IgA肾病伴新月体形成合并肾衰竭的治疗方案比较及肾组织TWEAK的表达差异

Comparison of Therapeutic Regimen in IgA Nephropathy with Crescents and Renal Failure and Study of TWEAK Expression in Renal Tissue

目的:探讨糖皮质激素联合环磷酰胺的不同治疗方案对IgA肾病伴新月体形成合并肾衰竭患者的疗效和安全性及肾组织肿瘤坏死因子样凋亡微弱诱导剂(TWEAK)的表达差异。方法:将收治于我院的59位IgA肾病伴有新月体形成的肾衰竭患者根据治疗方案的不同纳入以下4组:对照组、糖皮质激素(G)组、G+环磷酰胺(C)组和G冲击+C组,观察24周各组的疗效和安全性。此外,免疫组织化学染色观察TWEAK在肾组织中的表达和分析其与临床指标的相关性。结果:G组、G+C组和G冲击+C组治疗后的24 h尿蛋白定量、血肌酐、eGFR水平均优于对照组(P<0.05)。对临床疗效进行比较,发现G组(47.06%)、G+C组(50.00%)和G冲击+C组(58.33%)总有效率均高于对照组(7.14%),差异具有统计学意义(P<0.05)。对药物安全性进行比较,3个治疗组不良反应发生率差异无统计学意义(P>0.05)。免疫组织化学分析结果显示总体有效组TWEAK表达和分布均低于无效组(P<0.05)。且TWEAK的表达量与尿红细胞数无明显相关性(P>0.05),但与尿蛋白定量、血肌酐存在正相关(P<0.05),与eGFR存在负相关(P<0.05)。结论:单用半量糖皮质激素的治疗方案是IgA肾病伴新月体形成合并肾衰竭安全有效的方案,且临床应用更具优势,并且我们发现IgA肾病患者肾组织中TWEAK的表达可能与更差的肾脏预后相关。

Objective:To investigate the efficacy and safety of different glucocorticoids combined with cyclophosphamide in patients with IgA nephropathy with crescent formation and renal failure,and the difference in the expression of tumor necrosis factor-like weak inducer of apoptosis(TWEAK)in renal tissue.Methods:The 59 patients with renal failure with IgA nephropathy with crescents were enrolled in the following four groups according to different treatment options:The control group,glucocorticoid(G)group,G+cyclophosphamide(C)group and G+C group were used to observe the efficacy and safety of each group at 24 weeks.In addition,immunotissue staining observed the expression of TWEAK in renal tissue and analyzed its correlation with clinical indicators.Results:The 24-hour urinary protein quantification,blood creatinine and eGFR levels of G group,G+C group and G pulse+C group were better than those of the control group after treatment(P<0.05),but there was no statistical difference between the three treatment groups(P>0.05).Comparison of clinical efficacy was made,and it was found that G group(47.06%),G+C group(50.00%)and G+C group(58.33%)had a higher total efficacy rate was higher than that of the control group(7.14%),which was statistically different(P<0.05).Compare drug safety,There was no significant difference in the incidence of adverse reactions among the three treatment groups(P<0.05).Immunohistochemical analysis showed that TWEAK expression and distribution in the overall effective group were lower than those in the ineffective group(P<0.05).And there was no significant correlation between the expression of TWEAK and the number of urinary erythrocytes(P>0.05),but there was a positive correlation with urinary protein quantification,blood creatinine,(P<0.05),and a negative correlation with eGFR(P<0.05).Conclusion:Treatment regimens of half-dose glucocorticoids alone are safe and effective regimens for IgA nephropathy with crescent formation combined with renal failure,and clinical application has more advantages.We found that TWEAK expression in renal tissues of patients with IgA nephropathy may correlate with poorer renal prognosis.