免疫抑制剂治疗进展期IgA肾病疗效观察

Clinical Observation of Efficacy of Immunosuppressants in The Treatment of Progressive IgA Nephropathy

目的观察糖皮质激素和免疫抑制剂对进展期IgA肾病的疗效。方法本研究纳入1208例肾活检诊断为IgA肾病的患者,估算肾小球滤过虑(eGFR)水平将201例患者分为支持治疗组,糖皮质激素治疗组,免疫抑制剂治疗组。研究终点为患者达到终末期肾病(eGFR<15mL/min或接受肾脏替代治疗)或eGFR较基线降低50%。分析患者肾脏存活情况和预后不良危险因素。结果三组间肾脏存活情况具有统计学差异。支持治疗组78%的患者在随访期间达到肾脏终点,糖皮质激素治疗组63%的患者达到终点,而糖皮质激素加免疫抑制剂治疗组仅49%的患者达到终点,差异有统计学意义(P<0. 05)。糖皮质激素治疗组和糖皮质激素加免疫抑制剂治疗之间则差异无统计学意义(P=0. 58)。三组间3年肾存活比例差异有统计学意义(P<0. 05),支持治疗组(34%),糖皮质激素治疗组(50%)和糖皮质激素加免疫抑制剂组(52%)则更高。5年肾存活情况三组间差异无统计学意义(P=0. 24)。结论糖皮质激素或糖皮质激素联合免疫抑制剂能在短期内改善进展性Ig A肾病患者的肾脏预后。

Objective To observe the efficacy of glucocorticoids and immunosuppressants in the treatment of progressive Ig A nephropathy.Methods Based on eGFR,patients with Ig A nephropathy diagnosed by renal biopsy(n=1,208)were classified into supportive treatment group,glucocorticoids group,and immunosuppressants group.Kidney endpoint was that patients progressed to end-stage renal disease(eGFR<15 mL/min or need for renal replacement therapy)or eGFR decreased 50%from baseline.We analyzed the kidney survival and risk factors of poor outcomes.Results Significant difference in kidney survival was found among groups(P<0.05):78%of patients in supportive treatment group,63%of patients in glucocorticoids group,and 49%of patients in glucocorticoids+immunosuppressants group met the kidney endpoint during follow-up.However,no significant difference was showed between the groups of glucocorticoids and glucocorticoids+immunosuppressants(P=0.58).Among groups,3-year kidney survival(34%in supportive treatment group,50%in glucocorticoids group,and 52%in glucocorticoids+immunosuppressants group)was significantly different(P<0.05)but not 5-year kidney survival(P=0.24).Conclusion Glucocorticoids or combined with immunosuppressants could improve the outcomes of patients with progressive Ig A nephropathy in short period.