38例局灶增生硬化性IgA肾病患者的疗效观察

目的:观察足量激素和半量激素加吗替麦考酚酯两种方法治疗临床表现为肾病综合征的局灶增生硬化性IgA肾病患者的临床疗效及安全性。方法:38例肾病综合征患者,肾功能正常,经肾活检证实为原发性局灶增生硬化性IgA肾病,随机分为足量激素组(A组,20例)与半量激素加吗替麦考酚酯组(B组,18例),记录治疗前和治疗2月后两组患者的血浆白蛋白、24 h尿蛋白定量以及并发症等,采用两独立样本的t检验和χ2检验进行统计学分析。结果:较治疗前两组患者血浆白蛋白明显增加,24 h尿蛋白定量显著下降,差异有统计学意义(P<0.05);治疗2月后两组间血浆白蛋白、24 h尿蛋白定量比较差异无统计学意义(P>0.05);A组完全缓解率30.0%、部分缓解率45.0%、有效率75.0%,B组相应为22.2%、55.6%、77.8%,两组比较差异无统计学意义(P>0.05);A组满月脸和骨质疏松的发生率比B组高,差异有统计学意义(P<0.05)。结论:对于临床上表现为肾病综合征、肾功能正常的局灶增生硬化性IgA肾病患者,可选择足量激素和半量激素加吗替麦考酚酯两种方法进行初始治疗,后者较前者相对安全,并发症少,可适用于有经济条件的患者。

Observation of curative effect of 38 cases with focal hyperplasia hardening of IgA nephropathy

Objective: To observe the clinical efficacy and safety that enough glucocorticoid and half dose of glucocorticoid with mycophenolate mofetil were used to treat focal hyperplasia hardening of IgA nephropathy patients.Methods: 38 of nephrotic syndrome patients with normal renal function who were confirmed primary focal hyperplasia hardening of IgA nephropathy by percutaneous renal biopsy were observed.They were randomly divided into A group(20 cases,were given enough glucocorticoid) and B group(18 cases,were given half dose of glucocorticoid with mycophenolate mofetil).Before treatment and after treatment for 2 months of information of patients was recorded,such as plasma albumin,24 h urine protein,complications,et al.Two independent samples t-test and χ2-test were adopted to analyze data.Results: Comparing to before treatment,plasma albumin increased and 24 h urine protein decreased in two groups of patients.The difference was statistically significant(P<0.05).After treatment for 2 months,among the two groups in plasma albumin,24 h urine protein to compare difference not to have statistical significance(P>0.05).For A group,the complete remission rate of 30.0%,partial remission rate of 45.0%,eficiency of 75%,and for B group,the complete remission rate of 22.2%,partial remission rate of 55.6%,eficiency of 77.8%,the difference between the two groups was not statistically significant(P>0.05).The moon face and osteoporosis incidences of A group were higher than that of B group with significant differences(P<0.05).Conclusion: For focal hyperplasia hardening of IgA nephropathy patients(clinical manifestations was nephrotic syndrome with normal renal function),we suggest to use enough glucocorticoid or half dose of glucocorticoid with mycophenolate mofetil for initial therapy.The latter is a more safe treatment method with fewer complications,apply to the economic condition of the patients.