血清Gd-IgA1与伴有中度蛋白尿的IgA肾病的相关性分析  

Correlation analysis between serum Gd-IgA1 and IgA nephropathy with moderate proteinuria

作　　者：吴旭[1] 吴炜飞[1] 程志群[1] WU Xu;WU Weifei;CHENG Zhiqun(Department of Nephrology,Huzhou Central Hospital,Affiliated Cent Hospital Huzhou University,Huzhou 313000,China)

机构地区：[1]湖州市中心医院湖州师范学院附属中心医院肾内科,浙江湖州313000

出　　处：《中国现代医生》2022年第16期25-29,共5页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2020RC035);浙江省湖州市第二批科技计划立项项目(2019GYB52)。

摘　　要：目的 探讨伴有中度蛋白尿的IgA肾病患者血清Gd-IgA1水平及其与临床、病理及预后等的相关性。方法收集2019年1~12月在湖州市中心医院肾内科住院且尿蛋白定量为1~3.5 g/d的初次诊断为IgA肾病的患者90例,随机分为三组:A组(30例),单用ACEI/ARB;B组(30例),ACEI/ARB联合小剂量糖皮质激素(泼尼松0.5 mg/kg);C组(30例),ACEI/ARB联合小剂量糖皮质激素和霉酚酸酯(1.0~1.5 g/d),治疗时间为1年。同时选取30例健康体检者作为对照组(D组),收集治疗前、治疗1年后的临床资料,并检测血清Gd-IgA1,分析血清Gd-IgA1与伴有中度蛋白尿的IgA肾病患者临床、病理及预后的关系。结果 治疗前,与D组相比,A组、B组和C组患者的血清Gd-IgA1水平明显升高(均P<0.05)。治疗1年后,与A组相比,B组和C组的血清Gd-IgA1水平明显下降(均P<0.05)。B组和C组治疗后的血清Gd-IgA1水平较治疗前明显下降(均P<0.05)。治疗前后血清GdIgA1水平与同时期24 h尿蛋白定量、血肌酐呈正相关,与eGFR呈负相关(P<0.05)。与肾脏病理分级低的患者相比,肾脏病理分级高的患者肾穿刺时血清Gd-IgA1水平显著升高(P<0.05)。治疗1年后,B组和C组的部分缓解率和完全缓解率均高于A组,无效率低于A组,差异有统计学意义(均P<0.05)。结论 血清Gd-IgA1水平在伴有中度蛋白尿的IgA肾病患者中明显升高,且该水平与患者的24 h尿蛋白定量、血肌酐和肾脏病理等相关。对尿蛋白定量在1~3.5 g/d的IgA肾病患者,与单用ACEI/ARB相比,联用激素或联合免疫抑制剂治疗,预后可能更好。Objective To explore the serum Gd-IgA1 in IgA nephropathy patients with moderate proteinuria,and its correlation with clinical,pathological and prognostic indicators.Methods A total of 90 patients who were hospitalized in the Department of Nephrology in our hospital from January 2019 to December 2019, with a quantitative urine protein of1 to 3.5 g/d and were first diagnosed with IgA nephropathy were collected. They were randomly divided into three groups: Group A: 30 cases, ACEI/ARB alone;Group B: 30 cases, ACEI/ARB combined with low-dose glucocorticoid(prednisone 0.5 mg/kg);Group C: ACEI/ARB combined with low-dose glucocorticoid and Mycophenolate mofetil(1.0~1.5 g/d);Thirty health examination volunteers were selected as healthy control group(Group D). The clinical data before treatment and after 1 year of treatment were collected, and the serum Gd-IgA1 was detected, and the relationship between serum Gd-IgA1 and the clinical,pathological and prognosis of IgA nephropathy patients with moderate proteinuria was analyzed. Results Before treatment, compared with group D, the serum Gd-IgA1 level of patients in group A,group B and group C was significantly increased(all P<0.05). After 1 year of treatment, compared with group A, serum Gd-IgA1 levels in group B and C decreased significantly(all P<0.05).In group B and C, the serum Gd-IgA1 level was significantly decreased after treatment compared with that before treatment(all P<0.05).Before treatment and after treatment, serum Gd-IgA1 was positively correlated with 24-hour urine protein quantification, and blood creatinine, but negatively correlated with eGFR. Compared with patients with low renal pathological grade, patients with high renal pathological grade had significantly higher serum Gd-IgA1 levels at renal puncture(P<0.05). After 1 year of treatment,the partial remission rate and complete remission rate of group B and group C were higher than group A, and the inefficiency was lower than group A, the difference was statistically significant(all P<0.05) Conlusion S

关 键 词：Gd-IgA1 中度蛋白尿 IGA肾病 相关性 

分 类 号：R692.3[医药卫生—泌尿科学]