Recurrence and influencing factors of hepatitis B surface antigen seroclearance induced by peginterferon alpha-based regimens

BACKGROUND The long-term stability of hepatitis B surface antigen(HBsAg)seroclearance following peginterferon alpha(peg-IFN-α)-based therapy has not been extensively studied,leaving the full potential and limitations of this strategy unclear.AIM To assess HBsAg recurrence after seroclearance achieved by peg-IFN-αregimens.METHODS This prospective,multicenter,observational study was conducted from November 2015 to June 2021 at three Chinese hospitals:The Second Affiliated Hospital of Xi’an Jiaotong University,Ankang Central Hospital,and The Affiliated Hospital of Yan’an University.Participants who achieved HBsAg seroclearance following peg-IFN-α-based treatments were monitored every 4-12 weeks post-treatment for hepatitis B virus(HBV)markers,HBV DNA,and liver function.The primary outcome was HBV recurrence,defined as the reemergence of HBsAg,HBV DNA,or both,at least twice within 4-8 weeks of follow-up.RESULTS In total,121 patients who achieved HBsAg seroclearance were enrolled.After a median follow-up of 84.0(48.0,132.0)weeks,four subjects were lost to follow-up.HBsAg recurrence was detected in 16 patients.The cumulative HBsAg recurrence rate in the intention-to-treat population was 15.2%.Multivariate logistic regression analysis demonstrated that consolidation time<12 weeks[odds ratio(OR)=28.044,95%CI:4.525-173.791]and hepatitis B surface antibody disappearance during follow-up(OR=46.445,95%CI:2.571-838.957)were strong predictors of HBsAg recurrence.HBV DNA positivity and decompensation of liver cirrhosis and hepatocellular carcinoma were not observed.CONCLUSION HBsAg seroclearance following peg-IFN-αtreatment was durable over 84 weeks of follow-up with a cumulative recurrence rate of 15.2%.

Validity and reliability of the Ocular Motor Nerve Palsy Scale

Objective and accurate assessment of the degree of ocular motor nerve palsy is helpful not only in the evaluation of prognosis, but also for the screening of treatment methods. However, there is currently no comprehensive measure of its severity. In this study, we designed the Ocular Motor Nerve Palsy Scale and investigated its validity and reliability. Six experts were invited to grade and evaluate the scale. The study recruited 106 patients with a definite diagnosis of unilateral isolated ocular motor nerve palsy. Three physicians evaluated the patients using the scale. One of the three physicians evaluated the patients again after 24 hours. The content validity index（CVI） and factor analysis were used to analyze the scale＇s construct validity. The intraclass correlation coefficient and Cronbach＇s alpha were used to evaluate the inter-rater and test-retest reliability and the internal consistency. The CVI results（I-CVI = 1.0, S-CVI = 0.9, Pc = 0.016, K＊ = 1） indicated good content validity. Factor analysis extracted two common factors that accounted for 85.2% of the variance. Furthermore, the load value of each component was above 0.8, indicating good construct validity. The Ocular Motor Nerve Palsy Scale was found to be highly reliable, with an inter-rater reliability intraclass correlation coefficient of 0.965（P 0.01）, a test-retest reliability intraclass correlation coefficient of 0.976（P 0.01）, and Cronbach＇s alpha values of 0.63–0.70. In conclusion, the Ocular Motor Nerve Palsy Scale with good validity and reliability can be used to quantify the severity of ocular motor nerve palsy. This study was registered at Chinese Clinical Trial Registry（registration number： Chi CTR-OOC-17010702）.

Glomerular Disease Associated with Takayasu Arteritis:6 Cases Analysis and Review of the Literature

Objective To evaluate the clinical features,renal histopathology and therapeutic response to glucocorticoid and immunosuppressive agents in patients with glomerular disease associated with Takayasu arteritis(TA).Methods Patients with TA and renal biopsy-confirmed glomerular disease were investigated retrospectively.None of them had renal artery stenosis or occlusive changes.Results Six patients with glomerulopathy,accounting for 3.75% of the 160 TA patients admitted to our hospital at the same period,were analyzed.All of them were females with a mean age of 35.5 ± 10.0 years.Four cases presented with lower extremity edema.Laboratory tests showed that one was nephrotic syndrome,three were nephrotic range proteinuria,and two of them had mild renal dysfunction.The other two patients were asymptomatic microscopic hematuria and proteinuria.Renal pathology revealed mild immunoglobulin A nephropathy in two cases,mild mesangial proliferative glomerulonephritis(GN),membranoproliferative GN,minimal change disease,and fibrillary GN in one case respectively.Five cases received glucocorticoids and cyclophosphamide therapy.Proteinuria and microscopic hematuria disappeared in 2 to 4 weeks after the initiation of therapy in three cases.The patient with membranoproliferative GN also reached complete remission of proteinuria and recovered renal function 6 months after the treatment.Conclusions TA may induce glomerular disease as a part of its histological spectrum.Apart from ischemic glomerular disease,glomerular disease should be suspected when TA patients have microscopic hematuria or proteinuria,that may be therapeutically responsive to glucocorticoids and immunosuppressive agent in relative early phase.

Helicobacter pylori and portal hypertensive gastropathy

To the Editor:H. pylori lives in the gastric epithelial cells, sometimes in gastric glands.Whetherornottheproliferationandbiologicalbehavior of H. pylori can be influenced by the status of the gastric mucosa is still unknown. Portal hypertensive gastropathy (PHG) is a blood drainage obstructive disease. In this pathologic environment, gastric mucosa may be further impaired when patients are infected with H. pylori. The role of H. pylori in the pathogenesis of PHG and

Postpartum Atypical Hemolytic Uremic Syndrome:an Unusual and Severe Complication Associated with Ig A Nephropathy

IGA nephropathy （IgAN） is one of the most commontypes of primary glomerulonephritis, which occursmore frequently in patients of reproductive age.Atypical hemolytic uremic syndrome （aHUS）without diarrhea is rare and has a poor prognosis. In theabsence of appropriate therapy, pregnancy-related aHUSis associated with high morbidity and mortality.

A new interpretation and quantitative method for diplopia test： 304 cases of ocular motor nerve palsy for clinical test and verify

We introduce a new interpretation and quantitative method for computerized diplopia test. By comparing this new method to the Hess screen test, we validate its applicability among 304 patients with ocular motor nerve palsy. This new method shows great assistant value as the Hess screen test in making accurate diagnosis and quantitative evaluation the severity of diplopia. Furthermore, it is more convenient and suitable for daily clinical use.

Compound heterozygous mutations in PMFBP1 cause acephalic spermatozoa syndrome:A case report

BACKGROUND Acephalic spermatozoa syndrome(ASS)is an extremely rare form of severe teratozoospermia,where in most of the sperm either appear to lack heads or have disconnected or poorly connected heads and tails.CASE SUMMARY We reported the case of a male patient with secondary infertility whose sperm showed typical ASS upon morphological analysis.Whole-exome sequencing was performed on the patient’s peripheral blood,which revealed two heterozygous variants of the PMFBP1 gene:PMFBP1c.414+1G>T(p.?)and PMFBP1c.393del(p.C132Afs*3).CONCLUSION It is speculated that the compound homozygous mutation of PMFBP1 may be the cause of ASS.We conducted a literature review in order to provide the basis for genetic counseling and clinical diagnosis of patients with ASS.

Lipids-induced Apoptosis Is Aggravated by Acyl-coenzyme A:Cholesterol Acyltransferase Inhibitor

Objective To investigate the role of acyl-coenzyme A:cholesterol acyltransferase inhibitor(ACATI) in apoptosis induced by lipids and whether lipids-induced apoptosis is accompanied by increase of free cholesterol in endoplasmic reticulum(ER),in order to further understand the mechanism of lipids-induced apoptosis in advanced atherosclerosis.Methods Human vascular smooth muscle cells(VSMCs) and phorbol 12-myristate 13-acetate(PMA) differentiated THP-1 macrophages were used.Tritiated thymidine incorporation was applied to detect cell proliferation.Cytotoxicity was assessed by lactate dehydrogenase(LDH) release.4',6-diamidino-2-phenylindole(DAPI) staining,caspase-3,-7 assay,and Annexin-V/propidium iodide(PI) staining were used to detect apoptosis.High performance liquid chromatography was used in intracellular free cholesterol and cholesterol ester assay.ER free cholesterol was quantified.Results Different lipids had different effects on proliferation and cytotoxicity of VSMCs.25-hydroxycholesterol(25OHC) had biphasic effects on the proliferation of VSMCs.At low concentration,it stimulated cell proliferation,but turned to proliferation inhibition as concentration reached 15 μg/mL.25OHC and acetylated low density lipoprotein(AcLDL) could respectively induce apoptosis in human VSMCs and PMA differentiated THP-1 macrophages,which was aggravated by ACATI,accompanied by increase of intracellular free cholesterol content.There was also an increase of cholesterol content in ER with AcLDL-induced apoptosis in THP-1 macrophages.Conclusions Lipids could induce apoptosis,accompanied by increase of intracellular free cholesterol content,which could be augmented by ACATI,suggesting that insults resulting in ER free cholesterol rise might be the initiator of apoptosis.

A Unique Case? Darier’s Disease Presented as Porcupine-Like Appearance and the Observation on Acitretin Treatment

Dyskeratosis follicularis (Darier’s disease, DD) is rare autosomal dominant disease characterized by hyperkeratotic papules that coalesce into plaques and occur primarily in seborrheic or intertriginous areas. Associated findings include nail abnormalities. A 3-year-old boy presented with porcupine-like appearance for 2 years. The lesion from the back was taken for light microscopy and electron microscopy. He was treated with acitretin (0.31 mg/d to 0.66 mg/d) for 8 years. Light microscopy and electron microscopy showed that the typical features of DD. The patient show good respond to the treatment. During 8 years treatment, the patient had dry mouth and pruritus. The skeletal abnormalities didn’t happen in the patient. The serum lipid profile, liver function and renal function within normal lever after treatment. Our findings showed that porcupine-like appearance is a unique pattern of DD. Acitretin may be a useful therapeutic agent in children with DD and less likely to cause skeletal problems.

内镜黏膜下剥离术治疗老年人大肠侧向发育型肿瘤的初步研究

目的回顾性对比分析老年人与中青年人大肠侧向发育型肿瘤(LST)的临床病理特点,探讨内镜黏膜下剥离术(ESD)对老年人大肠侧向发育型肿瘤的治疗效果。方法选取2011年9月-2016年9月在外院及该院检查发现,并在该院拟行ESD的LST患者,其中老年组(≥60岁)53例,中青年组(30~59岁)37例,比较老年组和中青年组的性别、病变形态分型、病变部位、病理类型、手术方法、平均住院时间及术后并发症等情况。结果病变形态分型,老年人以结节混合型(LST-G-M)为主,与中青年组比较,差异有统计学意义(P <0.05);中青年组以平坦隆起型(LST-NG-F)为主,与老年组比较,差异有统计学意义(P <0.05);两组pit pattern分型,老年人以Ⅲ_L型、Ⅳ型为主,青年组以Ⅱ型、Ⅲ_L型为主,Ⅱ型两组比较,差异有统计学意义(P <0.05);两组患者病变好发于直肠,尤其以老年组明显,与中青年组比较差异有统计学意义(P <0.05),其次是升结肠,其余均少见,左半结肠的发病率高于右半结肠;病理情况,老年组以管状绒毛状腺瘤为主,容易伴局部癌变,与中青年组比较差异有统计学意义(P <0.05)。结论老年人LST是大肠癌发病的高危人群,若老年人检查发现LST,排除手术禁忌后应及时行内镜下切除;ESD是治疗大肠LST的重要手段,尤其适合老年人LST的治疗,值得临床运用与推广。

Efficacy of intraorbital electroacupuncture for diabetic abducens nerve palsy： study protocol for a prospective single-center randomized controlled trial

Abducens nerve palsy（ANP） is commonly seen in patients with diabetes mellitus. The validity of acupuncture as a traditional Chinese medicine method in peripheral nerve repair is well established. However, its efficacy in randomized controlled trials remains unclear. Herein, we designed a protocol for a prospective, single-center, randomized controlled trial to investigate the effect of intraorbital electroacupuncture on diabetic ANP. We plan to recruit 60 patients with diabetic ANP, and randomly divide them into treatment and control groups. Patients in both groups will continue their glucose-lowering therapy. A neural nutrition drug will be given to both groups for six weeks. The treatment group will also receive intraorbital electroacupuncture therapy. We will assess efficacy of treatment, eyeball movement, diplopia deviation and the levels of fasting blood-glucose and glycosylated hemoglobin before treatment at 2, 4, and 6 weeks after treatment. The efficacy and recurrence will be investigated during follow-up（1 month after intervention）. This protocol was registered at Chinese Clinical Trial Registry on 16 January 2015（Chi CTR-IPR-15005836）. This study was approved by the Ethics Committee of First Affiliated Hospital of Harbin Medical University of China（approval number： 201452）. All protocols will be in accordance with Declaration of Helsinki, formulated by the World Medical Association. Written informed consent will be provided by participants. We envisage that the results of this clinical trial will provide evidence for promoting clinical use of this new therapy for management of ANP.

Therapeutic effect and apoptosis mechanism of lung-tonifying and expectorant decoction on lung cancer rats with Qi deficiency and blood stasis

Objective:To explore the effect and specific mechanism of lung-tonifying and expectorant decoction on lung cancer rats with Qi deficiency and blood stasis,and aim to provide a new idea on treating the disease with traditional Chinese medicine based on syndrome differentiation.Methods:A total of 60 C57BL/6J male rats were included in the study.The model of Qi deficiency and blood stasis was established in 60 rats by using multiple-factor stimulation.About 10 rats were randomly taken to verify whether the model establishment was successful and the rest of 50 rats were divided into 5 groups with 10 rats each:blank control group,cisplatin group,low dose group,medium dose group and high dose group.The blank control group was treated with normal saline,and cisplatin group was treated with cisplatin while the other three groups were treated with lung-tonifying and expectorant decoction at different doses.The volume change in transplanted tumor,tumor inhibition rate,apoptosis rate,and expression of Bc1-2,Bax.cleaved caspase-3 and cleaved caspase-9 in 5 groups were compared.Results:The rapidest growth rate of transplanted tumor volume was observed in blank control group and the slowest in cisplatin group.The growth rate was gradually decreased with the increasing dose of lung-tonifying and expectorant decoction,and the difference in growth of tumor volume among groups was statistically significant(P<0.05).The cisplatin group showed the highest tumor inhibition rate,with dose-dependent increase(P<0.05).The apoptosis rate in low dose group was higher than blank control group but lower than high dose group(P<0.05).The apoptosis rate in medium dose group was significantly higher man blank control group(P).05).The apoptosis rate in high dose group was significantly higher than control group(P<0.05).The positive expression rates of Bel-2 and Bax in all groups showed statistically significant difference(P<0.05),while expression of cleaved caspase-3 and cleaved caspase-9 in 5 groups was significantly different,with dose-dependent increase(P<0.05).Conclusions:The lung-tonifying and expectorant decoction inhibits the proliferation of tumor cells by inducing and activating the cell apoptosis in treatment of lung cancer with Qi deficiency and blood stasis,probably with good clinical therapeutic effect.

Adult reference values of the computerized diplopia test

AIM： To estimate the adult reference values for measured deviations by a computerized diplopia test and testify the validity.METHODS： Totally 391 participants were recruited and taken the computerized diplopia test. The plots and amplitude of deviations were recorded. The differences in different gender, age and visual acuity groups were analyzed respectively. Of 30 subjects were enrolled to testify the interobserver reliability. Another 46 subjects（including 26 normal subjects and 20 patients） were taken the test and theirs deviations were recorded to testify the validity of the reference value.RESULTS： The max horizontal and vertical deviations were 2.55° and 0.76° with normal corrected visual acuity while 3.88° and 1.46° for subjects with poor corrected vision. The differences between age groups was insignificant（Z =3.615, 4.758; P =0.461, 0.313 for horizontal and vertical respectively）. The max horizontal deviation of female was smaller than male（Z =-2.177; P =0.029）,but the difference in max vertical deviation was insignificant（Z =-1.296; P =0.195）. The mean difference between observers were both-0.1°, with 95% confidence limits（CI） of-1.4° and 1.6° in max horizontal deviations while-2.1° and 1.8° in max vertical deviation. The mean deviation of 26 normal subjects was 1.02° ±0.84° for horizontal and 0.47° ±0.30° for vertical which both within the range of reference values. The mean deviation of 20 patients was 13.51°±11.69° for horizontal and 8.34°±8.58°for vertical which both beyond the reference range.CONCLUSION： The max amplitude of horizontal and vertical deviation is pointed as the numerical parameters of computerized diplopia test. The reference values are different between normal corrected visual acuity and poor corrected vision. These values may useful for evaluating patients with diplopia in veriety conditions during clinical practice.

Diagnosis and Treatment of Infective Endocarditis in Chronic Hemodialysis Patients

Objective To analyze the clinical features of hemodialysis patients complicated by infective endo carditis. Methods The clinical features of six such patients admitted to Peking Union Medical College Hospital during the year 1990 to 2009 were analyzed. All of them were diagnosed based on Chinese Children Diagnostic Criteria for Infective Endocarditis. Results The average age of the six patients was 52.3±19.3 years old. Four were males. Vascular accesses at the onset of infective endocarditis were as follows： permanent catheters in three, temporary catheters in two, and arteriovenous fistula in one. Three were fbund with mitral valve involvement, two with aor tic valve involvement, and one with both. Five vegetations were found by transthoracic echocardiography, and one by transesophageal echocardiography. Four had positive blood culture results. The catheters were all removed. Four of the patients were improved by antibiotics treatment, in which two were still on hemodialy sis in the following 14-24 months and the other two were lost to follow-up. One patient received surgery, but died of heart failure alter further hemodialysis for three months. One was well on maintenance hemodi alvsis for three months after surgery. Conclusions Infective endocarditis should be suspected when hemodialysis patients suffer from long-term fever, for which prompt blood culture and transthoracic echocardiography confirmation could be performed. Transesophageal echocardiography could be considered even when transthoracic echocardiography produces negative findings. With catheters removed, lull course of appropriate sensitive antibiotics and surgery if indicated could improve the outcome of chronic hemodialysis patients complicated by infective cndocarditis.

Filaggrin mutations are associated with ichthyosis vulgaris in the Southern Chinese population

Filaggrin (FLG) plays an important role in the epidermal barrier function, which identified in patients with ichthyosis vulgaris(IV).To study the genetics of FLG mutations in Southern Chinese patients with IV. We evaluated the influence of five mutations (3321 delA, 441delA, 1249 insG, E1795X and S3296X) in a cohort of 65 IV Chinese patients and in 100 control individuals using the Sequenom? MassARRAY? system. The null allele frequency of 3321delA was 52.31%(34/65). FLG mutation 441delA was only found in one IV patients. FLG mutations 1249insG, E1795X and S3296X were not found in these patients. These findings show that the mutation 3321delA represent the most frequent genetic cause in Southern Chinese IV patients. Our findings confirm and extend the knowledge of the influence of FLG mutations in IV.

Non-Hodgkin's Lymphoma Primarily Presenting with Fanconi Syndrome and Acute Kidney Injury

KIDNEY involvement is common in non-Hodgkin＇s lymphoma （NHL） with incidence up to 30%-40% in autopsy studies. However, it us- ually occurs late in the course of the diseaseand is clinically silent. Clinically overt renal disease including acute kidney injury （AKI） as its primary manifestation is rarely reported, moreover, Fanconi syndrome （FS） is extremely rare as the main manifestation in NHL. In this report, we presented a case of NHL primarily presenting with FS and AKI due to diffuse interstitial infiltration of NHL cells and emphasized the important role of renal biopsy, especially renal immunohistochemical analysis in the diagnosis of renal diffuse lymphoma.

Disseminated Fusarium bloodstream infection in a child with acute myeloid leukemia:A case report

BACKGROUND Disseminated Fusarium is rare in healthy children.Children with hematological tumors may have secondary fungal infections,including Fusarium infections,which are due to tumor bone marrow infiltration or prolonged bone marrow suppression after chemotherapy.Because of the lack of typical clinical manifestations and effective antifungal drugs,early diagnosis and treatment of the disease are difficult,and the prognosis is poor.CASE SUMMARY The patient in this case was a 13-year-old female child with rash and fever as the first symptoms.She had the characteristics of the four stages of skin that are typical of Fusarium infection.She was diagnosed with disseminated Fusarium infection through skin biopsy and blood culture and diagnosed with Fusarium solani infection based on the morphological characteristics of the blood culture.After treatment with liposome amphotericin B combined with voriconazole,the child recovered.CONCLUSION This case highlights that for children with secondary agranulocytosis after receiving chemotherapy for hematological malignancies,once typical abnormal skin damage is found,the possibility of Fusarium infection should be considered,and voriconazole alone or in combination with polyenes may be the most effective anti-Fusarium drugs.Amphotericin B,the traditional drug of disseminated Fusarium disease,has a high mortality rate,and it is not recommended to use it alone.Adequate neutrophil counts are essential for the treatment of disseminated Fusarium bloodstream infection.

Single-shot phase-shifting digital holography with a photon-sieve-filtering telescope

A method of single-shot phase-shifting digital holography with a photon-sieve-filtering telescope is proposed.Three copy images with different phases are first generated by use of a monofocal photon-sieve filter in Kepler telescope,and then interfere with the reference plane wave by a beam combiner.The hologram is captured by a charge-coupled device(CCD)in one single exposure.The complex-valued amplitude of the test object can be reconstructed by three-step phase-shifting interferometry through three frames of extracted sub-interferograms from the single-exposure hologram.The principle and simulation experiments are carried out and verified the validity of our proposed method.This method can be applied for snapshot imaging and three-dimensional object construction.

Herschel Investigation of Cores and Filamentary Structures in the Perseus Molecular Cloud

Cores and filamentary structures are the prime birthplaces of stars,and play key roles in the process of star formation.Latest advances in the methods of multi-scale source and filament extraction,and in making highresolution column density map from Herschel multi-wavelength observations enable us to detect the filamentary network structures in highly complex molecular cloud environments.The statistics for physical parameters shows that core mass strongly correlates with core dust temperature,and M/L strongly correlates with M/T,which is in line with the prediction of the blackbody radiation,and can be used to trace evolutionary sequence from unbound starless cores to robust prestellar cores.Crest column densities of the filamentary structures are clearly related with mass per unit length(M_(line)),but are uncorrelated by three orders ranging from~10^(20) to~10^(22) cm^(-2) with widths.Full width at half maximum has a median value of 0.15 pc,which is consistent with the 0.1 pc typical inner width of the filamentary structures reported by previous research.We find 70%of robust prestellar cores(135/199)embedded in supercritical filaments with M_(line),>16 M⊙pc^(-1),which implies that the gravitationally bound cores come from fragmentation of supercritical filaments.On the basis of observational evidence that the probability distribution function with power-law distribution in the Perseus south is flatter than in the north,the number of young stellar objects in the south is significantly less than that in the north,and dust temperature is different.We infer that the south region is more gravitationally bound than the north region.

Efficacy of Leflunomide, Telmisartan, and Clopidogrel for Immunoglobulin A Nephropathy： A Randomized Controlled Trial

Background： The efficacy and safety of telmisartan combined with clopidogrel, leflunomide, or both drugs for immunoglobulin A nephropathy （IgAN） are unclear. This study was designed to evaluate the efficacy and safety of telmisartan combined with clopidogrel, leflunomide, or both drugs for IgAN. Methods： It is a multicenter, prospective, double-dummy randomized controlled trial. Primary IgAN patients were recruited in 13 renal units across Beijing, China, from July 2010 to June 2012. After a 4-week telmisartan （80 mg/d） wash-in, 400 patients continuing on 80 mg/d telmisartan were randomly assigned to additionally receive placebo （Group A）, 50 mg/d clopidogrel （Group B）, 20 mg/d leflunomide （Group C）, or 50 mg/d clopidogrel and 20 mg/d leflunomide （Group D）. The 24-week intervention was completed by 360 patients. The primary endpoint was change in 24-h proteinuria at 24 weeks. A linear mixed-effect model was used to analyze the changes at 4, 12, and 24 weeks. Generalized estimating equations were used to evaluate changes in hematuria grade. This trial was registered at the Chinese Clinical Trial Registry. Results： The effects oftelmisartan combined with leflunomide on changes in proteinuria （0.36 [95% confidence interval （CI） 0.18 0.55] g/d, P 〈 0.001）, in serum uric acid （76.96 [95% CI 57.44-96.49] μmol/L, P 〈 0.001）, in serum creatinine （9.49 [95% CI 6.54-12.44]μmol/L, P 〈 0.001）, and in estimated glomerular filtration rate （-6.72 [95% CI-9.46 to -3.98] ml.min -1. 1.73 m -2, p 〈 0.001） were statistically significant, whereas they were not statistically significant on changes in systolic and diastolic blood pressure and weight （P 〉 0.05）.Telmisartan combined with clopidogrel had no statistical effect on any outcome, and there was no interaction between the interventions. No obvious adverse reactions were observed. Conclusions： Telmisartan combined with leflunomide, not clopidogrel, is safe and effective for decreasing proteinuria in certain IgAN patients.