糖皮质激素联合环磷酰胺治疗原发性IgA肾病伴肾病综合征及肾功能不全的疗效分析  

Effect of glucocorticoid combined with cyclophosphamide in the treatment of primary IgA nephropathy with nephrotic syndrome and renal insufficiency

作　　者：张小荣[1] Zhang Xiaorong(Department of Nephrology, Yuncheng Emergency Center （Yuncheng Red Cross Hospital）, Yuncheng ,Shanxi 044000, Chin)

机构地区：[1]运城市急救中心运城市红十字会医院肾内科,山西省运城044000

出　　处：《中国基层医药》2018年第4期477-480,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的 探讨糖皮质激素联合环磷酰胺（cytoxan,CTX）治疗原发性免疫球蛋白A肾病（Immuno-globulin A nephropathy,IgAN）伴肾病综合征及肾功能不全的疗效.方法 选取70例原发性IgA肾病伴肾病综合征及肾功能不全患者作为研究对象,遵循单盲随机分配原则将患者分为各两组,每组35例,对照组给予单纯糖皮质激素治疗,观察组患者给予糖皮质激素、环磷酰胺联合治疗,比较两组肾功能指标、24 h尿蛋白水平、血清白蛋白水平、不良反应发生情况.结果 治疗后,两组患者的内生肌酐清除率、肾小球滤过率与治疗前比较均未出现下降（t=0.368、0.186、0.234、0.200,均P〉0.05）,其24 h尿蛋白均明显降低（t=4.417、9.576,均P〈0.05）,血清白蛋白水平明显增高（t=5.922、9.433P〈0.05）,而两组治疗后内生肌酐清除率[（16.23±7.57）mL/min比（16.09±7.69）mL/min]、肾小球滤过率[（37.12±9.52）mL/min比（37.64±9.67）mL/min]差异均无统计学意义（t=0.077、0.227,均P〉0.05）,观察组治疗后的24 h尿蛋白水平（1.18±0.30）g、血清白蛋白水平（36.24±2.39）g/L优于对照组[（1.50±0.27）g、（33.92±2.07）g/L,t=4.691、4.341,均P〈0.05）];治疗期间,观察组的不良反应发生率（25.71％）与对照组（22.86％）比较差异无统计学意义（χ2=0.078,P〉0.05）.结论 糖皮质激素与环磷酰胺联用可在一定程度上减少IgA肾病伴肾病综合征及肾功能不全患者的尿蛋白,提高血清白蛋白浓度,但其与单纯应用糖皮质激素相比,对肾功能并无明显的额外改善作用,且不良反应较为严重,临床上应谨慎使用.Objective To explore the effect of glucocorticoid combined with cyclophosphamide （ cytoxan, CTX） for the treatment of primary immunoglobulin A nephropathy （ IgAN ） with nephrotic syndrome and renal insufficiency .Methods 70 IgAN patients with nephrotic syndrome and renal insufficiency were selected as the research subjects,According to randomized single blind ,the patients were randomly divided into two groups ,35 cases in each group .The control group was treated with glucocorticoid ,the observation group was treated with glucocorticoid and cyclophosphamide combination therapy .The renal function indicators ,24 hour urine protein level ,serum albumin level,the occurrence of adverse reactions were compared between the two groups .Results After treatment, the endogenous creatinine clearance rate and glomerular filtration rate of the two groups were not decreased compared with before treatment （t =0.368,0.186,0.234,0.200,all P 〉0.05）,the 24 hour urinary protein were decreased significantly （t=4.417,9.576,all P〈0.05）,serum albumin levels were significantly increased （t=5.922,9.433, all P〈0.05）.After treatment,the endogenous creatinine clearance rate [（16.23 ±7.57） mL/min,（16.09 ± 7.69）mL/min],glomerular filtration rate [（37.12 ±9.52） mL/min,（37.64 ±9.67） mL/min] between the two groups had no statistically significant differences （t=0.077,0.227,all P〉0.05）.After treatment,the 24 -hour urinary protein level and serum albumin level of the observation group [（1.18 ±0.30）g,（36.24 ±2.39）g/L]were better than those of the control group[（1.50 ±0.27）g,（33.92 ±2.07）g/L,t=4.691,4.341,all P〈0.05].During the treatment, the incidence rate of adverse reactions in the observation group （ 25.71％） had no statistically significant difference compred with that in the control group （22.86％） （χ2 =0.078,P〉0.05）.Conclusion For IgAN patients with nephrotic syndrome and renal insufficiency , glucocorticoid combined with cyclophosphamide can reduce the

关 键 词：肾病 脂性 免疫球蛋白A 肾机能不全 糖皮质激素 环磷酰胺 

分 类 号：R692[医药卫生—泌尿科学]