吗替麦考酚酯在原发性IgA肾病中的治疗作用

发布时间：2019-03-27 15:43

【摘要】：目的:通过比较糖皮质激素联合吗替麦考酚酯和单用糖皮质激素对我中心49例原发性IgA肾病患者的疗效,进一步评价吗替麦考酚酯在原发性IgA肾病中的治疗作用,以期为临床治疗提供决策依据。方法:收集2012年1月-2015年6月于吉林大学第二医院肾病内科住院治疗并经肾组织活检确诊为原发性IgA肾病的患者49例,入选患者均符合:1)24小时尿蛋白定量1.0g/d;2)血肌酐2mg/dl(176μmol/L);3)初次接受治疗。根据患者用药情况,分为治疗组(糖皮质激素联合吗替麦考酚酯)和对照组(单用糖皮质激素),其中治疗组患者21例,对照组患者28例,统计分析治疗前及治疗后第1、2、3、6个月临床资料。吗替麦考酚酯给药方案:吗替麦考酚酯起始剂量为1.0-1.5g/d,分两次服用,连续6个月。糖皮质激素给药方案:泼尼松起始剂量为0.6-1.0mg/(kg·d),最高不超过80mg/d,规律减量。对照组泼尼松剂量同治疗组。若患者肾活检组织病理光镜检查见纤维素样坏死或大量细胞性新月体,给予静脉甲泼尼龙0.5-1.0g/d冲击治疗,3天为1疗程,若患者临床指标未见明显好转,可于4天后再次给予第2疗程冲击治疗。结果:我们根据是否包括应用糖皮质激素冲击治疗的患者将结果分为两个部分。包括应用糖皮质激素冲击治疗的患者:治疗6个月后,治疗组11例完全缓解,4例部分缓解,6例无效,总有效率71.4%;对照组9例完全缓解,10例部分缓解,9例无效,总有效率67.8%;二者之间差异无统计学意义(P0.05)。治疗组尿蛋白定量低于对照组[(1.22±1.52)g/d vs(1.43±1.67)g/d],差异无统计学意义(P0.05)。不包括应用糖皮质激素冲击治疗的患者:治疗6个月后,治疗组10例完全缓解,4例部分缓解,2例无效,总有效率87.5%;对照组8例完全缓解,10例部分缓解,9例无效,总有效率66.6%;治疗组完全缓解率明显高于对照组(62.5%vs 29.6%),差异有统计学意义(P0.05)。治疗组尿蛋白定量明显低于对照组[(0.62±0.77)g/d vs(1.49±1.67)g/d],差异有统计学意义(P0.05)。两组不良反应发生率差异无统计学意义(P0.05)。结论:1.对于不伴纤维素样坏死或大量细胞性新月体的原发性IgA肾病,糖皮质激素联合吗替麦考酚酯的疗效优于单用糖皮质激素。2.吗替麦考酚酯在治疗原发性IgA肾病过程中未见明显不良反应。
[Abstract]:Objective: to compare the therapeutic effects of corticosteroids combined with metotrexate and glucocorticoid alone on 49 patients with primary IgA nephropathy in our center, and to evaluate the therapeutic effect of metotrexate on primary IgA nephropathy. In order to provide a decision-making basis for clinical treatment. Methods: 49 patients with primary IgA nephropathy diagnosed by renal biopsy from January 2012 to June 2015 in the Department of Nephropathy of the second Hospital of Jilin University were collected. The results were as follows: 1) the 24-hour urinary protein quantity was 1.0 g / d; 2) Serum creatinine (2mg/dl) (176 渭 mol / L); 3) was treated for the first time. According to the drug use, they were divided into two groups: treatment group (corticosteroids combined with mycophenolate ester) and control group (corticosteroids alone), in which 21 patients in the treatment group and 28 patients in the control group were treated with corticosteroids. The data were analyzed before and after the treatment. 3, 6 months clinical data. Regimen: the initial dose of meticol ester was 1.0-1.5 g / d and was given twice for 6 months in a continuous period of 6 months. The dose was 1. 0 and 1.5 g 路d-1 for 6 months, and the initial dose was 1.0-1.5 g / d. Glucocorticoid administration regimen: the initial dose of prednisone was 0.6-1.0mg/ (kg 路d), up to no more than 80 mg / d, regular reduction). The dosage of prednisone in control group was the same as that in treatment group. If pathological examination of renal biopsy tissue showed fibrin-like necrosis or a large number of cellular crescents, intravenous methylprednisolone 0.5-1.0g/d shock therapy was given for 3 days as a course of treatment, if the clinical parameters of the patients were not significantly improved. The second course of shock therapy can be given again after 4 days. Results: we divided the results into two parts according to whether they included patients treated with corticosteroids. Including patients treated with glucocorticoid shock: after 6 months of treatment, 11 cases in the treatment group had complete remission, 4 cases had partial remission, 6 cases had no effect, and the total effective rate was 71.4%. In the control group, 9 cases were completely relieved, 10 cases were partial remission, 9 cases were ineffective, and the total effective rate was 67.8%; there was no significant difference between the two groups (P0.05). The quantity of urinary protein in the treatment group was lower than that in the control group [(1.22 卤1.52) g / d vs (1.43 卤1.67) g / d], and there was no significant difference between the two groups (P0.05). After 6 months of treatment, 10 cases in the treatment group were completely relieved, 4 cases were partial remission, 2 cases were ineffective, and the total effective rate was 87.5%. The complete remission rate in the treatment group was significantly higher than that in the control group (62.5%vs 29.6%) (P0.05). The quantity of urinary protein in the treatment group was significantly lower than that in the control group [(0.62 卤0.77) g / d vs (1.49 卤1.67) g / d], the difference was statistically significant (P0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P0.05). Conclusions: 1. In the treatment of primary IgA nephropathy without fibrin-like necrosis or massive cellular crescents, glucocorticoid combined with mycophenolate ester is superior to glucocorticoid alone. 2. There was no significant adverse reaction in the treatment of primary IgA nephropathy.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R692.31

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