吗替麦考酚酯联合泼尼松对IgA肾病患者尿β2-MG、U-mAlb及α1-MG水平的影响

Effect of mycophenolate mortiate combined with prednisone on urinaryβ2⁃MG,U⁃mAlb andα1⁃MG levels in patients with IgA nephropathy

目的 观察吗替麦考酚酯联合泼尼松治疗免疫球蛋白A(IgA)肾病对患者尿β2微球蛋白(β2-MG)、尿微量白蛋白(U-mAlb)及尿液α1微球蛋白(α1-MG)水平的影响。方法 选取秦皇岛市第一医院肾内科2019年1月至2022年1月收治的89例IgA肾病患者为研究对象,采用信封随机法分为泼尼松组(n=43)和联合组(n=46)。泼尼松组给予常规治疗联合小剂量泼尼松治疗,联合组在泼尼松组基础上联合吗替麦考酚酯治疗。比较两组尿β2-MG、U-mAlb、α1-MG、N-乙酰-β-D氨基葡萄糖苷酶(NAG)及尿足细胞蛋白的水平,检测两组肾功能、血管内皮生长因子(VEGF)、转化生长因子-β1(TGF-β1)、转化生长因子-α(TGF-α)、血尿酸、血红蛋白的差异,统计两组疗效。结果 治疗后,两组尿液β2-MG、U-mAlb、α1-MG、NAG下降,且联合组低于泼尼松组,差异有统计学意义(P<0.05)。治疗后,两组尿NPHS1蛋白、Podocin蛋白下降,且联合组低于泼尼松组,差异有统计学意义(P<0.05)。治疗后,两组VEGF、TGF-β1、TGF-α下降,且联合组低于泼尼松组,差异有统计学意义(P<0.05)。治疗后,两组Scr、BUN、24hU-TP、eGFR下降,且联合组24hU-TP、e GFR下降后水平低于泼尼松组,差异有统计学意义(P<0.05)。结论 吗替麦考酚酯联合小剂量泼尼松治疗IgA肾病可保护患者足细胞,减轻肾损伤,提高疗效。

Objective To observe the effects of mortemycophenate combined with prednisone on urinaryβ2-microglobulin(β2-MG),urinary microalbumin(U-mAlb)and urinaryα1-microglobulin(α1-MG)levels in patients with IgA nephropathy.Methods Eighty-nine patients with IgA nephropathy were ad-mitted to the Department of Nephrology at the First Hospital of Qinhuangdao City from January 2019 to Janu-ary 2022.They were selected as the study participants,and divided into two groups using the envelope random method:the prednisone group(n=43)and the combination group(n=46).The prednisone group received con-ventional treatment along with low-dose prednisone,while the combination group received mycophenolate in addition to prednisone.The levels of urinaryβ2-MG,U-mAlb,α1-MG,n-acetyl-β-D glucosaminidase(NAG)and urinary podocytoprotein were compared between the two groups.The differences in renal func-tion,vascular endothelial growth factor(VEGF),transforming growth factor-β1(TGF-β1),transforming growth factor-α(TGF-α),blood uric acid and hemoglobin between the two groups were also measured.The therapeutic effects of the two groups were analyzed.Results After treatment,the levels of urineβ2-MG,U-mAlb,α1-MG,NAG,urinary nephropathy protein(NPHS1)protein,Podocin protein,VEGF,TGF-β1,TGF-α,renal function decreased in both groups.The levels of serum creatinine(Scr)and urea nitrogen(BUN)in the combination group were lower than those in the prednisone group(P<0.05).The total effective rate of the combined group was higher than that of prednisone group,and the difference was statistically significant(P<0.05).Conclusion The combination of mortemycophenol ester and low-dose prednisone in the treatment of IgA nephropathy can protect renal cells,reduce kidney injury and enhance the effectiveness of treatment.