吗替麦考酚酯联合环磷酰胺对 IgA 肾病患者肾功能及 VEGF 水平的影响

摘要

目的：观察吗替麦考酚酯联合环磷酰胺（ CTX）对IgA肾病患者和血清血管内皮生长因子（ VEGF）水平的影响。方法选取2012年3月—2015年3月IgA肾病患者96例，根据随机数字表将患者分为观察组及对照组各48例。对照组给予吗替麦考酚酯持续治疗12个月，观察组在对照组基础上静脉滴注环磷酰胺1000 mg／次，每月1次，连续应用6个月。观察治疗1年后疗效、对比分析2组治疗前后肾功能及VEGF等指标的变化。结果观察组总有效率为95 q．83％，高于对照组的79．17％（χ2＝6．095， P ＝0．013）。与治疗前比较，2组治疗后SCr、BUN、24 hUP、VEGF均降低、CCr升高，差异均有统计学意义（ P ＜0．05）；治疗后BUN（4．33±1．24）mmol／L、SCr（86．92±14．67）μmol／L、24hUP（42．86±5．26）mg／24h、VEGF（109．64±23．78）ng／ml低于对照组的（7．98±2．53）mmol／L、（102．16±21．25）μmol／L、（85．36±4．28） mg／24h、（135．25±26．47） ng／ml，差异均有统计学意义（ t ＝5．754、4．824、7．265、5．963、5．469， P ＜0．05），而观察组Ccr为（55．98±22．02）ml／min，高于对照组的（46．32±18．63）ml／min（ t ＝5．963， P ＝0．000）。观察组不良反应率为6．25％（3／48），对照组为10．42％（5／48），差异比较无统计学意义（χ2＝0．545， P ＝0．462）。结论吗替麦考酚酯联合环磷酰胺能有效提高IgA肾病患者临床治疗效果，改善患者肾功能，安全有效，其作用机制可能与VEGF表达下调有关。%Objective To observe the effect of mycophenolate mofetil combined cyclophosphamide ( CTX) on IgA ne-phropathy and serum vascular endothelial growth factor (VEGF) in patients with diabetic nephropathy.Methods Ninty-six patients with IgA nephropathy from March 2012 to March 2015 were enrolled and divided into observation group and control group with 48 cases in each group.The control group was given to the mycophenolate mofetil continuous treatment of 12 months, the observation group on the basis of treatment in the control group, also intravenous infusion of cyclophosphamide 1000 mg/times, 1 times a month, for 6 consecutive months.After 1 years of treatment, the effect of the 2 groups were com-pared and analyzed the renal function and VEGF and other indicators of change before and after treatment.Results The total efficiency of observation group was 95.83%, which was higher than 79.17%in the control group (χ2 =6.095, P =0.013). Compared with before treatment, SCr increased, BUN, 24 hUP, VEGF, CCr were decreased after the treatment in the 2 groups, the difference was statistically significant ( P <0.05); after the treatment, BUN (4.33 ±1.24) mmol/L, SCr (86.92 ± 14.67) mol/L, 24hUP (42.86 ±5.26) mg/24h, VEGF (109.64 ±23.78) ng/ml were lower than that of the control group (7.98 ±2.53) mmol/L, (102.16 ±21.25) mol/L, (85.36 ±4.28) mg/24h,(135.25 ±26.47) ng/ml, the differences were statistically significant ( t =5.754, t =4.824, t =7.265, t =5.963, t =5.469, P <0.05);observation group's Ccr was(55.98 ±22.02) ml/min, which was higher than that of the control group(46.32 ±18.63) ml/min( t =5.963, P =0.000).The adverse reactions rate was 6.25%(3/48) in the observation group, control group was 10.42%(5/48),the difference between the two groups was not statistically significant(χ2 =0.545, P =0.462).Conclusion The clinical effect of mycophenolate mofetil combination of cyclophosphamide for IgA nephropathy patients with VEGF nephropathy can be effective.