羟氯喹与糖皮质激素治疗IgA肾病效果比较

Comparison of the efficacy between hydroxychloroquine and corticosteroid in treatment of patients with IgA nephropathy

目的比较羟氯喹(HCQ)和糖皮质激素治疗IgA肾病的效果和安全性。方法选取2017年1月至2020年12月温州市中西医结合医院收治的IgA肾病患者60例,均耐受最大剂量肾素血管紧张素阻滞剂治疗3个月以上,24 h尿蛋白水平仍持续>1.0 g。其中30例患者给予HCQ治疗,为HCQ组;另30例患者给予糖皮质激素治疗,并视病情联合免疫抑制剂治疗,为激素组。观察并比较治疗24周后两组患者尿蛋白缓解率、24 h尿蛋白水平、血肌酐、估算的肾小球滤过率、不良反应发生情况等。结果治疗24周后,HCQ组尿蛋白缓解率低于激素组(43.33%比70.00%,P<0.05)。与治疗前相比,两组患者治疗24周后24 h尿蛋白水平均有明显下降(均P<0.05),但两组间比较无统计学差异(P>0.05)。两组患者治疗前后血肌酐、估算的肾小球滤过率比较差异均无统计学意义(均P>0.05)。治疗期间,HCQ组不良反应发生率低于激素组(3.33%比20.00%,P<0.05)。结论HCQ在IgA肾病中的降尿蛋白作用是有效的,治疗缓解率可能低于糖皮质激素,但安全性较高。

Objective To compare the efficacy and safety between hydroxychloroquine(HCQ)and corticosteroid in treatment of patients with IgA nephropathy.Methods Sixty patients with IgA nephropathy admitted to Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2017 to December 2020,who had proteinuria more than 1.0 g/d despite treatment with optimized renin-angiotensin system inhibitor therapy for more than 3 months,were enrolled in the study.Patients were treated with HCQ(HCQ group,n=33)or corticosteroids(corticosteroid group,n=30).The proteinuria,serum creatinine,estimated glomerular filtration rate(eGFR)and adverse reactions were examined before and after treatment in two groups.Results The reduction rate of proteinuria 24 weeks after treatment in the HCQ group was lower than that in the corticosteroid group(43.33%vs.70.00%,P<0.05).Proteinuria were decreased in both groups after treatment(P<0.05),while there was no significant difference between the two groups(P>0.05).The serum creatinine and eGFR were comparable for the HCQ and corticosteroid groups(all P>0.05).The incidence of adverse reactions in the HCQ group was lower than that in the corticosteroid group(3.33%vs.20.00%,P<0.05).Conclusion The antiproteinuric effect of HCQ might be slightly inferior to that of corticosteroids over 24 weeks of treatment in patients with IgA nephropathy.However,HCQ treatment is safer than corticosteroid treatment.