甲泼尼龙、盐酸氮芥冲击疗法治疗IgA肾病的临床效果及安全性评价

Clinical Effect and Safety Evaluation of Methylprednisolone and Nitrogen Mustard Hydrochloride Shock Therapy in the Treatment of IgA Nephropathy

目的:明确甲泼尼龙、盐酸氮芥冲击疗法对免疫球蛋白A(IgA)肾病患者临床疗效及安全性,为其临床应用提供试验证据。方法:选取2019年1月-2020年2月江西省中医肾病临床医学研究中心收治的120例IgA肾病患者。随机将其分为治疗组和对照组,各60例。对照组在基础治疗上给予泼尼松。治疗组在对照组基础上,给予甲泼尼龙、盐酸氮芥冲击疗法。两组均连续治疗12个月。比较两组24小时尿蛋白、血清白蛋白、尿素氮(BUN)、血清肌酐(Scr)、总胆固醇(TC)、甘油三酯(TG)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、纤维蛋白原(FIB)、白细胞计数、谷草转氨酶、谷丙转氨酶、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+),记录疗效及不良反应发生情况。结果:治疗后,治疗组24小时尿蛋白、BUN、Scr、TC、TG、IL-6、TNF-α、FIB、谷丙转氨酶、谷草转氨酶、CD8^(+)均低于对照组(P<0.05)。治疗后,治疗组血清白蛋白、白细胞计数、CD4^(+)、CD4^(+)/CD8^(+)均高于对照组(P<0.05)。治疗组总有效率高于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:甲泼尼龙、盐酸氮芥联合冲击治疗可有效提高IgA肾病临床疗效,值得临床推广。

Objective:To clarify the clinical efficacy and safety of Methylprednisolone and Nitrogen Mustard Hydrochloride shock therapy on immunoglobulin A(IgA)nephropathy patients and provide experimental evidence for its clinical application.Method:A total of 120 patients with IgA nephropathy admitted to the Clinical Medical Research Center of Traditional Chinese Medicine in Jiangxi Province from January 2019 to February 2020 were selected.They were randomly divided into treatment group and control group,60 cases in each group.The control group was given Prednisone on the basic treatment.Based on the control group,the treatment group was given Methylprednisolone and Nitrogen Mustard Hydrochloride shock therapy.Both groups were treated continuously for 12 months.24 h urine protein,serum albumin,urea nitrogen(BUN),serum creatinine(Scr),total cholesterol(TC),triglyceride(TG),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),fibrinogen(FIB),white blood cell count,aspartate aminotransferase,alanine aminotransferase,CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)were compared between the two groups,and the efficacy and occurrence of adverse reactions were recorded.Result:After treatment,24 h urine protein,BUN,Scr,TC,TG,IL-6,TNF-α,FIB,alanine aminotransferase,aspartate aminotransferase and CD8^(+)in the treatment group were lower than those in the control group(P<0.05).After treatment,serum albumin,white blood cell count,CD4^(+),CD4^(+)/CD8^(+)ratio in the treatment group were higher than those in the control group(P<0.05).The total effective rate in treatment group was higher than that in control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:The combination of Methylprednisolone and Nitrogen Mustard Hydrochloride shock therapy can effectively improve the clinical efficacy of IgA nephropathy,which is worthy of clinical promotion.