口服甲泼尼龙和泼尼松治疗IgA肾病的临床比较

目的 比较口服甲泼尼龙和泼尼松治疗IgA肾病（IgAN）的疗效和不良反应。方法 收集85例IgAN且口服肾上腺皮质激素（激素）治疗患者的临床资料，按照其口服激素的种类和频率，分为每日甲泼尼龙组MP-QD组，34例，甲泼尼龙0.4 mg/（kg·d）]，每日泼尼松组PDN-QD组，31例，泼尼松0.5 mg/（kg·d）]和隔日泼尼松组PDN-QOD组，20例，泼尼松0.5 mg/kg隔日1次]，比较3组患者的年龄、性别、血压、病理结果、不良反应以及治疗前后的血清肌酐、尿蛋白水平等临床资料。结果 经激素治疗后，3组患者的尿蛋白水平均比治疗前降低（P均< 0.05），组间比较差异无统计学意义（P > 0.05），3组患者治疗前后的血清肌酐水平无明显变化（P均> 0.05）。Kaplan-Meier生存分析显示，3组的无不良反应累积生存率比较差异有统计学意义（P < 0.05），其中MP-QD组的无不良反应平均生存时间最短。多因素Cox回归分析显示MP-QD组患者不良反应的发生风险分别是PDN-QD组患者的2.475倍（P = 0.045）、PDN-QOD组的5.814倍（P = 0.019）。结论 口服甲泼尼龙或泼尼松治疗IgAN患者，6个月的随访期间尿蛋白减少、血清肌酐水平无明显变化，口服甲泼尼龙患者的不良反应发生风险更高。

Comparable outcomes using oral methylprednisolone vs. prednisone in IgA nephropathy

Objective To compare the efficacy and side effects of oral methylprednisolone and prednisone in the treatment of IgA nephropathy. Method A total of 85 IgA nephropathy patients who were treated with oral corticosteroid were retrospectively analyzed. According to the type and frequency of oral corticosteroid, patients were divided into daily methylprednisolone group (MP-QD group(n = 34)： methylprednisolone 0.4 mg/(kg·d), daily prednisone group (PDN-QD group(n = 31)： prednisone 0.5 mg/(kg·d) and alternate day prednisone group (PDN-QOD group(n = 20)： prednisone 0.5 mg/(kg·qod). The clinical data of the patients were analyzed, including age, gender, blood pressure, pathological results, adverse reactions, and changes in serum creatinine and urinary protein quantity after corticosteroid therapy. Results After corticosteroids treatment, the urinary protein quantity was significantly decreased (P < 0.05), while serum creatinine was not significantly changed compared with those before corticosteroids treatment in 3 groups (all P > 0.05). Kaplan-Meier survival analysis showed that the cumulative free adverse reaction survival rate in 3 groups were statistically significant(P < 0.05), and the mean survival time without adverse reaction of the MP-QD group was the shortest. Multivariate Cox regression analysis showed that the risk of adverse reactions in MP-QD group was 2.475 times higher than that in PDN-QD group (P = 0.045) and 5.814 times higher than that in PDN-QOD group (P = 0.019),respectively. Conclusions Oral methylprednisolone or prednisone therapy in patients with IgA nephropathy significantly decreased the excretion of urine protein and no obvious change was found in the level of serum creatinine in 6-month follow-up period. However, more adverse effects were observed in the patients who received oral methylprednisolone.