足量泼尼松联合环磷酰胺治疗IgA肾病的疗效及影响因素

Efficacy and Influencing Factors of Adequate Prednisone Combined with Cyclophosphamide Therapy in the Treatment of IgA Nephropathy

目的探讨足量泼尼松联合环磷酰胺治疗IgA肾病(IgAN)的疗效,并分析其影响因素。方法收集2018年1月—2020年1月在成都中医药大学附属医院经肾活检确诊为IgAN并使用足量泼尼松联合环磷酰胺治疗的33例患者临床资料,分析疗效及影响因素。结果33例患者经治疗后完全缓解10例(30.30%),部分缓解11例(33.33%),未缓解12例(32.36%),总缓解21例(63.64%)。缓解组年龄、24 h尿蛋白定量、Lee氏分级均低于未缓解组(P<0.05)。依据牛津分型分组后,比较各组缓解率:肾小球毛细血管内皮细胞增生(E)1组>E0组(P<0.05);肾小管萎缩和(或)肾间质纤维化(T)2组<T0组和T1组(P<0.05),T1组<T0组(P<0.05);新月体(C)2组<C0组和C1组(P<0.05),C1组和C0组缓解率差异无统计学意义。结论足量泼尼松联合环磷酰胺治疗IgAN疗效显著;年龄越大、24 h尿蛋白定量水平越高、肾小管萎缩和/或肾间质纤维化程度越严重、新月体越多,缓解率越低;E1、C1对足量泼尼松联合环磷酰胺治疗具有良好应答。

Objective To investigate the efficacy of adequate prednisone combined with cyclophosphamide in the treatment of IgAN,and analyze its influencing factors.Methods Review 33 patients who were diagnosed with IgAN by renal biopsy and were treated with sufficient prednisone combined with cyclophosphamide intravenous pulse therapy in the nephrology department of our hospital from January 2018 to January 2020 were collected,and the efficacy and factors affecting the efficacy were analyzed.Results After treatment,33 patients had complete remission in 10 cases(30.30%),partial remission in 11 cases(33.33%),no remission in 12 cases(32.36%),and total remission in 21 cases(63.64%).The age,24-hour urine protein quantification,and Lee's grade in the remission group were lower than in the non-remission group(P<0.05).After grouping according to Oxford classification,compare the remission rate of each group were compared:glomerular capillary endothelial cell hyperplasia(E)1 group>E0 group(P<0.05);renal tubular atrophy and/or renal interstitial fibrosis(T)2 groups<T0 group and T1 group(P<0.05),T1 group<T0 group(P<0.05);crescent(C)2 groups<C0 group and C1 group(P<0.05);there was no significant difference in remission rate between C1 group and C0 groups.Conclusion Adequate prednisone dose combined with cyclophosphamide therapy has a significant effect on IgAN;the older the age,the higher the 24-hour urine protein level,the more severe the renal tubular atrophy and/or the renal interstitial fibrosis,the more crescents,and the lower the remission rate;E1 and C1 have a good response to adequate doses of prednisone combined with cyclophosphamide intravenous pulse therapy.