探讨低蛋白饮食对2型糖尿病早期肾病的影响

目的 探讨低蛋白饮食对2型糖尿病早期肾病在肾功能和营养状况方面的影响.方法 住院及门诊134例早期肾病患者,按就诊顺序分为低蛋白治疗组和正常蛋白组,实验期为1年.结果 两组患者体重指数、血常规及血液生化、血糖指标、肾功能等方面治疗后差异无统计学意义.治疗后两组间血清白蛋白比较差异有统计学意义.实验组尿白蛋白排泄率明显下降.结论 低蛋白膳食可以显著减少2型糖尿病早期肾病患者尿蛋白排泄率,从而改善营养状况,保护肾功能. Abstract： Objective To discuss the effect of a low-protein diet or type 2 diabitic nephropathy in renal function and nutritional aspect. Methods One hundred and thirty-four patients treated in hospital or by clinic doctors with microalbuminuria was conducted into two groups with 67 assigned to a protein-restricted diet and 67 assingned to normal protein diet in one year. Results In test group albuminuria decreased significantly (P<0.01).The patients blood glucose, total choiesterol,triglyceride,body mass inder (BMI) had not significant difference between two groups. Conclusions Protein-restricted diet beneficially reduced albuminuria in type 2 diabetes mellitus with microalbuminuria, so as to improve nutritional status and delay the development and progression of diabetic nephropathy.     

低分子量肝素在胸部肿瘤合并高凝血状态病人围术期的临床应用

目的 使用低分子量肝素(LMWH)预防胸部肿瘤合并高凝血状态病人的围术期血栓性疾病的发生.方法 对2006年1月至2007年10月我科收治的合并高凝血状态的食管癌、贲门癌、肺癌病人,在围术期皮下注射低分子量肝素,每日1次,从术前3～5 d开始直至病人下床,观察术中出血量及术后胸液量,并统计血栓性疾病发生率.结果 该组病人围术期血栓性疾病发生率得到了明显控制.结论 低分子量肝素对预防胸部肿瘤合并高凝血状态病人的围术期血栓性疾病的发生有明显效果,安全可靠. Abstract： Objective To evaluate the efficacy of low molecular weight heparin for preventing thromboembolism disease in perioperative of thoracic tumor with blood hypercoagulabale state. Methods From January 2006 to October 2007, we diagnosed and treated 72 patients with lung cancer and carcinoma of esophagus and cardia. All the patients were treated with LMWH qd from the 3 -5 days before operation until ambulation after operation. To observe the postoperative total amount effusion and to statistic of incidence of thromboembolism disease. Results Incidence of thromboembolism disease decreased more significantly of this group than usual. Conclusions Application of LMWH for preventing thromboembolism disease in periopetive of thoracic tumor with blood hypercoagulabale state is an effective, safe and reliable treatment.     

低分子肝素联合贝那普利治疗2型糖尿病肾病的临床分析

目的:探讨低分子肝素钠联合贝那普利治疗2型糖尿病肾病的临床疗效。方法:对我科收治的64例糖尿病肾病患者,在常规降糖、降脂治疗下,随机分为低分子肝素联合贝那普利治疗组(T组,n=32)及单用贝那普利对照组(C组,n=32)。治疗8周后,分别比较两组治疗前、后平均动脉压(MAP)、24h尿蛋白、血清白蛋白(ALB)、尿白蛋白排泄(UAER)、血肌酐(Scr)的变化。结果:治疗后两组UAER均较治疗前有显著下降(P<0.05),T组较C组降低更显著(P<0.05);两组ALB较治疗前升高,且T组升高较C组明显(P<0.05);两组MAP有所下降(P<0.05),但两组间比较无显著性差异(P>0.05);两组Scr治疗前、后及组间比较,差异无统计学意义(P>0.05)。治疗组未见明显不良副作用。结论:低分子肝素与血管紧张转化酶抑制剂联合应用可降低糖尿病肾病患者的尿蛋白,提升血清白蛋白,延缓糖尿病肾病进程。     

不同剂量替米沙坦联合低分子肝素治疗IgA肾病尿蛋白的临床观察

目的 探讨替米沙坦联合低分子肝素治疗对IgA肾病患者的尿蛋白、血压控制及肾功能的保护作用.方法 49例IgA肾病患者随机分成三组,第一组给予常规用量替米沙坦80 mg口服治疗;第二、第三组分别给予80 mg及160 mg不同剂量的替米沙坦治疗,且每日皮下注射低分子肝素钙4100U.检测血常规、血浆白蛋白、血尿素氮、血钾、血肌酐、尿蛋白定量等指标.结果 所有患者在服用替米沙坦和皮下注射低分子肝素钙后尿蛋白均有不同程度下降,总有效率:第一组为75.0％,第二组为75.0％,第三组为82.3％.结论 替米沙坦联合低分子肝素对IgA肾病患者有明显的降低蛋白尿的作用,大剂量替米沙坦组的治疗效果更显著(P＜0.01);对于非高血压的IgA肾病患者,服药前后血压均无明显差异(P＞0.05).     

体外肝素对血浆PT、APTT影响因素的研究及临床应用

目的 :探讨体外不同浓度肝素及不同浓度硫酸鱼精蛋白对血浆凝血酶原时间 (PT)、活化的部分凝血活酶时间 (APTT)的影响 ,了解该实验对PT、APTT真实结果及正确分析和判断。方法 :采用 0 .1U/mL～ 2 .0U/mL肝素 ,1.0 μg/mL～ 2 0 μg/mL硫酸鱼精蛋白 ,测定 2 4 0份随机标本分成的各组血浆标本的PT、APTT及加入上述试剂后的PT、APTT时间。结果 :肝素活性在 2 .0U/mL以下时对PT无明显影响 ,硫酸鱼精蛋白在 10 μg/mL以下时对PT、APTT亦无明显影响。肝素在 0 .2U/mL时对APTT影响非常明显 ,两者呈相关 (r =0 .98,P <0 .0 5 )。讨论 :临床上可采用回归方程△APTT =1.2 2 +30 .4 1A(A为肝素活性U/mL)回归方法验证 ,也可以用加硫酸鱼精蛋白中和后复测APTT的方法来纠正肝素对APTT的影响 ,对DIC的动态监测及治疗具有重要意义     

Baseline proteinuria, urinary osmotic pressure, and renal function as positive predictors of corticosteroids plus cyclophosphamide treatment efficacy in IgA nephropathy

Background Very limited data are available on factors predictive of corticosteroids plus cyclophosphamide treatment efficacy on IgA nephropathy （IgAN）.The aim of the study was to research the clinical factors predictive of treatment efficacy in IgAN.Methods One hundred and fifty-nine patients with IgAN （proteinuria ≥2 g/d and estimated glomerular filtration rate 30-89 ml·min-1·1.73 m-2） were treated with corticosteroids/cyclophosphamide followed by a 12-month follow-up.According to their response,these patients were divided into remission group （proteinuria ＜0.5 g/d） and non-remission group （proteinuria ≥0.5 g/d）,and their clinical data collected.Results In the present study,72.96％ of the individuals underwent a complete remission,and their response was related to baseline proteinuria,urinary osmotic pressure,and renal function （P ＜0.05）.Patients with baseline proteinuria more than 3 g/d,urinary osmotic pressure greater than 600 mOsm/L,and eGFR 60-89 ml·min-1·1.73 m-2 responded well to the combination of corticosteroids and cyclophosphamide （86.90％ vs.57.33％,P=0.000; 81.48％ vs.64.10％,P=0.014; 83.17％ vs.55.17％,P=0.000）.Conclusion The response to the combination of corticosteroids and cyclophosphamide might be well associated with baseline proteinuria,urinary osmotic pressure,and renal function in patients with IgAN.     

小剂量肝素对脓毒症大鼠凝血功能的影响

目的 探讨小剂量肝素对脓毒症大鼠凝血功能的影响.方法 健康雄性Wistar大鼠40只,随机分为正常对照组、内毒素2 h组、内毒素6 h组、内毒素+肝素2 h组,内毒素+肝素6 h组5组,每组8只,静脉注射LPS建立脓毒症模型.不同时间点测定各组大鼠血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)的变化.结果 与正常对照组相比,内毒素2 h组和内毒素6 h组PT及APTT的延长差异显著(P<0.01),内毒素+肝素2 h组与内毒素+肝素6 h组间PT,APTT差异有统计学意义(P<0.05);内毒素+肝素2 h组与内毒素2 h组相比,以及内毒素+肝素6 h组与内毒素6 h组相比,PT和APTT延长明显改善(P<0.05);内毒素+肝素6 h组与内毒素+肝素2 h组相比,PT和APTT无统计学差异(P>0.05).结论 肝素的早期应用可减缓PT、APTT的延长,改善脓毒症时发生的凝血功能障碍.     

低分子肝素对糖尿病大鼠早期肾脏病变的防护作用

目的探讨低分子肝素对实验性糖尿病大鼠早期肾脏病变的防护作用及机制.方法将大鼠随机分为正常对照组、糖尿病组和低分子肝素治疗组,每组各30只大鼠.分别于1、2、4周测定肌酐清除率、尿白蛋白、肾重、体重、肾脏肥大指数、部分凝血酶时间(APTT)和抗Xa因子活性,观察肾脏组织病理变化并进行体视学分析.结果低分子肝素治疗组于实验期间体重高于糖尿病组,第2、4周肌酐清除率分别为4.01 ml/min±0.39 ml/min及2.20 ml/min±0.34 ml/min;第4周尿24 h白蛋白为9.6 μg±3.0 μg,明显低于糖尿病组(P<0.05).APTT于治疗第2、4周分别为20.88 s和21.01 s,较糖尿病组延长(P<0.01),肾组织病理较糖尿病组有所改善.而两组血糖无明显差异(P>0.05).低分子肝素治疗组的肾脏肥大指数于1、2、4周分别为0.67±0.06,0.69±0.06、0.73±0.07(×102),高于糖尿病组(P<0.05).肾小球平均面积和体积密度于第4周时略高于糖尿病组,但无统计学意义.结论低分子肝素对糖尿病大鼠早期肾脏病变有一定程度的防护作用,其机制可能与改善肾小球内血液动力学有关.     

Evaluation on the Safety and Efficacy of Tirofiban in the Treatment of Acute Coronary Syndrome

To evaluate the safety and efficacy of tirofiban, a specific inhibitor of the platelet glyco- protein Ⅱb/Ⅲa receptor, in the treatment of unstable angina and myocardial infarction without per- sistent ST elevation (acute coronary syndrome, ACS), a total of 200 patients were randomly assigned to a heparin group and a tirofiban heparin group on double-blind basis and the treatment effects of the two protocols on ACS were compared when the patients of both groups were taking aspirin at the same time. The composite primary end-point events consisted of death, myocardial infarction, or re- fractory ischemia. Our results showed that the frequency of the composite primary end point events in 30 days was lower in tirofiban heparin group as compared with that of heparin group (13.9% vs 29.3 %, P=0.010). The rates of the other composite end point events in the tirofiban heparin group were also lower than those in the heparin group in 4.5 days and in 30 days. Bleeding complication occurred in 7.0% of the patients receiving heparin alone and in 12.7% of the patients receiving tirofiban and heparin in combination (P=0.1717). The study showed that the incidence of ischemic events in pa- tients with ACS receiving tirofiban heparin was lower when compared with that of patients who re- ceived only heparin and aspirin, suggesting that tirofiban might be of special value in the treatment of ACS.     

肝素对脓毒症大鼠肺损伤的影响

目的研究肝素对内毒素(LPS)诱导的脓毒症大鼠肺损伤的影响及血清组织因子途径抑制物(TFPI)含量的变化。方法将健康、雄性Wistar大鼠24只,随机分为正常对照组、LPS 2 h组、LPS+肝素2 h组,每组8只。尾静脉注射LPS建立脓毒症模型。于不同时间点处理大鼠后获得肺部组织,光镜下观察肺组织病理变化,进行比较;同时检测血清TFPI水平的变化。结果与正常对照组相比,LPS 2 h组和LPS+肝素2 h组血清TFPI均显著升高(分别为P<0.05,P<0.01);LPS+肝素2 h组与LPS 2 h组相比血清TFPI升高,差异有统计学意义(P<0.05)。病理观察发现正常对照组大鼠肺组织结构清晰,肝素干预组大鼠肺组织病理损害较LPS 2 h组减轻。结论肝素的应用可使脓毒症大鼠血清TFPI水平升高,显著改善大鼠肺组织的损伤。     

开搏通治疗SHR糖尿病大鼠对肾功能的影响

目的 :研究系统性高血压在糖尿病肾病发病机理中的作用 ,以及血管紧张素转换酶抑制剂开搏通 ( Captopril)治疗自发性高血压 ( SHR)糖尿病 ( DM)大鼠对肾功能的影响。　 方法 :建立起自发性高血压大鼠链脲菌素 ( STZ)诱导的糖尿病动物模型 ( SHR+DM) ,设立开搏通治疗组、常规三联降压组 (利血平 +肼苯哒嗪 +双氢克尿噻 )、未治疗组及正常对照组。测定 4周及 16周时肾功能包括尿白蛋白排泄量、肌酐清除率 ( Ccr)以及肾小球面积。　 结果 :与正常血压 WKY大鼠比较 ,4周及 16周的早期糖尿病 SHR大鼠即已存在肾功能变化 ,提示高血压可能在糖尿病肾病的发展中起重要作用。　 结论 :开搏通及常规三联降压治疗既能使 SHR+DM大鼠的血压降至正常 ,又可使肾功能变化得到改善 ,而前者作用明显优于后者     

血清同型半胱氨酸、胱抑素C及尿微量白蛋白联合检测在糖尿病早期肾病中的意义

目的分析糖尿病早期肾病患者应用血清同型半胱氨酸以及胱抑素C、尿微量白蛋白联合检测的价值。方法选取2017年10月～2018年12月我院193例2型糖尿病患者,分为单一糖尿病组(n=74)、早期糖尿病肾病组(n=62)、临床糖尿病肾病组(n=57),并选取67例健康体检人士为对照组,对比四组各项结果。结果临床糖尿病肾病患者m ALB、Cys C以及Hcy水平均明显高于其他组,早期糖尿病肾病组患者mALB、Cys C以及Hcy水平均明显高于单一糖尿病组(P0.05)。糖尿病各组患者mALB、Cys C以及Hcy水平均明显高于对照组(P0.05)。临床糖尿病肾病组患者均明显高于其他各组(P0.05)。早期糖尿病肾病组患者各项指标均高于单一糖尿病组患者(P0.05),糖尿病各组患者阳性检出率均明显高于对照组(P0.05)。Hcy+Cys C、mALB+Cys C、Hcy+mALB联合检测阳性检出率均明显高于单项检测(P0.05),Hcy+Cys C+mALB阳性检出率明显高于单项检测以及联合检测,差异有统计学意义(P0.05)。单项检测特异度以及敏感度差异均无统计学意义(P0.05),联合检测敏感特异度与单项检测特异度差异无统计学意义(P0.05),联合检测敏感度明显高于单项检测,差异有统计学意义(P0.05)。结论糖尿病早期肾病患者应用mALB、Cys C以及Hcy联合检测能够使阳性检出率以及敏感度得到显著提高。     

Doxium及Diamicron联合应用对大鼠糖尿病肾病防治的研究

目的为了提高糖尿病肾并发症的治疗效果。本实验考察了微循环改善药导升明(Doxium)与降血糖药达美康(Diamicron)联合应用对大鼠糖尿病肾病的防治作用。方法四氧嘧啶(Alloxan)3次皮下注射制备糖尿病大鼠模型,8周后经尿蛋白检测确定糖尿病肾病模型建立。将大鼠随机分成5组:①Doxium治疗组(Doxium,n=20):糖尿病肾病大鼠每天接受Doxium灌胃100 mg/kg;②Diamicron治疗组(Diamicon,n=20):糖尿病肾病大鼠每天接受Diamicron灌胃80 mg/kg;③Diamicron及Doxium联合用药组(Dox+Dia,n=20):糖尿病肾病大鼠每天接受Diamicron 40 mg/kg及Doxium 50 mg/kg灌胃;④糖尿病肾病模型鼠(DM,n=20):糖尿病肾病大鼠每天接受生理盐水灌胃;⑤正常对照组(Con,n=20):血糖正常的大鼠每天接受生理盐水灌胃。分别在药物治疗后4、8周检测大鼠的红细胞山梨醇含量、尿量、尿蛋白,在药物治疗后8周处死大鼠检测大鼠肾指数和肾脏脂质过氧化物(LPO)。结果Doxium及Diamicron合用明显改善红细胞山梨醇含量,肾组织LPO、尿量、尿蛋白等指标。结论提示Doxium及Diamicron合用较两药单独应用明显改善四氧嘧啶大鼠糖尿病肾病生理、生化指标,其机制可能与合用药物同时抑制蛋白非酶糖化、醛糖还原酶和氧自由基有关。     

不同抗凝剂对电化学发光法检测孕酮的影响

目的探讨不同抗凝剂对电化学发光法检测孕酮的影响。方法用普通真空采血管及含有肝素锂抗凝剂和柠檬酸钠抗凝剂的真空采血管各采取患者样本20例分别检测孕酮,以血清检测结果为标准,肝素锂抗凝血浆和柠檬酸钠抗凝血浆检测结果分别与其比对。结果肝素锂抗凝血浆与血清两组数据比较差异无显著性(P>0.05),柠檬酸钠抗凝血浆与血清两组数据比较差异有显著性(P<0.05),相关系数r=0.99,回归方程为y=0.84725x+0.5。结论使用肝素锂抗凝血浆电化学发光法检测孕酮对结果无影响,使用柠檬酸钠抗凝血浆检测孕酮结果须进行校正以修正抗凝剂的影响。     

Retrospective study of mycophenolate mofetil treatment in IgA nephropathy with proliferative pathological phenotype

Background Mycophenolate mofetil （MMF） and cyclophosphamide （CTX） are widely used in treating various kidney diseases.However,whether they are effective and which one is better for treating IgA nephropathy patients with proliferative pathological phenotype in renal diseases,such as endocapillary proliferation,cellular crescents,and/or capillary loops fibrinoid necrosis is still unknown.We,therefore,initiated a study to compare the effects of MMF and CTX in treating IgA nephropathy with the above pathological lesions.Methods One hundred and nineteen patients with IgA nephropathy who had at least one of the three aforementioned lesions were enrolled.All patients were treated with prednisone; 48 patients received prednisone only （Pred group）,40 received MMF and prednisone （MMF ＋ Pred group）,and 31 were treated with CTX and prednisone （CTX ＋ Pred group）.The median time of follow-up was 30 months （maximum：96 months）.The primary endpoint was defined as renal survival.The incidence of remission of proteinuria was the secondary endpoint.Results Serum creatinine in all groups declined significantly at different follow-up times （P=0.002）,and the differences among the three groups were significant （P＜0.001）.At 24 months of follow-up,the decline rates were 12.35％,32.95％,and 24.14％ in the Pred,MMF ＋ Pred,and CTX ＋ Pred groups respectively.For urine protein excretion,the decline rates were 49.12％ （Pred）,73.67％ （MMF ＋ Pred）,and 63.53％ （CTX ＋ Pred） respectively at 24 months of follow-up.The differences among the three groups were not significant （P=0.714）.Renal survival （the primary endpoint） was significantly different （P=0.027）; however,the sencondary endpoint was similar for all the three groups （P=0.100）.Conclusions For IgA nephropathy patients with endocapillary proliferation,cellular crescents,and/or fibrinoid necrosis of capillary loops,prednisone combined with MMF was more effective in lowering the serum creatinine than with CTX.Combined MMF and orednisone treatment led to a better renal survival compared to that of prednisone with CTX.     

胰岛素对游离脂肪酸所致大鼠内皮依赖性血管舒张功能损害的影响

目的：探讨游离脂肪酸（FFA）是否可独立直接地导致内皮细胞功能异常以及增强胰岛素作用,能否缓解FFA所致的内皮功能异常,方法：将SD雄性大鼠29只,分为4组,对照组大鼠5只经颈静脉插管输入生理盐水,FFA组9只采用脂肪乳＋肝素静脉输注,升高血FFA水平2－4倍,Ins组5只用正常血糖高胰岛素钳夹技术输入短效胰岛素;FFA＋Ins组10只,在脂肪乳＋肝素静脉输注的同时用胰岛素钳夹技术输入胰岛素,输液结束后处死动物,取出主动脉置于器官池中,通过力转换器,放大器以及电子计算机记录主动脉环的张力,观察离体主动脉环对乙酰胆碱或硝普钠的舒张反应。结果：对照组及Ins组内皮依赖性血管舒张功能（EDV）良好,FFA组EDV明显受损,FFA＋Ins组EDV介于对照组与FFA组之间,各组动物非内皮依赖性血管舒张功能无明显差别。结论：由于循环中FFA水平升高可直接导致内皮细胞功能异常,因此推测FFA具有致动脉粥样硬化的作用,而升高血中胰岛素浓度有助于部分缓解FFA所致的内皮依赖性血管舒张功能异常。     

药物配合护理干预对糖尿病肾病的治疗影响

目的：观察药物配合护理干预对糖尿病肾病的治疗影响。方法：40例糖尿病肾病患者平分为两组,均采用常规降糖、厄贝沙坦和低分子肝素钙治疗,治疗组患者在上述药物治疗的基础上,积极采用整体护理措施。结果：两组治疗前24 h尿蛋白定量、24 h尿清蛋白排泄率比较差异无统计学意义。两组治疗后24 h尿蛋白定量、UAER均显著下降（P〈0.05）,组间比较,治疗组优于对照组（P〈0.05）。治疗组患者满意度为90.0%,明显优于对照组的65.0%,差异具有统计学意义（P〈0.05）。结论：药物结合临床整体护理配合治疗糖尿病肾病能够更能显著减轻蛋白尿,保护肾脏功能,更有效的延缓肾病进展,同时提高患者满意度,值得推广应用。     

伊贝沙坦联合低分子肝素治疗糖尿病肾病的效果观察

目的观察低分子肝素联合伊贝沙坦治疗糖尿病肾病的疗效。方法80例糖尿病肾病患者随机分为对照组40例和实验组40例,在原有治疗方案基础上,对照组给予伊贝沙坦,实验组给予伊贝沙坦联用低分子肝素,治疗1疗程（4周）,观察治疗前后患者血压、肾功、24h尿蛋白、尿岛-MG及血尿酸的改变。结果治疗后两组肾功、24h尿蛋白、尿β2-MG及血尿酸均较治疗前有显著下降（P〈0．05）,实验组较对照组降低更为显著（P〈0．05）,并且无出血等并发症发生。结论低分子肝素联合伊贝沙坦可显著降低早期糖尿病肾病患者的24h尿蛋白,具有保护肾功能的作用。     

Effects of Heparin on Transforming Growth Factor-β_1 and Extracellular Matrix Components in the Glomeruli of Diabetic Rats

The key mechanism of diabetic glomerular scle-rosis is proliferation of mesangial cells and overaccu-mulation of extraceluar matrix(ECM) .Research onthis mechanism has been done in recent years,butreports on the relationship between growth factorandexpression of ECM,especially ordinary heparin' sregulation on this expression,are not enough in doc-uments. In orderto understand betterthe mechanismof diabetic nephropathy and prospect the clinical ap-plication of ordinary heparin' s preventive a…     

根据细胞周期序贯联合用药对阿霉素肾病大鼠的疗效

目的观察三种根据细胞周期序贯联合用药方案对阿霉素肾病大鼠的治疗效果并进行比较。方法38只大鼠随机分为正常对照组（n=6）、肾病组（n=8）和治疗组（n=24）。采用阿霉素诱导肾病大鼠模型。治疗组随机分为3组：Mp＋Cs＋CTX组、Mp＋Rap＋CTX组、Mp＋LEF＋CTX组,分别采取三种根据细胞周期序贯联合用药方案治疗4周。以S-丽春红法测24h尿蛋白定量,全自动生化仪检测血清总蛋白（TP）、白蛋白（ALB）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）。结果①肾病组大鼠24h尿蛋白定量显著高于正常对照组,3个治疗组的大鼠24h尿蛋白定量均显著低于肾病组;肾病组大鼠血清TP水平显著低于正常对照组,Mp＋Cs＋CTX组、Mp＋Rap＋CTX组的大鼠血清’T1）水平显著高于肾病组;肾病组大鼠血清ALB水平显著低于正常对照组,3个治疗组大鼠血清ALB水平均显著高于肾病组。②3个治疗组中Mp＋Cs＋CTX组的大鼠24h尿蛋白定量、血清TP、血清ALB水平与肾病组相比变化最为显著。结论三种根据细胞周期序贯联合用药方案对阿霉素肾病大鼠尿蛋白排出量增加和血清蛋白水平下降均有改善,其中激素联合Cs与CTX的治疗方案疗效最好。