激素间歇冲击及小剂量维持治疗IgA肾病的随机对照研究  

Corticosteroid Intermissive Pulse and Maintained Low-dose Therapy in IgA Nephropathy:a Randomised Controlled Clinical Trial

作　　者：熊子波[1] 罗琼[1] 熊祖应[1] 王青[1] 姜蕾[1] 邵进[1] 侯霜[1] 

机构地区：[1]北京大学深圳医院肾内科,北京518000

出　　处：《中国中西医结合肾病杂志》2007年第1期20-23,共4页Chinese Journal of Integrated Traditional and Western Nephrology

摘　　要：目的:探讨激素间歇冲击及小剂量维持与血管紧张素转换酶抑制剂治疗中度蛋白尿IgA肾病的疗效及其影响因素。方法:47例IgA肾病患者随机分为实验组和对照组。对照组(21例)给予ACEI药物治疗,实验组(26例)在此基础上口服泼尼松0.5mg/kg,隔日给药,治疗12个月,并在治疗的第1、3、5个月初分别给予甲基泼尼松龙0.5g/d,冲击3d。对肾脏病理改变进行WHO分级并对各种病变进行半定量分析。结果:两组间在性别、年龄、临床及病理资料间无统计学差异。平均随访14个月后,实验组尿蛋白完全缓解8例(30.8%),部分缓解14例(53.8%),无缓解4例(15.4%);而对照组分别为4例(19.1%),3例(23.8%),12例(57.1%),有统计学差异(P<0.01)。治疗前后,实验组血肌酐分别为(89.9±30.3)μmol/L及(88.2±32.8)μmol/L;对照组分别为(89.5±37.9)μmol/L及(104.0±49.7)μmol/L,但两者比较均无统计学意义(P>0.05)。多因素分析显示疗效与肾小球硬化率及肾小管间质病变呈负相关。结论:激素间歇冲击及小剂量维持治疗能显著减少蛋白尿,维持肾功能稳定。影响疗效的主要因素为肾小球硬化率及肾小管间质病变程度。Objective：To evaluate the effects of the steroid therapy and angiotensin converting enzyme inhibitor（ACEI） on IRA nephropathy, and to find the influencing factors of the therapeutic effects. Methods-we enrolled 47 consective patients who had biopsy-proven IgA nephropathy, proteinuria excretion of 1.0 g-3.5 g daily. Patients were randomly assigned either the control group（21patients,Benazepril 10mg per day） or the experiment group （26 patients, intravenous methylpredrfisolone 0.5 g per day for 3 consecutive days at the beginning of months 1,3 and 5, plus oral prednison 0.5 mg/kg on alternate days for 12 months）. Every pathological parmeter of glomerulus, tubulointerstitial and vascular were analyzed by using Katafuchi semi - quantitative standards. Results： There were no difference in baseline characteristics between the two groups. In the experiment group, 8 patients （30.8%） were complete remission, 14 patients （53.8%） were part remission and 4 patients（ 15.4% ） were no response, while in the control group, there were 4（19.1%）,3（23.8%） and 12 （57.1%） respectively （P〈0.01）.During the follow-up petiod, serum ereatinine contration was decreased from （89.9 ± 30.3）μmol/L to （88.2±32.8）μmol/L in the experiment group, while in the control group, serum creatinine concentration was increassed slightly from（89.5 ± 37.9）μmol/L to（104.0 ±49.7）μmol/L,but no significant difference（P〉0.05）.A logistic multivariate analysis showed significant correlations between theraputic effects and glomerulor sdemsis and tubulointerstitial lesions .Conclusion：Steroid therapy is effective in reducing proteinuria and protecting renal function in IgA nephropathy.Glomerulor sclerosis and tubulointerstitial lesions were confirmed as the affecting factors of influencing theraputic effects.

关 键 词：IGA肾病 激素 随机对照实验 

分 类 号：R692.3[医药卫生—泌尿科学]