上海交通大学学报（医学版）

›› 2013, Vol. 33 ›› Issue (2): 162-.doi: 10.3969/j.issn.1674-8115.2013.02.007

• 论著（临床研究） • 上一篇    下一篇

单纯激素、激素联合环磷酰胺和激素联合麦考酚酯治疗肾功能不全IgA肾病的临床研究

王伟铭, 贾晓媛, 潘晓霞, 沈平雁, 刘 剑, 徐丽梨, 李 娅, 王朝晖, 李 晓, 任 红, 张 文, 陈 楠   

  1. 上海交通大学 医学院附属瑞金医院肾脏科, 上海 200025
  • 出版日期:2013-02-28 发布日期:2013-03-07
  • 通讯作者: 陈 楠, 电子信箱: chen-nan@medmail.com.cn。
  • 作者简介:王伟铭（1965—）, 男, 主任医师；电子信箱: wweiming@medmail.com.cn。
  • 基金资助:

    卫生行业科研专项项目（201002010）；国家重点基础研究发展计划（973计划）（2012CB517700）；上海市科学技术委员会科研计划项目（08dz1900502）

Clinical study on treatment of IgA nephropathy with renal insufficiency by corticosteroid, corticosteroid combined with cyclophosphamide and corticosteroid combined with mycophenolate mofetil

WANG Wei-ming, JIA Xiao-yuan, PAN Xiao-xia, SHEN Ping-yan, LIU Jian, XU Li-li, LI Ya, WANG Zhao-hui, LI Xiao, REN Hong, ZHANG Wen, CHEN Nan   

  1. Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
  • Online:2013-02-28 Published:2013-03-07
  • Supported by:

    Scientific Research Foundation of Medical Profession, 201002010；National Basic Research Program of China, 973 Program, 2012CB517700；Shanghai Science and Technology Committee Foundation, 08dz1900502

PDF (PC)

1384

摘要：

目的 观察单纯激素、激素联合环磷酰胺（CTX）、激素联合霉酚酸酯（MMF）治疗伴慢性肾功能不全原发性IgA肾病（IgAN）患者的临床效果和安全性。方法 选取经肾穿刺确诊的原发性IgAN患者作为研究对象，慢性肾脏病 (CKD) 3~4期，肾脏病理表现为中度损伤。60例患者依照随机表进入本研究，分别采用单纯激素（单纯激素组，n=20）、激素联合CTX(激素+CTX组，n=20)、激素联合MMF（激素+ MMF组，n=20）的方案进行治疗。观察治疗期间患者的24 h尿蛋白定量、肾功能指标变化及治疗不良反应的发生情况。结果 随着治疗时间的延长，各组患者24 h尿蛋白定量均呈整体下降趋势；治疗3、6、12个月时的单纯激素组和激素+CTX组及治疗12个月时的激素+MMF组患者的24 h尿蛋白定量均显著低于基线值（P<0.05）。治疗6个月时的激素+CTX组和治疗3、6个月时的激素+MMF组患者的估算肾小球滤过率(eGFR)均显著高于基线值（P<0.05）。在治疗12个月时，各组患者的血清肌酐水平与基线值比较差异均无统计学意义（P>0.05）。激素+MMF组8例患者（8/20）在治疗3~4个月时发生严重肺部感染，患者的eGFR基线值显著低于本组未发生严重肺部感染的患者（P<0.05）。结论 单纯激素、激素联合CTX和激素联合MMF治疗均能显著降低伴肾功能受累的原发性IgAN患者24 h尿蛋白定量，治疗期间肾功能维持稳定；因存在发生肺部重度感染并发症的可能，在使用MMF治疗时必须严密随访。

关键词: 原发性IgA肾病, 慢性肾功能不全, 激素, 环磷酰胺, 霉酚酸酯

Abstract:

Objective To investigate the clinical efficacy and safety of corticosteroid, corticosteroid combined with cyclophosphamide (CTX) and corticosteroid combined with mycophenolate mofetil (MMF) in IgA nephropathy (IgAN) with renal insufficiency. Methods Patients confirmed as primary IgAN by renal biopsy were selected, with chronic renal disease (CKD) of 3-4 stage and moderate renal lesions. Sixty patients were enrolled, and randomly received corticosteroid therapy (corticosteroid group, n=20), corticosteroid combined with CTX therapy (corticosteroid+CTX group, n=20) and corticosteroid combined with MMF therapy (corticosteroid+MMF group, n=20). The 24 h urine protein, renal function parameters and adverse effect were observed during treatment. Results With the time of treatment, 24 h urine protein was gradually reduced in each group, and 24 h urine protein in corticosteroid group and corticosteroid+CTX group 3, 6 and 12 months after treatment and in corticosteroid+MMF group 12 months after treatment was significantly lower than the baseline(P<0.05). The estimated glomerular filtration rates (eGFR) in corticosteroid+CTX group 6 months after treatment and in corticosteroid+MMF group 3 and 6 months after treatment were significantly higher than the baseline (P<0.05). There was no significant difference between serum creatinine 12 months after treatment and the baseline in each group (P>0.05). Eight patients (8/20) in corticosteroid+MMF group suffered from serious pulmonary infection during treatment for 3 to 4 months, the baseline eGFR of whom was significantly lower than that of patients without serious pulmonary infection in corticosteroid+MMF group (P<0.05). Conclusion Twenty-four hour urine protein can be significantly decreased with corticosteroid therapy, corticosteroid combined with CTX therapy and corticosteroid combined with MMF therapy in patients with IgAN and impaired renal function, and stable renal function can be maintained during treatment. Intensive follow-up should be carried out in the treatment with MMF due to the possibility of occurrence of serious pulmonary infection.

Key words: IgA nephropathy, chronic renal function failure, corticosteroid, cyclophosphamide, mycophenolate mofetil