尿激酶联合血管紧张素转换酶抑制剂治疗IgA肾病的疗效及其对PA／PAI的影响

75例Lee分级≥Ⅲ级的IgA肾病 (IgAN)患者随机分为单用血管紧张素转换酶抑制剂 (ACEI) (苯那普利 10mg/d)组 (A组 )及尿激酶 (UK)联合苯那普利组 (UA组 ) ,观察两组的疗效及联合用药对血浆PA/PAI的影响。治疗 3个月时UA组与A组总有效率分别为 6 9 5 7%、39 47% (P <0 0 5 )。A组尿NAG酶无显著变化 ,肌酐清除率 (Ccr)显著下降 ,PT及纤维蛋白原 (FIB)无显著变化。UA组尿NAG酶明显下降 ,Ccr无明显变化 ,PT延长 ,FIB水平明显降低 ,可使患者低下的血浆t PA及尿PA活性得以恢复 ,而不影响其血浆PAI 1水平 ,使血肌酐 (Scr)稳定 ,80 95 % ( 17/ 2 1)患者尿蛋白在 1 0g/d以下 ,37例中仅 3例轻微出血。结果表明 ,UK联合ACEI治疗中晚期IgAN疗效优于单用ACEI者 ,可使IgAN患者的纤溶能力提高 ,为一种安全有效的方案。

THE EFFECT OF UROKINASE COMBINED WITH ANGIOTENSIN CONVERTING ENZYME INHIBITOR ON IgA NEPHROPATHY AND PLASMA PA/PAI

75 cases with IgA nephropathy (IgAN) were divided into two groups:angiotensin-converting enzyme inhibitor treatment group(group A; Benazepril 10mg/d) and urokinase (UK) combined with Benazepril treatment group(group UA).After 3 months of treatment, the total effective rate in group UA was significantly higher than that in group A(69 57% vs 39 47%, P <0 05).In group A,Urinary NAGase did not change significantly, Ccr decreased significantly, but the contents of urinary NAGase, plasminogen time(PT) and plasma fibrinogen(FIB) did not change obviously.In group UA,Ccr was not influenced obviously,whereas the contents of urinary NAGase and FIB were decreased significantly.Meanwhile, PT was prolonged.The decreasing activity of plasma t-PA and urinary PA in patients with IgAN also recovered.UA did not influence the level of plasma PAI-1.It made Scr stable and the level of proteinuria was lower than 1 0g/d in 80 95% of patients(17/21).Only three of 37 patients manifested slight bleeding The results suggusted that UK combined with ACEI is an effective and safe therapy on IgAN with moderate to advanced pathological changes.