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目的 观察联合应用尿激酶(UK)和血管紧张素转换酶抑制剂(ACEI)苯那普利治疗IgA肾病(IgAN)的效果。方法 将71例Lee分级≥Ⅲ级的IgAN患者随机分为两组:UK+ACEI组及ACEI组,随访观察两组的疗效。结果 (1)12个疗程后,UK+ACEI组24h尿蛋白定量明显下降(P<0.01),血白蛋白(AIb)水平升高(P<0.05),疗效优于ACEI组。(2)治疗前应用Katafuchi IgA肾病积分系统进行IgAN的病理评分,在肾小球积分≥7分的患者中,治疗至12个疗程时,UK+ACEI治疗效果优于ACEI组(P<0.05)。(3)UK+ACEI组中有10例患者进行了重复肾活检,经治疗后多数患者病理改变保持稳定。结论 UK联合ACEI治疗中重度IgAN安全有效,疗效优于单用ACEI者。肾小球硬化及间质炎细胞浸润的程度可作为估计UK治疗IgAN效果的指标。
Objective To observe the effect of benazepril combined with urokinase (UK) and angiotensin converting enzyme inhibitor (ACEI) on IgA nephropathy (IgAN). Methods Seventy-one IgAN patients with Lee grade Ⅲ or higher were randomly divided into two groups: UK + ACEI group and ACEI group. The curative effect of the two groups were followed up. Results (1) After 24 courses of treatment, the urinary protein excretion of UK + ACEI group decreased significantly (P <0.01) and the level of serum albumin (AIb) increased (P <0.05). (2) The Katafuchi IgA nephropathy scoring system was used to evaluate the pathological score of IgAN before treatment, and the effect of UK + ACEI was better than that of ACEI group (P <0.05) in treatment of 12 courses of glomerular score≥7 points, . (3) Ten patients in the UK + ACEI group underwent repeated renal biopsy, and most of the patients remained stable after treatment. Conclusion UK combined with ACEI in the treatment of moderate and severe IgAN is safe and effective, and the curative effect is better than ACEI alone. The extent of glomerulosclerosis and interstitial inflammatory cell infiltration can be used as an index to estimate the effect of UK treatment of IgAN.