甲强龙冲击治疗小于25%新月体且非肾病综合征的IgA肾病的回顾性分析  

Retrospective study of methylprednisolone pulse treatment in non-nephrotic syndrome IgA nephropathy patients with less than 25% of crescents

作　　者：朱恒梅[1] 祝胜郎[1] 陈结慧[1] 杨芸 何艳[2] ZHU Hengmei ,ZHU Shenglang ,CHEN Jiehui ,et al.(1.Department of Nephrology,Nanshan People＇sHospital,Shenzhen 510082,China;2.First Clinical Medical College of Nanchang University,Nanchang 330006,China)

机构地区：[1]广东省深圳市南山区人民医院肾内科,深圳518067 [2]南昌大学第一临床医学院,南昌330006

出　　处：《江西医药》2018年第6期511-516,共6页Jiangxi Medical Journal

基　　金：2016年深圳市科技计划项目(编号JCYJ20160429181842402);2014年深圳市南山区科技计划资助项目(编号南科研卫2014054号)资助

摘　　要：目的探讨甲强龙冲击治疗肾脏病理为小于25%新月体(牛津分型:C1)且非肾病综合征的IgA肾病的疗效及安全性。方法回顾分析本中心2012年7月-2015年12月行肾穿刺活检确诊为C1且非肾病综合征的IgA肾病,选取其中联合ACEI(ARB)和甲强龙冲击治疗的患者33例,并随机选取其中单纯使用ACEI(ARB)的31例患者作为对照组,观察24-48个月,分析两组患者24h尿蛋白定量,肌酐清除率(eGFR)年平均下降速率,进入终末期肾病(ESRD)的发生率以及不良事件发生率。结果在48个月的观察期间,甲强龙组有0人进入ESRD,而对照组有3人(9.68%)进入ESRD。Kaplan-Meier生存分析提示两组ESRD发生率没有统计学差异(P=0.171)。甲强龙组eGFR年平均下降速率(-1.67 8.07mL/min/1.73m^2),明显低于对照组(3.82 7.84mL/min/1.73m^2)(P=0.008)。随访6个月、12个月时,甲强龙组尿蛋白完全缓解率及部分缓解率均高于对照组,有显著性差异。随访24个月时,甲强龙组尿蛋白部分缓解率高于对照组,但两组完全缓解率无统计学差异。随访36个月、48个月时两组完全缓解率及部分缓解率均无统计学差异。随访期间两组感染发生率(χ~2=3.355,P=0.067)及严重感染发生率(χ~2=3.226,P=0.072)无显著性差异,但甲强龙冲击治疗与感染有关联(OR=2.971,95%CI,0.903-9.780),与严重感染有较强关联(OR=8.077,95%CI,0.931-70.043)。随访期间,两组均无新发糖尿病、骨折、消化道出血、死亡病例。结论对于肾穿刺活检确诊为C1(>=1并<25%肾小球有新月体)且表现为非肾病综合征的IgA肾病患者,甲强龙冲击治疗对蛋白尿的早期缓解有益,且对蛋白尿的持续缓解及延缓eGFR下降有潜在获益。但同时因甲强龙冲击治疗与较高的感染率相关,进行治疗决策时需充分考虑其感染相关风险。Objective To investigate the efficacy and safety of methylprednisolone pulse treatment in non-nephrotic syndrome IgA nephropathy patients with less than 25% of crescents（Oxford classification：C1）. Methods We retrospectively analyzed nonnephrotic syndrome IgA nephropathy diagnosed as C1 by renal biopsy from July 2012 to December 2015,selected 33 patients with combined ACEI（ARB） and methylprednisolone pulse therapy,and randomly selected 31 patients who only use ACEI（ARB） as a control group. During a follow-up period of 24-48 months,we analyzed 24-hour Urine protein excretion,annual average rate of decrease of creatinine clearance（eGFR）,incidence of end-stage renal disease（ESRD）,and adverse events rate between the two groups. Results 0 of 33 patients in the methylprednisolone group and 3 of 31 in the control group reached ESRD by 48 months of follow-up（P=0.171）. The average annual eGFR decline rate in the methylprednisolone group（-1.678.07 mL/min/1.73 m2） was significantly lower than that in the control group（3.82 7.84 mL/min/1.73 m2）（P=0.008）. At 6 months and 12 months of follow-up,the complete remission rate and partial remission rate of urine protein in the methylprednisolone group were higher than those in the control group,with significant differences. At 24 months of follow-up,the partial remission rate of urinary protein in the methylprednisolone group was statistically higher（P=0.001）. There was no significant difference in complete/partial remission rate between the two groups at 36 months and 48 months of follow-up. During follow-up,there was no significant difference in the incidence of infection（χ~2=3.355,P=0.067） and severe infection（χ~2=3.226,P=0.072） between the two groups,but methylprednisolone pulse therapy was related with infection（OR=2.971,[95% CI,0.903-9.780]）,and was strongly related with severe infection（OR=8.077, [95% CI,0.931-70.043]）. And there were no new cases of diabetes,fractures,gastrointestinal bleeding,or deaths in both grou

关 键 词：IGA肾病 新月体 甲强龙 

分 类 号：R692.3[医药卫生—泌尿科学]