肾上腺糖皮质激素联合ACEI/ARB治疗原发性IgA肾病的疗效观察

目的 研究肾上腺糖皮质激素联合血管紧张素转化酶抑制剂或血管紧张素受体拮抗剂(ACEI/ARB)治疗原发性IgA肾病的疗效。 方法 利用笔者所在科室慢性肾脏病患者随访数据,选取其中经肾活检确诊并长期正规随访的原发性IgA肾病患者,按照其既往治疗方案,排除使用过其他免疫抑制及未使用ACEI/ARB治疗者,分为肾上腺糖皮质激素组(激素组)和对照组。收集并比较两组患者的各项临床指标及实验室结果。 结果 共入组92例患者,其中女性50例,占54.3%,激素组40例,对照组52例,平均随访时间27.8个月。随访中激素组无患者出现肌酐翻倍,对照组8例出现肌酐翻倍,其中2例进入透析。随访前激素组24h尿蛋白定量、舒张压高于对照组(P均<0.05)。随访末激素组舒张压、平均动脉压、24h尿蛋白定量低于对照组(P均<0.05)。对照组随访末血肌酐较随访前升高(P<0.05),激素组随访末血浆白蛋白较随访前升高(P<0.05)、随访末24h尿蛋白定量较随访前降低(P<0.01)。激素组eGFR(估计肾小球滤过率)随访中上升,对照组则下降,比较两者改变差值差异有统计学意义(P<0.05)。 结论 肾上腺糖皮质激素联合ACEI/ARB治疗能够减少IgA肾病患者尿蛋白,有效改善其预后。

Effect of Corticosteroid Plus ACEI/ARB Therapy for Primary IgA Nephropathy

Objective To assess the effect of corticosteroid plus angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) therapy for primary IgA nephropathy patients. Methods Patients with IgA nephropathy confirmed by renal biopsy were selected in long-term follow-up, and these patients who used other immunosuppressive agents or didn't accepte ACEI/ARB therapy were excluded. All enrolled patients were divided into two groups, corticosteroid group and control group. The clinical index and laboratory data of these patients were collected and compared. Results Totally 92 patients including 50(54.3%) women were enrolled, of which 40 cases were in corticosteroid group and the other 52 cases in control group. The average follow-up time was 27.8 months. At the end of follow-up, no patient had doubled creatinine in corticosteroid group while 8 in control group, of which 2 cases accepted hemodialysis. Before follow-up, the 24h hours urine protein and diastolic pressure in corticosteroid group were more or higher than the control group significantly (P<0.05). To the contrary, at the end of follow-up, 24h hours urine protein, diastolic pressure and mean arterial pressure were less or lower than control group obviously (P<0.05). In control group, the creatinine level increased at the end of follow-up compared to beginning (P<0.05). In corticosteroid group, the plasma albumin increased(P<0.01) and 24h hours urine protein decreased(P<0.05) obviously. The eGFR(estimated glomerular filtration rate) improved in corticosteroid group while declined in control group and the difference between two groups was significant(P<0.05). Conclusion Corticosteroid plus ACEI/ARB can effectively decrease the urine protein and improve the prognosis of patients with IgA nephropathy.