激素联合血管紧张素转换酶抑制剂治疗中度蛋白尿IgA肾病的随机对照研究

目的探讨激素与血管紧张素转换酶抑制剂(ACEI)联合治疗中度蛋白尿IgA肾病患者的疗效及其影响因素。方法选择2003年5月—2009年1月在北京大学深圳医院住院的102例IgA肾病患者,均满足血肌酐<133μmol/L,尿蛋白为1.0～3.5 g/24 h。按照随机数字表分为试验组和对照组。对照组(50例)给予ACEI类药物治疗(洛汀新10 mg/d),试验组(52例)在此基础上口服泼尼松0.5 mg/kg,隔日给药,治疗12个月,并在治疗的第1、3、5个月初分别给予甲基泼尼松龙0.5 g/d,冲击3 d。对肾脏病理改变进行分级并对各种病变进行半定量分析。结果在0、2、4、6、8、10、12个月时两组患者平均24 h尿蛋白水平分别为:试验组(2.07±0.88)g/24 h、(0.82±0.66)g/24 h、(0.63±0.53)g/24 h、(0.56±0.51)g/24 h、(0.58±0.47)g/24 h、(0.57±0.48)g/24 h及(0.64±0.54)g/24 h;对照组(1.88±0.67)g/24 h、(1.67±0.75)g/24 h、(1.55±0.81)g/24 h、(1.24±0.77)g/24h、(1.44±0.92)g/24 h、(1.31±0.79)g/24 h及(1.28±0.85)g/24 h,两组在治疗2个月后尿蛋白水平间差异有统计学意义(P<0.01);而试验组和对照组的血肌酐水平在治疗期间均稳定,且两组间差异无统计学意义(P>0.05)。多因素分析显示激素联合ACEI治疗的疗效与肾小球硬化积分及肾小管间质积分呈负相关。结论激素联合ACEI治疗中度蛋白尿IgA肾病,能更有效降低尿蛋白,稳定肾功能。其中影响疗效的主要因素为肾小球硬化率及肾小管间质病变程度。

Corticosteroids Plus Angiotensin Converting Enzyme Inhibitor in Treating IgA Nephropathy: A Randomized Control Trial

Objective To evaluate the efficacy of the corticosteroids plus angiotensin converting enzyme inhibitor(ACEI) in treating IgA nephropathy and its influencing factors.Methods Totally 102 inpatients with IgA nephropathy hospitalized in Peking University Shenzhen Hospital were randomly enrolled.All of them met the inclusion criteria: serum creatinine above 133 μmol/L and urine proteins 1.0-3.5 g/24 h.These patients were divided into two groups: control group(n=50) and experiment group(n=52).The former were administered with Benazepril 10mg per day while the latter,on this basis,orally administered with methylprednisolone at a dose of 0.5 g per day,once every other day for 12 months,who also needed the therapy of pulse methylprednisolone at the beginning of the 1st,3rd and 5th months for three consecutive days.Renal pathology processed classification and semi-quantitative analysis.Results The 24 h urinary protein levels on average were(2.07±0.88)g/24 h,(0.82±0.66)g/24 h,(0.63±0.53)g/24 h,(0.56±0.51)g/24 h,(0.58±0.47)g/24 h,(0.57±0.48)g/24 h and(0.64±0.54) g/24 h in experiment group and(1.88±0.67)g/24 h,(1.67±0.75)g/24 h,(1.55±0.81)g/24 h,(1.24±0.77)g/24 h,(1.44±0.92)g/24 h,(1.31±0.79)g/24 h and(1.28±0.85) g/24 h in control group before treatment,two,four,six,eight,ten,and twelve months later respectively,and the difference two month after the treatment was significant(P<0.01).The serum creatinine level in both groups remained normal and no significant difference was found between the two groups(P>0.05).Logistic multivariate analysis showed the efficacy of steroid plus ACEI was negatively correlated to the scores of glomerulo sclerosis and renal tubulointerstitial.Conclusion Steroids plus ACEI is effective in reducing proteinuria and stabilizing renal function in patients with IgA nephropathy.Glomerulor sclerosis and tubulointerstitial lesions can affect the efficacy.