三种不同免疫抑制剂联合糖皮质激素治疗IgA肾病的效果比较

Clinical curative effect of three different immunosuppressants combined with glucocorticoid on IgA nephropathy

目的比较三种不同免疫抑制剂联合糖皮质激素治疗IgA肾病的效果。方法回顾性分析濮阳市安阳地区医院2018年4月至2021年4月收治的148例IgA肾病患者的临床资料,患者均采用糖皮质激素治疗,依据联用的免疫抑制剂,分别将联用雷公藤多苷(TW)、来氟米特(LEF)、环磷酰胺(CTX)的患者纳入TW组(48例)、LEF组(46例)和CTX组(54例)。比较三组患者的疗效、不良反应发生率及治疗前后肾功能指标、血清指标[单核细胞趋化蛋白-1(MCP-1)、细胞间黏附分子-1(ICAM-1)以及转化生长因子-β1(TGF-β1)]水平。结果 TW组(95.83%,46/48)与LEF组(93.48%,43/46)治疗总有效率均高于CTX组(75.93%,41/54),P均<0.05;而TW组与LEF组治疗总有效率比较差异未见统计学意义(P>0.05)。治疗后,三组肾功能指标均低于治疗前(P均<0.05),且TW组与LEF组肾功能指标低于CTX组(P<0.05),TW组与LEF组比较差异未见统计学意义(P>0.05)。治疗后,三组MCP-1、ICAM-1、TGF-β1水平均低于治疗前(P均<0.05),且TW组与LEF组MCP-1、ICAM-1、TGF-β水平低于CTX组(P<0.05),TW组与LEF组上述血清指标比较差异未见统计学意义(P>0.05)。TW组(6.25%,3/48)与LEF组(8.33%,4/46 )不良反应发生率低于CTX组(27.78%,15/54),P<0.05;TW组与LEF组不良反应发生率比较差异未见统计学意义(P>0.05)。结论糖皮质激素联合TW与LEF治疗IgA肾病的疗效相当,且均优于糖皮质激素联合CTX。

Objective To compare the efficacy of three different immunosuppressants combined with glucocorticoid in the treatment of immunoglobulin A(IgA)nephropathy.Methods The clinical data of 148 patients with IgA nephropathy treated in Anyang District Hospital of Puyang City from April 2018 to April 2021 were retrospectively analyzed.And all patients were treated with glucocorticoids.According to immunosuppressants,patients who were treated with tripterygium wilfordii polyglycoside(TW),leflunomide(LEF)and cyclophosphamide(CTX)were included in TW group(48 cases),LEF group(46 cases)and CTX group(54 cases),respectively.The curative effect were compared among the three groups,the indexes of renal function and serum indexes,including monocyte chemoattractant protein-1(MCP-1),intercellular cell adhesion molecule-1(ICAM-1),transforming growth factor-β1(TGF-β1)before and after treatment,and incidence of adverse reactions were compared among the three groups.Results The total effective rate of TW group(95.83%,46/48)and LEF group(93.48%,43/46)were higher than that of CTX group(75.93%,41/54),all P<0.05;but there was no significant difference in the total effective rate between TW group and LEF group(P>0.05).After treatment,the renal function indexes of the three groups were lower than those before treatment(all P<0.05),and the renal function indexes of TW group and LEF group were lower than those of CTX group(P<0.05),but there was no significant difference in these inderxes between TW group and LEF group(P>0.05).After treatment,the levels of MCP-1,ICAM-1 and TGF-β1 of the three groups were lower than those before treatment(all P<0.05),the levels of MCP-1,ICAM-1 and TGF-β1 of the TW group and LEF group were lower than those of CTX group(P<0.05),but there was no significant difference in these inderxes between TW group and LEF group(P>0.05).The incidence of adverse reactions in TW group(6.25%,3/48)and LEF group(8.33%,4/46)were lower than that in CTX group(27.78%,15/54),P<0.05;however,there was no significant difference in the incidence of adverse reactions between TW group and LEF group(P>0.05).Conclusions The efficacy of glucocorticoid combined with TW and LEF in the treatment of IgA nephropathy is the same,and they are better than glucocorticoid combined with CTX.