环磷酰胺联合糖皮质激素治疗IgA肾病的临床研究

目的观察环磷酰胺（CTX）联合激素治疗IgA肾病（IgAN）的疗效和安全性。方法选择IgAN患者56例，分别采用CTx加激素治疗（CTX组）及大剂量激素治疗（激素组）各28例，观察治疗前和治疗后6、12个月时的相关指标变化，并进行疗效评价。结果CTX组入组时eGFR显著低于激素组（P〈0.05），节段小球硬化明显高于激素组（P〈0.05），两组治疗6、12个月时的24h尿蛋白定量、收缩压、舒张压均较治疗前显著下降（P均〈O.05），血清白蛋白水平较治疗前显著升高（P〈0.05），CTX组12个月时的eGFR较治疗前显著上升（P〈0.05）。治疗12个月时CTX组的总有效率明显高于激素组（P〈0.05），而完全缓解率和部分缓解率的差异两组无统计学意义（P〉0.05）。两组不良反应类似（P〉0.05）。结论环磷酰胺联合激素治疗IgA肾病安全、有效，可在临床推广应用。

Clinical research of combination of cyclophosphamide and steroids in IgA nephropathy

Objective To investigate the efficacy and safety of combination of cyclophosphamide （CTX） and steroids in IgA nephropathy （IgAN）. Methods 56 IgAN patients were divided to CTX group treated with CTX and steroids and to steroids group treated with steroids. Relative parameters were recorded pretreatment and 6 and 12 months after treatment. The efficacy was evaluated. Results At admission, eGFR was significantly lower in CTX group compared with steroids group（P~0.05）, the percentage of segmental glomerular sclerosis was higher in steroids group（P〉0.05）. At 6 and 12 months after treatment, 24-hour urinary protein, systolic blood pressure and diastolic blood pressure significantly decreased compared to pretreatment in these two groups（all P〈0. 05）, serum albumin significantly elevated compared to pretreatment（P〈0.05）. In CTX group, eGFR was significantly elevated at 12 months after treatment than pretreatment（P〉0.05）. Overall effective rate 12 months after treatment was significantly higher in CTX group than in steroids group（P〈0.05）, while the difference of complete remission rate and partial remission rate had no statistic meanings （P〉0.05）. Adverse events were similar between these two groups（P〉0.05）. Conclusion The combination of cyclophosphamide can be considered as one effective and safe option to treat IgA nephropathy.