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目的观察单纯激素、激素联合环磷酰胺(CTX)、激素联合霉酚酸酯(MMF)治疗伴慢性肾功能不全原发性IgA肾病(IgAN)患者的临床效果和安全性。方法选取经肾穿刺确诊的原发性IgAN患者作为研究对象,慢性肾脏病(CKD)3～4期,肾脏病理表现为中度损伤。60例患者依照随机表进入本研究,分别采用单纯激素(单纯激素组,n=20)、激素联合CTX(激素+CTX组,n=20)、激素联合MMF(激素+MMF组,n=20)的方案进行治疗。观察治疗期间患者的24 h尿蛋白定量、肾功能指标变化及治疗不良反应的发生情况。结果随着治疗时间的延长,各组患者24 h尿蛋白定量均呈整体下降趋势;治疗3、6、12个月时的单纯激素组和激素+CTX组及治疗12个月时的激素+MMF组患者的24 h尿蛋白定量均显著低于基线值(P<0.05)。治疗6个月时的激素+CTX组和治疗3、6个月时的激素+MMF组患者的估算肾小球滤过率(eGFR)均显著高于基线值(P<0.05)。在治疗12个月时,各组患者的血清肌酐水平与基线值比较差异均无统计学意义(P>0.05)。激素+MMF组8例患者(8/20)在治疗3～4个月时发生严重肺部感染,患者的eGFR基线值显著低于本组未发生严重肺部感染的患者(P<0.05)。结论单纯激素、激素联合CTX和激素联合MMF治疗均能显著降低伴肾功能受累的原发性IgAN患者24 h尿蛋白定量,治疗期间肾功能维持稳定;因存在发生肺部重度感染并发症的可能,在使用MMF治疗时必须严密随访。
Objective To observe the clinical effects and safety of simple hormones, hormones combined with cyclophosphamide (CTX) and hormone combined with mycophenolate mofetil (MMF) in patients with primary IgA nephropathy with chronic renal failure (IgAN). Methods Primary IgAN patients diagnosed by renal biopsy were selected as study objects. Chronic kidney disease (CKD) stage 3 ~ 4 and pathological renal manifestations were moderate injury. Sixty patients were enrolled in this study according to a randomized table. Hormone alone (n = 20), hormone combined with CTX (n = 20), hormone combined with MMF ) Of the program for treatment. Observe the 24 h urinary protein in patients during treatment, changes in renal function indicators and the incidence of adverse reactions. Results With the prolongation of treatment time, the 24-hour urinary protein in all groups showed an overall decreasing trend. The levels of hormones + MMF at 3, 6, and 12 months after treatment with hormone alone and hormone + CTX and at 12 months The 24 h urinary protein in the group of patients was significantly lower than the baseline (P <0.05). Estimated glomerular filtration rate (eGFR) was significantly higher in the hormone + CTX group at 6 months and in the hormone + MMF group at 3 and 6 months (P <0.05). At 12 months of treatment, there was no significant difference in serum creatinine between baseline and baseline values (P> 0.05). In the hormone + MMF group, 8 patients (8/20) developed severe pulmonary infection at 3 to 4 months of treatment. The baseline eGFR of patients in the hormone + MMF group was significantly lower than that of the patients without severe pulmonary infection (P <0.05). Conclusions Hormone alone, hormones combined with CTX and hormones combined with MMF can significantly reduce 24 h urinary protein in primary IgAN patients with renal involvement, and maintain renal function during the treatment. Complications due to severe pulmonary infection may be present , The use of MMF treatment must be followed up closely.