麦考酚酸酯对IgA肾病患者尿TGF-β1与ECM的影响

Effect of mycophenolate mofetil on TGF-β1 and ECM in urine of patients with IgA nephropathy

目的探讨麦考酚酸酯(Mycophenolate mofetil,MMF)治疗IgA肾病(IgA nephropathy,IgAN)的疗效及其对患者尿转化生长因子-β1(transforming growth factor-β1,TGF-β1)与细胞外基质(extracellular matrix,ECM)的影响。方法80例IgAN患者按照随机数字表法分为对照组与观察组,各40例,均给予甲基泼尼松龙治疗,对照组与观察组在此基础上分别给予环磷酰胺(cyclophosphamide,CTX)与MMF治疗。比较两组临床疗效、治疗前后实验室相关指标水平、尿TGF-β1及ECM主要组分水平变化情况。结果观察组临床总有效率(87.50%)高于对照组(65.00%),差异有统计学意义(χ2=5.591,P=0.018)。2组患者治疗后24 h尿蛋白、尿红细胞计数水平低于治疗前,血浆白蛋白水平高于治疗前,且观察组改善更显著,差异有统计学意义(P<0.05)。2组患者治疗后尿TGF-β1、透明质酸(hyaluronic acid,HA)、层黏连蛋白(laminin,LN)、III型前胶原(procollagen III,PCIII)、IV型胶原(collagen,IV-C)水平较治疗前均降低,且观察组治疗前后上述指标水平改善幅度均分别大于对照组,差异均有统计学意义(P<0.05)。结论麦考酚酸酯治疗IgA肾病的疗效显著,可能机制为通过降低患者尿TGF-β1与ECM水平而发挥疗效。

Objective To explore the efficacy of mycophenolate mofetil(MMF)in treating IgA nephropathy(IgAN)and its effect on transforming growth factor-β1(TGF-β1)and extracellular levels matrix(ECM).Methods Firstly,80 IgAN patients were randomly divided into a control group(n=40)and an experimental group(n=40).Both groups were then treated with methylprednisolone.Secondly,the control and the experimental group were subjected to treatment with cyclophosphamide(CTX)and with MMF,respectively.Lastly,the clinical efficacy in the two groups,the levels of laboratory-related indicators,the levels of urine TGF-β1 and the major components of ECM of the two groups as observed before and after treatment were documented and compared.Results The total clinical effective rate of the experimental group(87.50%)was higher than that of the control group(65.00%).The difference was statistically significant(χ^2=5.591,P=0.018).The levels of urinary protein and urinary red blood cell count of the two groups as observed at 24 hours after treatment were lower than those before treatment.The plasma albumin level was higher than that before treatment.The improvement in the experimental group was more significant.The differences were statistically significant(P<0.05).The levels of urine TGF-β1,hyaluronic acid(HA),laminin(LN),procollagen III(PCIII)and type IV collagen(IV-C)as observed after treatment became lower than those before treatment.The improvement in the levels of these variables in the experimental group as observed before and after treatment was greater than those in the control group.The differences were statistically significant(P<0.05).Conclusions Mycophenolate mofetil proves to be effective in treating IgA nephropathy probably by a mechanism that can exert effect by lowering the urinary TGF-β1 and ECM levels.