泼尼松联合霉酚酸酯结合中药治疗重症 IgA 肾病

摘要

目的：比较泼尼松联合霉酚酸酯（MMF）结合中药汤剂与泼尼松联合环磷酰胺（CYC）治疗重症IgA肾病的临床疗效。方法：84例重症IgA肾病患者根据入院先后顺序按随机原则分别给予泼尼松联合MMF结合中药汤剂治疗（MMF组，n＝42），或采用泼尼松联合CYC治疗（CYC组n＝42），持续12个月。两组患者基础病情无差异，随访时间18个月，观察两组患者临床缓解率以及相应实验室指标如24 h尿蛋白定量、血肌酐、血浆白蛋白、总蛋白、血脂变化，并比较两组治疗的不良反应。结果：1）临床缓解率：治疗18个月时MMF组临床总有效率高于CYC组，分别为85.7％ VS 61.8％（P＜0.05）；2）观察期末，MMF组患者24 h尿蛋白定量（0.6±0.3）明显低于CYC组（1.4±0.5）（P＜0.05），血浆白蛋白和总蛋白（43.2±4.3和70.2±8.1）均显著高于CYC组患者（36.9±3.6和60.3±7.6）（P＜0.05）；3）血脂变化：MMF组血脂较治疗前明显降低，而CYC组无变化（P＜0.05）；4）不良反应发生率：MMF组不良反应发生率（4.76％）明显低于CYC组（19.0％）。结论：泼尼松联合MMF治结合中药汤剂疗重症IgA肾病，临床缓解率高于泼尼松联合CYC静脉滴注疗法，能更有效降低患者24 h尿蛋白定量，改善患者血脂和血浆白蛋白水平，维持患者肾功能稳定，并且MMF不良反应发生率显著低于CYC疗法。%Objective:To compare efficacy of 1) Prednisone and mycophenolate mofetil (MMF) and herbal decoctions with 2) predni-sone and cyclophosphamide ( CYC ) for treating severe IgA nephropathy .Methods:Eighty-four patients with severe IgA nephropathy were randomly given prednisone and MMF and herbal decoction (MMF group, n=42), or treated with prednisone and CYC (CYC group n=42), for 12 months.Patients were of no difference in terms of basic illness severity .In 18-month followups, observe clinical effective rate and the corresponding laboratory indicators such as 24-hour urine protein quantitative , serum creatinine , serum albumin , total protein, serum lipid levels, and adverse event.Results:1) Effective rate:Total effective rate of MMF group was higher than that of the CYC group, 85.7%vs.61.8%(P<0.05);2) 24 h proteinuria in MMF group (0.6 ±0.3) was significantly lower than that of the CYC Group (1.4 ±0.5) (P<0.05), serum albumin and total protein (43.2 ±4.3 and 70.2 ±8.1) are substantially higher than those of the CYC Group (36.9 ±and 3.6 ±7.6) (P<0.05);3) Lipids:MMF group lipids significantly reduced after treat-ment, CYC groups showed no significant change (P<0.05);4) Adverse event: AE incidence of MMF Group (4.76%) was signifi-cantly lower than that of CYC Group (19%).Conclusion:Compared with prednisone and intravenous infusion of CYC therapy , Predni-sone and MMF combined with TCM treatment is more effective to treat severe IgA nephropathy , reduce the 24 h urinary protein , improve serum lipids and serum albumin level , maintain renal function , and have less adverse reaction .