福辛普利联合缬沙坦治疗IgA肾病患儿的疗效及其对尿转化生长因子β1水平的影响

发布时间：2018-02-28 18:53

本文关键词： 福辛普利缬沙坦 IgA 肾病转化生长因子β1　出处：《安徽医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的IgA肾病(Immunoglobulin A glomerulo-nephritis,IgAN)是一组免疫病理特征以肾小球系膜区IgA沉积为主的临床综合征,临床上以血尿最为常见,此外还通常伴有蛋白尿,以及高血压、肾功能衰竭等,疾病呈慢性进展过程。目前,IgA肾病成为导致终末期肾病(End-stage renal disease,ESRD)的主要疾病之一。因此,近年来IgAN的治疗一直受到重视。然而其发病具体原因目前尚不知晓,也没有特异性治疗措施。当前对治疗IgA肾病合并蛋白尿的患者多在综合治疗基础上加用血管紧张素转换酶抑制剂(Angiotensin converting enzyme inhibitor,ACEI)药物,而将ACEI和血管紧张素II受体拮抗剂(AngiotensinII receptor antagonist,ARB)联合应用治疗IgAN的临床研究尚不多,然而我们临床上发现,联合应用ACEI和ARB不仅能减少单用ACEI药物所致副作用,而且临床疗效也显著改善。为此我们前瞻性观察了福辛普利与缬沙坦联合应用对IgA肾病患儿的治疗效果,并通过检测患儿尿转化生长因子β1(Transforming growth factor-beta,TGF-β1)水平的变化对该治疗机制进行了探讨。方法选取30例符合诊断标准及纳入标准的住院IgA肾病患儿,按照患儿家长知情同意后将其随机分为对照组和治疗组各15例;对照组采用综合治疗(按分级标准及临床表现给予包括糖皮质激素、双嘧达莫等)基础上加福辛普利治疗,治疗组在对照组的基础上加用缬沙坦治疗,随访终点为6个月;分别于治疗前、治疗后15天、1月、3月、6月检测血肌酐、血生化、血脂、尿敏感肾功能、24小时尿蛋白定量,同时检测尿TGF-β1水平。同时,选取我院同期体检的健康儿童15例为正常组,测定尿TGF-β1水平。结果1.治疗15天后,两组分别与治疗前相比较,尿蛋白定量与尿TGF-β1含量均无下降。2.治疗1个月后,对照组与治疗前相比较,尿蛋白定量及尿TGF-β1含量有下降,但差异无统计学意义(P0.05);治疗组与治疗前相比较,尿蛋白定量下降明显,差异有统计学意义(P0.05),尿TGF-β1含量虽有下降,但差异无统计学意义(P0.05)。3.治疗3个月后,两组与治疗前相比较,尿蛋白定量与尿TGF-β1含量均有明显下降(P0.05),且治疗组与对照组相比较,下降更显著(P0.05)。4.治疗6个月后,两组与治疗前相比较,尿蛋白定量与尿TGF-β1含量均有明显下降(P0.05),且治疗组与对照组相比较,下降更显著;但与同组治疗3个月相0比较,仅尿蛋白定量的下降差异有统计学意义(P0.05)。结论福辛普利合缬沙坦有较好的降低IgA肾病患儿尿蛋白的作用,可能与其早期改善肾纤维化作用有关。
[Abstract]:Objective Immunoglobulin A glomerulo-nephritis-IgANA is a group of clinical syndrome characterized by IgA deposition in glomerular Mesangial area. Hematuria is the most common clinical syndrome, in addition to proteinuria, hypertension, renal failure and so on. At present, IgA nephropathy is one of the major diseases leading to End-stage renal disease. Therefore, the treatment of IgAN has been paid more attention in recent years. However, the specific causes of the disease have not been known yet. There is also no specific treatment. Currently, patients with IgA nephropathy complicated with proteinuria are treated with angiotensin converting enzyme inhibitor ACEI on the basis of comprehensive therapy. However, there are few clinical studies on the combination of ACEI and angiotensin II receptor antagonist, Angiotensin II receptor antagonistritin, in the treatment of IgAN. However, we have found that the combination of ACEI and ARB can not only reduce the side effects of ACEI alone. For this reason, we prospectively observed the efficacy of fosinopril combined with valsartan in the treatment of children with IgA nephropathy. The therapeutic mechanism of TGF- 尾 1 was studied by detecting the level of transforming growth factor-beta1 in children. Methods 30 hospitalized children with IgA nephropathy who met the diagnostic criteria and were included in the criteria were selected. According to their parents' informed consent, they were randomly divided into control group (n = 15) and treatment group (n = 15). The control group was treated with fosinopril on the basis of comprehensive treatment (including glucocorticoid, dipyridamole, etc.) according to grading criteria and clinical manifestations. The treatment group was treated with valsartan on the basis of the control group and followed up for 6 months. Before treatment, 15 days after treatment, January, March and June, serum creatinine, blood biochemistry, blood lipids and urinary sensitive renal function were measured respectively. Urine TGF- 尾 1 level was measured simultaneously. Meanwhile, 15 healthy children in our hospital were selected as normal group, and urine TGF- 尾 1 levels were measured. Results 1.After 15 days of treatment, the two groups were compared with those before treatment. After one month of treatment, the urine protein and urine TGF- 尾 1 levels in the control group decreased, but there was no significant difference between the two groups (P 0.05). The quantity of urine protein decreased obviously, the difference was statistically significant (P 0.05), the content of urine TGF- 尾 1 decreased, but the difference was not statistically significant. After 3 months of treatment, the two groups were compared with those before treatment. Urine protein and urine TGF- 尾 1 content were significantly decreased in the treatment group compared with the control group, and the decrease was more significant than that in the control group. After 6 months of treatment, the two groups were compared with those before treatment. Urine protein quantity and urine TGF- 尾 1 content were significantly decreased in the treatment group than in the control group, but were significantly decreased in the treatment group than in the control group, but compared with that in the same group for 3 months. Conclusion fosinopril combined with valsartan has a better effect on reducing urinary protein in children with IgA nephropathy, which may be related to the early improvement of renal fibrosis in children with IgA nephropathy.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R726.9

【参考文献】