论文部分内容阅读
目的:观察轻中度肾衰竭Ig A肾病(Ig AN)患者不同肾脏病理活动积分应用免疫抑制治疗的疗效,分析其相关性,为提高Ig AN伴有肾衰竭患者疗效提供依据。方法:回顾性分析70例接受糖皮质激素(GC)或GC联合环磷酰胺(CTX)治疗合并轻中度肾衰竭[30 ml/min≤肾小球滤过率(e GFR)≤90 ml/min]的Ig AN患者的临床资料及病理资料。根据患者病理活动性病变积分占总积分百分比,比值的均数为47%,将患者分为低活动积分组(34例,<47%)和高活动积分组(36例,≥47%)。根据治疗方案不同将上述两组患者分别分为GC治疗组与GC联合CTX治疗组,其中低活动积分组使用GC治疗患者18例,GC联合CTX治疗组16例;高活动积分组使用GC治疗15例,GC联合CTX治疗21例。随访1年,记录所有患者治疗前后24 h尿蛋白定量、血清肌酐(Scr)和e GFR等临床数据,进行统计学分析。结果:(1)高活动积分组患者单用GC治疗组和GC联合CTX治疗组尿蛋白,在治疗6、12个月时尿蛋白水平较基线有明显下降,差异有统计学意义(P<0.01),Scr下降和e GFR上升较基线差异有统计学意义(P<0.05);(2)高活动积分组患者GC联合CTX治疗组在6、12个月时尿蛋白水平较单用GC组有明显下降(P<0.05),Scr和e GFR之间没有意义(P>0.05)。(3)低活动积分组GC治疗组与GC联合CTX治疗组在治疗6、12个月时尿蛋白水平较基线有所下降差异有统计学意义(P<0.05),Scr和e GFR较基线差异无统计学意义(P>0.05)。(4)高活动积分组较低活动积分组,尿蛋白、Scr和e GFR在治疗6、12个月时,组间结果分析,差异均有统计学意义(P<0.05)。结论:在轻中度肾衰竭Ig AN患者中,对于肾脏活动性病变较重的患者使用GC与GC联合CTX治疗可以降低患者尿蛋白水平、改善肾功能,且GC联合CTX较单纯GC治疗在降低患者尿蛋白上可以取得更好效果。
Objective: To observe the curative effect of immunosuppressive therapy in patients with IgA nephropathy (Ig AN) in patients with mild to moderate renal failure, and to analyze the correlation between them for improving the therapeutic effect of IgAN in patients with renal failure. Methods: A retrospective analysis of 70 patients receiving glucocorticoid (GC) or GC combined with cyclophosphamide (CTX) in patients with mild to moderate renal failure [30 ml / min ≤ glomerular filtration rate (e GFR) ≤ 90 ml / min] of Ig AN patients with clinical data and pathological data. Patients were divided into low activity score group (34 cases, <47%) and high activity score group (36 cases, ≥47%) according to the percentage of pathological active lesions in total score. The two groups were divided into GC group and GC combined with CTX treatment group according to the different treatment options. 18 cases were treated with GC in low active score group and 16 cases were treated with GC combined with CTX. The high activity score group was treated with GC 15 Cases, GC combined with CTX treatment of 21 cases. All patients were followed up for 1 year. The clinical data of 24 h urinary protein, serum creatinine (Scr) and e GFR before and after treatment were recorded and statistically analyzed. Results: (1) Compared with baseline, urinary protein in patients with high activity score group treated with GC alone and GC combined with CTX was significantly lower than that of baseline at 6 and 12 months (P <0.01) (P <0.05). (2) Compared with baseline, the level of Scr and eGFR increased significantly (P <0.05). (2) Compared with baseline, urinary protein levels in GC and CTX treatment group at 6 and 12 months (P <0.05). There was no significant difference between Scr and e GFR (P> 0.05). (3) There was a significant difference in urinary protein levels between the low-activity score GC group and the GC plus CTX group at 6 and 12 months (P <0.05), and the differences of Scr and e GFR from baseline No statistical significance (P> 0.05). (4) There was significant difference between the high activity group, low activity group, urinary protein, Scr and eGFR at 6 and 12 months after treatment, the results of the analysis between the groups were statistically significant (P <0.05). CONCLUSIONS: In patients with mild to moderate renal failure and IgAN, GC and GC combined with CTX may reduce urinary protein levels and improve renal function in patients with severe renal pathological changes, and GC combined with CTX is more effective than pure GC in decreasing Patients with urinary protein can achieve better results.