舒洛地特联合活性维生素D3 治疗IgA肾病的临床观察

摘要

Objective To investigate the effects of combined therapy with activated vitamin D3( calcitriol) and sulodexide in IgA ne-phropathy patients. Methods Sixty eight primary IgA nephropathy patients of Lee's Grade I to IV diagnosed by renal biopsy in our hospi-tal were enrolled. All patients were randomly divided into two groups. Group A (19 males and 15 females) were treated by telmisartan 80mg per day,and Group B (17 males and 17 females)were treated by telmisartan 80mg, calcitriol 0. 25μg/d, and sulodexide 600 LSU/day intravenous drip for 2 weeks, and then 250 LSU twice a day for 6 weeks. The serum creatinine(Scr), urea nitrogen(BUN), phos-phorus(P), calcium(Ca2+), 24 hour urinary protein (Tp/24h) and coagulation function(PT, APTT, TT, FIB) were measured at the experiment onset and 8 weeks later. Results There were no obvious adverse effects during the treatments in each group. There was no significant difference in the serum creatinine, urea nitrogen, phosphorus, calcium, and coagulation function indexes between the two groups neither at the experiment onset nor after 8 weeks (P>0. 05). Compared to experiment onset,24h urine protein were both significant-ly decreased (P < 0. 05) in the two groups after 8 weeks. Compared to group A(1. 72±0. 46g),24h urine protein in group B(1. 05±0. 32g) was significantly decreased after 8 weeks (P < 0. 05). Conclusion Combination therapy with calcitriol and sulodexide can reduce urine protein excretion in IgA nephropathy patients, and its renal protective effect was better than only telmisartan treatment.%目的 观察舒洛地特联合活性维生素D3 治疗IgA肾病的临床疗效. 方法 选取笔者医院经肾活检诊断的68例IgA肾病住院患者,按照数字表法将患者随机分为常规治疗对照组( A组)以及舒洛地特联合活性维生素D3 治疗观察组( B组) ,每组患者34例. A组患者使用替米沙坦 (80mg/d)治疗,B组患者在A组的治疗基础上联合应用舒洛地特(600 LSU,静脉滴注, 1次/天,疗程2周;然后序贯250 LSU,口服,2次/天,疗程6周)与活性维生素D3(骨化三醇0. 25μg/d)治疗,治疗时间为8周,观察两组患者治疗期间有无不良反应发生,治疗前后患者24h 尿蛋白定量、血清肌酐、尿素氮、血磷、血钙、凝血功能的变化.结果 两组患者治疗期间无严重不良反应(如高血压、低血压、高钾、高钙等)发生. 经过8周治疗,两组患者治疗前后血肌酐、尿素氮、血磷、血钙、凝血功能指标差异均无统计学意义(P>0. 05),治疗后两组患者24h尿蛋白定量较治疗前均有显著下降(P<0. 05),B组患者联合用药变化更明显,且与A组治疗后相比,差异也有统计学意义(P<0. 05). 结论 舒洛地特联合活性维生素D3 能更好地减轻IgA肾病患者蛋白尿,延缓其肾脏进展.