羟氯喹对IgA肾病患者血清及尿IL-6、TNF-α水平的影响研究

Effect of hydroxychloroquine on serum and urinary IL-6 and TNF-a levels in patients with IgA nephropathy

目的 探讨羟氯喹对IgA肾病(IgAN)患者炎症因子血清及尿IL-6、TNF-α水平的影响。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IgAN患者32例。采用随机数字表法将患者分为羟氯喹组和对照组,各16例。对照组患者予每日双倍剂量肾素血管紧张素系统阻断药等常规治疗,疗程24周。羟氯喹组在对照组治疗基础上加服羟氯喹片,疗程24周。于治疗前、治疗24周后观察并比较两组患者24 h尿蛋白水平、血肌酐、估算的肾小球滤过率(eGFR)、尿蛋白缓解情况,血清及尿IL-6、TNF-α水平,用药期间不良反应。结果 治疗后,两组患者24 h尿蛋白水平、血肌酐、eGFR比较差异均无统计学意义(均P>0.05),仅羟氯喹组患者24 h尿蛋白水平低于治疗前(P<0.05)。羟氯喹组患者尿蛋白缓解率高于对照组(56.25%比18.75%,P<0.05)。治疗后,两组患者血清及尿IL-6、TNF-α水平均较治疗前降低(均P<0.05),且羟氯喹组患者血清及尿IL-6、TNF-α水平均低于对照组(均P<0.05)。治疗期间,两组患者均未见明显不良反应。结论 羟氯喹治疗IgAN能稳定患者肾功能,降低蛋白尿,提高尿蛋白缓解率,并能下调血清及尿IL-6、TNF-α水平。

Objective To investigate the effect of hydroxychloroquine on serum and urinary IL-6 and TNF-αlevels in patients with IgA nephrology.Methods Thirty-two patients with IgA nephropathy treated in Wenzhou Hospital of Integrated traditional Chinese and Western Medicine were randomly assigned into study group(n=16)and control group(n=16).Patients in both groups received double dose of renin-angiotensin-aldosterone system inhibitor therapy for 24 weeks;while patients in study group received additional hydroxychloroquine tablets.The 24 h urinary protein excretion,serum creatinine,estimated glomerular filtration rate(eGFR),the levels of IL-6 and TNF-αin serum and urine were examined.And occurrences of adverse reactions were documented.Results After treatment,there were no significant differences in 24 h urinary protein excretion,serum creatinine and eGFR between two groups(P>0.05).The 24 h urinary protein excretion in study group was lower than that before treatment(P<0.05),the remission rate of urinary protein in study group was higher than that in control group(56.25%vs.18.75%,P<0.05).The levels of IL-6 and TNF-αin serum and urine were decreased in both groups after treatment(P<0.05),while the levels were lower in study group than those in control group(P<0.05).No significant adverse reactions occurred in both groups during the treatment.Conclusion The treatment of hydroxychloroquine for IgA nephropathy can stabilize renal function,increase the remission rates of proteinuria,decrease serum and urine IL-6 and TNF-αlevels.