不同剂量阿法骨化醇治疗IgA肾病的临床观察

目的:观察不同剂量阿法骨化醇治疗IgA肾病(IgAN)的临床疗效和安全性。方法:将62例IgAN患者按随机数字表法均分为对照组和观察组。两组患者均给予低盐、低脂、低蛋白饮食,维持原有肾素血管紧张素系统(RAS)阻滞药双倍剂量不变等常规治疗。在此基础上,对照组患者给予阿法骨化醇胶丸0.25μg,口服,qd;观察组患者给予阿法骨化醇胶丸0.5μg,口服,qd。合并高血压患者在血压不达标的情况下加服长效钙离子拮抗药控制血压。两组患者疗程均为12周。观察两组患者临床疗效,治疗前后血清胱抑素C(Cys-C)、血尿素氮(BUN)、血肌酐(Scr)、血钙(Ca)、血磷(P)、血全段甲状旁腺激素(iPTH)、24小时尿蛋白定量(24 hUTP)、平均动脉压(MAP)及不良反应发生情况。结果:治疗后观察组患者总有效率显著高于对照组,Cys-C、24 hUTP均显著低于对照组,差异有统计学意义(P<0.05)。两组患者治疗前后BUN、Scr、Ca、P、iPTH、MAP比较,差异均无统计学意义(P>0.05)。两组患者治疗期间均未见明显不良反应发生。结论:大剂量阿法骨化醇可更有效地降低IgAN患者尿蛋白水平、保护肾功能,且安全性较好。

Clinical Observation of Different Doses of Alfacalcidol in the Treatment of IgA Nephropathy

OBJECTIVE：To observe the clinical efficacy and safety of different dosage of alfacalcidol in the treatment of IgA nephropathy（IgAN）. METHODS：62 patients with IgAN were randomly divided into control group and observation group. Both groups were given low-salt,low-lipid and high-quality low-protein diet,and maintained previous conventional treatment as double dose of RAS block,etc. On this basis,control group was additional given Alfacalcidol capsule 0.25 ug orally once a day;observation group was additional given Alfacalcidol capsule 0.5 ug orally once a day. IgAN patients with hypertension were given long-acting calcium antagonist when the blood pressure was not up to the standard. Treatment course of 2 groups lasted for 12 weeks. Clinical efficacy,Cys-C,BUN,Scr,Ca,P,iPTH,24 h hUTP,MAP and ADR were observed in 2 groups before and after treatment.RESULTS：The total effective rate of observation group was significantly higher than that of control group;Cys-C and 24 hUTP of2 groups after treatment;there was statistical significance（P〈0.05）. BUN,Scr,Ca,P,iPTH and MAP of 2 groups had no statistical significance after treatment（P〉0.05）. No obvious ADR was observed in 2 groups. CONCLUSIONS：Large dose of alfacalcidol can effectively reduce proteinuria and protect renal function in patients with IgAN and shows good safety.