肾上腺皮质激素与ACEI/ARB治疗局灶节段性肾小球硬化临床疗效比较

目的:比较ACEI/ARB与肾上腺皮质激素对非肾病综合征表现的局灶节段性肾小球硬化(FSGS)患者的临床疗效。方法:回顾性分析34例原发性FSGS患者的临床表现、实验室指标及治疗情况,比较ACEI/ARB组与肾上腺皮质激素组的临床疗效。结果:本研究共纳入34例原发性FSGS患者,男22例,女12例,男女比例1.83∶1,中位发病年龄38(22～80)岁,ACEI/ARB组和激素组治疗后蛋白尿水平较基础值均下降,但两组在治疗3个月,6个月时降蛋白尿作用差异无统计学意义,治疗3个月,6个月,12个月及24个月的临床缓解率差异无统计学意义。结论:ACEI/ARB与单纯激素治疗非肾病综合征FSGS患者的疗效相当,今后有待开展大样本、多中心、前瞻性对照研究,为该类患者制定合理有效治疗方案提供理论依据。

The Efficacy of ACEI/ARB and Steroids in Treatment of Non Nephrotic Focal Segmental Glomerulosclerosis

Objective：To compare the efficacy of ACEI/ARB and steroids in treatment of non nephrotic focal segmental glomerulosclerosis （FSGS） with 24 - hour proteinuria between 1.5 and 3.5 g. Methods： 34 cases of primary FSGS were retrospectively enrolled in this study from 2006 to 2012 and analysis was done to compare the clinical characteristics, laboratory findings and efficacy of treatment between ACEI/ARB and steroids. Results ：There were a total of 34 cases of primary FSGS. Median age of onset was 38 （22 - 80） years. There were 22 male and 12 female patients and sex ratio was 1.83： 1. Proteinuria was declined compared with the basis of values in ACEI/ARB group and steroids group, however, there was no statistical difference in lowering proteinuria between two groups when followed up for 3 months, 6 months. The remission rate was similar between 2 groups at 3, 6, 12,24 months. Conclusion：The efficacy was similar between ACEI/ARB and steroids in treatment of non nephrotie FSGS. The prospective randomized controlled trial is needed to further provide with theoretical basis to develop reasonable and effective treatment.