吗替麦考酚酯与环磷酰胺分别联合低剂量泼尼松治疗IgA肾病的效果比较

Effects of mycophenolate mofetil versus cyclophosphamide in combined therapy with low-dose prednisone for IgA nephropathy

目的对比吗替麦考酚酯和环磷酰胺分别联合低剂量泼尼松治疗IgA肾病的临床效果。方法抽取2016年9月至2020年5月焦作市人民医院收治的IgA肾病患者98例,按随机数字表法分为A组与B组,每组49例。两组均采用低剂量泼尼松治疗,B组加用环磷酰胺治疗,A组加用吗替麦考酚酯。比较两组的疗效、肾功能[血肌酐(SCr)、尿素氮(BUN)]水平、肾脏纤维化[层粘连蛋白(LN)、基底金属蛋白酶组织抑制剂-1(TIMP-1)]水平及不良反应发生率。结果A组总有效率(95.92%,47/49)高于B组(77.55%,38/49),P<0.05。治疗后,A组SCr、BUN水平[(86.42±4.78)μmol/L、(4.27±0.36)mmol/L]低于B组[(101.52±6.82)μmol/L、(7.85±0.48)mmol/L],LN、TIMP-1水平[(90.83±4.17)、(340.72±12.43)μg/L]亦低于B组[(118.73±6.32)、(451.03±16.82)μg/L],P均<0.05。A组不良反应发生率(6.12%,3/49)与B组(10.20%,5/49)比较差异未见统计学意义(P>0.05)。结论与环磷酰胺比较,吗替麦考酚酯应用于IgA肾病治疗中,能提高临床疗效,预防肾脏纤维化,改善肾功能,具备用药安全性。

Objective To compare the effects of mycophenolate mofetil and cyclophosphamide in combined therapy with low-dose prednisone for immunoglobulin A(IgA)nephropathy.Methods 98 patients with IgA nephropathy treated in Jiaozuo People’s Hospital from September 2016 to May 2020 were selected and divided into group A and group B according to the random number table method,with 49 cases in each group.Both groups were treated with low-dose prednisone,on this basis,group B was treated with cyclophosphamide,and group A was treated with mycophenolate mofetil.The efficacy,renal function levels,including serum creatinine(SCr)and blood urea nitrogen(BUN),renal fibrosis levels,including laminin(LN)and tissue inhibitor of metalloproteinase-1(TIMP-1),and the incidence of adverse reactions of the two groups were compared.Results The total effective rate in group A was 95.92%(47/49),which was higher than the 77.55%(38/49)in group B(P<0.05).After treatment,the levels of SCr and BUN in group A were(86.42±4.78)μmol/L and(4.27±0.36)mmol/L,lower than the(101.52±6.82)μmol/L and(7.85±0.48)mmol/L in group B(P<0.05).After treatment,the levels of LN and TIMP-1 in group A were(90.83±4.17)and(340.72±12.43)μg/L,lower than the(118.73±6.32)and(451.03±16.82)μg/L in group B(all P<0.05).There was no significant difference in the incidence of adverse reactions between group A(6.12%,3/49)and group B(10.20%,5/49),P>0.05.Conclusions Compared with cyclophosphamide,the application of mycophenolate mofetil in the treatment of IgA nephropathy can improve the clinical efficacy,prevent renal fibrosis,improve renal function,with drug safety.