多种免疫抑制剂联用治疗以大量蛋白尿为主要表现的IgA肾病的疗效研究——附22例中期报告

目的：探讨泼尼松、麦考酚吗乙酯（mycophenolate mofetil，MMF）、环孢素联用治疗以大量蛋白尿（蛋白尿等于或大于3．5g／24h）为主要表现的IgA肾病的临床疗效及安全性。方法：42例经肾脏病理活组织检查确诊的IgA肾病患者，随机分别采取泼尼松联合MMF、环孢素治疗（试验组，22例）或标准剂量泼尼松治疗（对照组，20例），记录并比较2组治疗6个月的体重指数、收缩压、舒张压、血清肌酐、尿蛋白定量、肾小球滤过率等指标，观察2组不良反应的发生情况。结果：经过6个月的治疗，2组的蛋白尿均得到明显的缓解，其中试验组的尿蛋白从治疗前的（4．1±0．6）g／24h降至（0．8±0．1）g／24h（P〈0．01），对照组的尿蛋白则由治疗前的从（4．0±0．5）g／24h降至（1．8±0．1）∥24h（P〈0．01），试验组治疗6个月的尿蛋白定量明显少于对照组。治疗期间2组患者的体重指数、收缩压、舒张压、血清肌酐、肾小球滤过率均无明显变化（均为P〉0．05），试验组出现上呼吸道感染l例、带状疱疹1例，对照组出现上呼吸道感染1例，均经抗感染、抗病毒治疗后得到控制。试验组出现一过性转氨酶升高1例，予护肝治疗后恢复正常。2组均无因发生不良反应而退出研究者。结论：肾上腺皮质激素、MMF、环孢素联用治疗以大量蛋白尿为主要表现的IgA肾病疗效优于单用标准剂量肾上腺皮质激素，且其耐受性、安全性良好。

Immunosuppressant therapy using prednisone, mycophenolate mofetil and cyclosporine in IgA nephropathy with severe proteinuria: an interim report of 22 cases

Objective： To investigate the effect and safety of immunosuppressant therapy using prednisone, mycophenolate mofetil and cyclosporine in IgA nephropathy with severe proteinuria（ t〉3.5 g/24 h）. Methods： Forty-two patients with IgA nephropathy proved by biopsy were enrolled and randomly assigned into standard dose prednisone therapy group （ control group, 20 cases） and group, 22 cases）. The body mass index （BMI）, systolic （DBP） , serum creatinine （Scr） , urine protein and glomerular combined immunosuppressant therapy group （trim blood pressure （SBP）, diastolic blood pressure filtration rate （GFR） were regularly measured. The data of two groups were compared in the 6th month. Adverse effects were recorded. Results： After immunosuppressant treatment of 6 months, urine protein were significantly reduced compared with baseline in both groups. The urine protein of trial group decreased from （4. 1 ± 0. 6） g/24 h to （0. 8 ± 0. 1 ） g/24 h （P 〈 0. 01 ）, and that of control group decreased from （4. 0 ± 0. 5 ） g/24 h to （ 1.8 ± 0. 1 ） g/24 h （ P 〈 0. 01 ）. The urine protein in trial group was lower than that of control group. BMI, SBP, DBP, Scr and GFR were unchanged in both groups during the treatment（P 〉 0. 05 ）. Upper respiratory tract infections （one patient in control group, one patient in trial group） and the herpes zoster（ one patient in trial group） were observed and cured through antiviral therapy and antibiotic therapy. The temporary transaminase rise （one patient in trial group） was observed and cured through liverprotecting therapy. No patient withdrew from the study due to adverse effects. Conclusion： Combined therapy with prednisone, mycophenolate mofetil, and cyclosporine appears to be more effective, tolerated and safe than standard dose prednisone therapy in reducing proteinuria in IgA nephropathy patients with severe proteinuria.