环磷酰胺联合糖皮质激素治疗不同血尿程度IgA肾病的疗效分析

Efficacy of cyclophosphamide combined with glucocorticoids therapy with different degrees of hematuria IgA nephropathy

目的通过分析环磷酰胺(CTX)联合糖皮质激素(GS)治疗不同血尿程度IgA肾病(IgAN)患者的疗效,以期为IgAN的治疗提供参考。方法回顾性分析2015年1月—2021年12月于山西省人民医院确诊并接受CTX联合GS治疗的原发性IgAN患者的临床资料。根据治疗前血尿严重程度将纳入的患者分为2组:轻度血尿组[尿红细胞计数(URBC)<30/高倍视野(HPF)]、重度血尿组[URBC≥30/HPF]。比较2组患者治疗前和治疗后1、3、6个月时的肾功能变化。主要结局:蛋白尿缓解率、估算肾小球滤过率(eGFR)斜率;次要结局:血肌酐(Scr)、eGFR、尿素氮(BUN)及不良反应。结果共纳入132例患者,轻度血尿组95例,重度血尿组37例。治疗后,重度血尿组各随访节点蛋白尿缓解率和eGFR斜率均高于轻度血尿组,组间比较差异有统计学意义(均P<0.05)。重度血尿组Scr呈下降趋势,轻度血尿组呈上升趋势,组间比较差异有统计学意义(P<0.05)。2组eGFR均呈先降后升趋势。重度血尿组eGFR变化较明显,组间比较差异有统计学意义(P<0.05)。2组BUN均呈先升后降趋势,重度血尿组BUN在各随访节点均较轻度血尿组低,组间比较差异有统计学意义(P<0.05)。结论CTX联合GS对于重度血尿组IgAN患者疗效较好,治疗前血尿程度可能是IgAN患者治疗决策的潜在依据。

Objective To evaluate the effect of cyclophosphamide(CTX)combined with glucocorticoids(GS)in the treatment of primary IgA nephropathy(IgAN)with different degrees of hematuria,and provide reference for therapy of IgAN.Methods The clinical data of the primary IgAN patients treated with CTX and GS at the Shanxi Provincial People's Hospital from January 2015 to December 2021 were retrospectively collected.According to the degree of baseline hematuria,they were divided into mild hematuria group[urinary red blood cell count(URBC)<30/high-power field(HPF)]and severe hematuria group(URBC≥30/HPF).The changes of renal function before therapy and 1st,3rd and 6th month after therapy were compared between the two groups.The main outcomes were proteinuria remission rate,estimated glomerular filtration rate(eGFR)slope.The secondary outcomes were serum creatinine(Scr),blood urea nitrogen(BUN),eGFR and adverse reactions.Results A total of 132 IgAN patients were included,95 cases in the mild hematuria group and 37 cases in the severe hematuria group.After therapy,proteinuria remission rate and eGFR slope in the severe hematuria group were higher than those in the mild hematuria group,and the difference between the two groups was statistically significant(all P<0.05).Scr in the severe hematuria group showed a downward trend,while that in the mild hematuria group showed an upward trend,and the difference between the groups was statistically significant(P<0.05).eGFR in both groups showed a trend of decreasing first and then increasing.The change of eGFR in the severe hematuria group was more obvious than that in the mild hematuria group(P<0.05).BUN in both groups showed a trend of increasing first and then decreasing.The level of BUN in the severe hematuria group was lower than that in the mild hematuria group at all time points(P<0.05).Conclusion The combination of CTX and GS has a good therapeutic effect on IgAN patients with severe hematuria.The level of hematuria before therapy may be latent basis for the selection of therapy decisions for IgAN.