮水平及24 h尿蛋白定量低于布累迪宁组、中等剂量糖皮质激素组,尿微量白蛋白水平高于布累迪宁组、中等剂量糖皮质激素组(P<0.05)。三组治疗后血清肌酐水平、24 h尿蛋白定量低于本组治疗前,尿微量白蛋白水平高于本组治疗前(P<0.05);布累迪宁组、布累迪宁联合中等剂量糖皮质激素组治疗后尿素氮水平低于本组治疗前,中等剂量糖皮质激素组治疗后尿素氮水平高于本组治疗前(P<0.05)。布累迪宁联合中等剂量糖皮质激素组治疗后IgA、TGF-β1水平低于布累迪宁组、中等剂量糖皮质激素组(P<0.05)。三组治疗后IgA、TGF-β1水平低于本组治疗前(P<0.05)。三组不良反应发生率比较,差异无统计学意义(P>0.05)。结论布累迪宁联合中等剂量糖皮质激素治疗IgA肾病的效果显著,能够改善患者肾功能,降低IgA、TGF-β1水平,安全性较高,为IgA肾病的治疗提供了新的治疗思路。

Background IgA nephropathy is the most common primary glomerular disease in China,which has a serious impact on the health and quality of life of patients.Glucocorticoid and bredinine are commonly used in the treatment of IgA nephropathy,but there are a few studies on the combination of them.Objective To study the clinical effect of bredinine combined with middle dose glucocorticoid in the treatment of IgA nephropathy in order to provide basis for clinical treatment.Methods From April 2015 to April 2017,45 patients with IgA nephropathy in Wuhan Fourth Hospital were selected as the study objects.The patients were randomly divided into three groups:bredinine group,middle dose glucocorticoid group and bredinine combined with middle dose glucocorticoid group,with 15 cases in each group.The patients in bredinine group were treated with bredinine tablets,150 mg/time,once a day.The patients in the middle dose glucocorticoid group were treated with prednisone acetate tablets,40 mg·kg-1·d-1.On the basis of the treatment with prednisone acetate tablets,bredenine tablets were added to the bredenine combined with middle close glucocorticoid group.The dosage and usage were the same as that of bredenine group.The treatment time of the three groups was 6 months.The total efficiency of the three groups was recorded.The levels of serum creatinine,urinary microalbumin,urea nitrogen,24 h urinary protein,IgA and TGF-β1 before and after treatment were measured.And the adverse reactions were calculated.Results The total effective rate of bredinine combined with middle dose glucocorticoid group was higher than that of bredinine group and middle dose glucocorticoid group(P<0.05).The level of serum creatinine,urea nitrogen and 24 h urine protein in bredinine combined with middle dose glucocorticoid group were lower than those in bredinine group and middle dose glucocorticoid group,and the level of microalbumin in urine was higher than that in bredinine group and middle dose glucocorticoid group(P<0.05).The levels of serum creatinine and 24 h urinary protein in three groups were lower than those before treatment,and the levels of urinary microalbumin were higher than those before treatment(P<0.05).The urea nitrogen level of bredinine group,bredinine combined with middle dose glucocorticoid group after treatment was lower than that before treatment,and that of middle dose glucocorticoid group after treatment was higher than that before treatment(P<0.05).The levels of IgA and TGF-β1 in bredinine group and middle dose glucocorticoid group were lower than those in bredinine group and middle dose glucocorticoid group(P<0.05).The levels of IgA and TGF-β1 in three groups were lower than those before treatment(P<0.05).There was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion Bredinine combined with glucocorticoid has a significant effect in the treatment of IgA nephropathy.It can improve the renal function,reduce the level of IgA and TGF-β1,and has a high safety.It provides a new treatment idea for IgA nephropathy.