泼尼松联合霉酚酸酯结合中药治疗重症IgA肾病

目的：比较泼尼松联合霉酚酸酯（MMF）结合中药汤剂与泼尼松联合环磷酰胺（CYC）治疗重症IgA肾病的临床疗效。方法：84例重症IgA肾病患者根据入院先后顺序按随机原则分别给予泼尼松联合MMF结合中药汤剂治疗（MMF组,n=42）,或采用泼尼松联合CYC治疗（CYC组n=42）,持续12个月。两组患者基础病情无差异,随访时间18个月,观察两组患者临床缓解率以及相应实验室指标如24 h尿蛋白定量、血肌酐、血浆白蛋白、总蛋白、血脂变化,并比较两组治疗的不良反应。结果：1）临床缓解率：治疗18个月时MMF组临床总有效率高于CYC组,分别为85.7%VS 61.8%（P〈0.05）;2）观察期末,MMF组患者24 h尿蛋白定量（0.6±0.3）明显低于CYC组（1.4±0.5）（P〈0.05）,血浆白蛋白和总蛋白（43.2±4.3和70.2±8.1）均显著高于CYC组患者（36.9±3.6和60.3±7.6）（P〈0.05）;3）血脂变化：MMF组血脂较治疗前明显降低,而CYC组无变化（P〈0.05）;4）不良反应发生率：MMF组不良反应发生率（4.76%）明显低于CYC组（19.0%）。结论：泼尼松联合MMF治结合中药汤剂疗重症IgA肾病,临床缓解率高于泼尼松联合CYC静脉滴注疗法,能更有效降低患者24 h尿蛋白定量,改善患者血脂和血浆白蛋白水平,维持患者肾功能稳定,并且MMF不良反应发生率显著低于CYC疗法。

Prednisone and Mycophenolate Mofetil Combined with Traditional Chinese Medicine for Treatment of Severe IgA Nephropathy

Objective： To compare efficacy of 1） Prednisone and mycophenolate mofetil（MMF） and herbal decoctions with 2） prednisone and cyclophosphamide（CYC） for treating severe IgA nephropathy.Methods： Eighty-four patients with severe IgA nephropathy were randomly given prednisone and MMF and herbal decoction（MMF group,n = 42）,or treated with prednisone and CYC（CYC group n = 42）,for 12 months.Patients were of no difference in terms of basic illness severity.In 18-month followups,observe clinical effective rate and the corresponding laboratory indicators such as 24-hour urine protein quantitative,serum creatinine,serum albumin,total protein,serum lipid levels,and adverse event.Results： 1） Effective rate： Total effective rate of MMF group was higher than that of the CYC group,85.7% vs.61.8%（P 0.05）;2） 24 h proteinuria in MMF group（0.6 ± 0.3） was significantly lower than that of the CYC Group（1.4 ± 0.5）（P 0.05）,serum albumin and total protein（43.2 ± 4.3 and 70.2 ± 8.1） are substantially higher than those of the CYC Group（36.9 ± and 3.6 ± 7.6）（P 0.05）;3） Lipids： MMF group lipids significantly reduced after treatment,CYC groups showed no significant change（P 0.05）;4） Adverse event： AE incidence of MMF Group（4.76%） was significantly lower than that of CYC Group（19%）.Conclusion： Compared with prednisone and intravenous infusion of CYC therapy,Prednisone and MMF combined with TCM treatment is more effective to treat severe IgA nephropathy,reduce the 24 h urinary protein,improve serum lipids and serum albumin level,maintain renal function,and have less adverse reaction.