雷公藤多苷联合泼尼松治疗IgA肾病的临床疗效及其对尿Smad2和TGF-β1的影响

Clincal Effects of Tripterygium Glycosides Combined with Prednisone on IgA Nephropathy and Its Effect on Urinary Smad2 and TGF-β1

目的探讨雷公藤多苷联合泼尼松治疗IgA肾病的临床效果及其对尿Smad2和TGF-β1的影响。方法选取于福建医科大学附属泉州第一医院就诊的IgA肾病患者共155例,随机分为3组,分别为雷公藤多苷组51例、泼尼松组52例和联合组52例,其中雷公藤多苷组失访1例,泼尼松组因严重感染退出研究2例,联合组因严重感染退出研究2例。泼尼松组口服泼尼松片,雷公藤多苷组口服雷公藤多苷片,联合组同时服用2种药物,治疗期12个月,评价治疗前后患者疗效,检测治疗前后血肌酐(serum creatinine,Scr)、肾小球滤过率(epidermal growth factor receptor,eGFR)、血尿素氮(blood urea nitrogen,BUN)、血尿酸(serum uric acid,SUA)、血清白蛋白(serum albumin,Alb)、总胆固醇(total cholesterol,TC)、24 h尿蛋白、尿Smad2及TGF-β1的变化。结果治疗前3组患者eGFR、BUN、SUA、Alb、TC差异无统计学意义,与治疗前相比,治疗后3组患者Alb、eGFR增加(P<0.05),与泼尼松组和雷公藤多苷组相比,联合组治疗后Alb显著增加(P<0.05),与治疗前相比,治疗后联合组BUN、SUA减小(P<0.05),雷公藤多苷组和泼尼松组无明显变化,差异无统计学意义,TC治疗前后无明显改变。治疗前,3组患者尿Smad2及TGF-β1差异无统计学意义,与治疗前相比,治疗后3组患者Smad2及TGF-β1均减小,与泼尼松组和雷公藤多苷组相比,联合组治疗后Smad2及TGF-β1表达显著减少(P<0.05)。雷公藤多苷组总有效率为66.00%,泼尼松组总有效率为62.00%,联合组总有效率为88.00%(P<0.05)。雷公藤多苷组不良反应发生率为20.00%,泼尼松组不良反应发生率为22.00%,联合组不良反应发生率为24.00%。结论泼尼松联合雷公藤多苷能降低IgA肾病患者尿Smad2及TGF-β1的表达,改善患者肾功能,具有一定的临床价值。

OBJECTIVE To explore the clinical effect of tripterygium glycosides combined with prednisone on IgA nephropathy and its effect on urinary Smad2 and TGF-β1. METHODS A total of 155 IgA nephropathy patients in Quanzhou First Hospital Affiliated to Fujian Medical University were randomly divided into three groups: tripterygium glycosides group(51 cases), prednisone group(52 cases) and combined treatment group(52 cases), among them, 1 case was lost in the tripterygium glycosides group, 2 cases were exit in the prednisone group due to severe infection, and 2 cases were exit in the combined treatment group due to severe infection. In the prednisone group, prednisone was taken orally, tripterygium glycosides group was treated with tripterygium glycosides tablets, and the combined group was treated with 2 drugs at the same time for 12 months. The curative effect of patients was evaluated before and after treatment and the changes of serum creatinine(Scr), epidermal growth factor receptor(eGFR), blood urea nitrogen(BUN), serum uric acid(SUA), serum albumin(Alb), total cholesterol(TC), 24 h proteinuria, Smad2 and TGF-β1 were detected before and after treatment. RESULTS There was no significant difference in eGFR, BUN, SUA, Alb, TC among the three groups before treatment. Compared with before treatment, Alb, eGFR after treatment increased in the three groups(P<0.05), and compared with prednisone group and tripterygium glycosides group, Alb in the combined group after treatment significant increased(P<0.05);Compared with before treatment, BUN and SUA after treatment decreased in the combined group(P<0.05), and there was no significant difference between prednisone group and tripterygium glycosides group, and TC was no significant change before and after treatment. There was no significant difference in urine Smad2 and TGF-β1 among the three groups before treatment. Compared with before treatment, Smad2 and TGF-β1 after treatment decreased in the three groups. After treatment, Smad2 and TGF-β1 in the three groups decreased, and compared with prednisone group and tripterygium glycosides group, Smad2 and TGF-β1 in the combined group after treatment significant decreased(P<0.05). The total effective rate of tripterygium glycosides group was 66.00%, prednisone group was 62.00%, and the combined group was 88.00%(P<0.05). The adverse reaction rate of tripterygium glycosides group was 20.00%, prednisone group was 22.00%, and the combined group was 24.00%. CONCLUSION Prednisone combined with tripterygium glycosides can reduce the expression of Smad2 and TGF-β1 in urine of IgA nephropathy patients, improve renal function of patients. It has a certain clinical value.