摘要
目的：观察甲泼尼龙片联合缬沙坦治疗IgA肾病的临床疗效及副作用.方法：60例IgA肾病患者,病理表现为LeeⅢ级以下、24h尿蛋白定量〉1.0g、血肌酐正常,随机分为3组：治疗Ⅰ组口服甲泼尼龙片1mg/（kg·d）,8～12wk后开始减量,每2wk减5mg,缬沙坦80mg/d;治疗Ⅱ组口服强的松1mg/（kg·d）,8～12wk后开始减量,每2wk减5mg,当强的松减至20mg/d时,改用甲泼尼龙片,总疗程1a,缬沙坦80mg/d;对照组口服强的松1mg/（kg·d）,8～12wk后开始减量,每2wk减5mg,总疗程1a,缬沙坦80mg/d,每组20例.3组患者基础病情无显著差异,随访时间≥18mo,疗效指标包括临床缓解率、24h尿蛋白定量和血脂变化.比较观察3组治疗的临床疗效和副作用.结果：①临床缓解率：治疗12mo时临床总有效率3组均〉70%（P〈0.05）,3组间疗效无显著差异;②24h尿蛋白定量的变化：3组治疗后24h尿蛋白定量均显著降低（P〈0.05）,3组间无显著差异;③血脂变化：3组治疗后血脂均明显降低（P〈0.05）,3组间无显著差异;④副作用：治疗Ⅰ组发生5例明显水肿而被迫改为强的松口服,治疗Ⅱ组及对照组无明显副作用.对照组停药后复发5例,而治疗Ⅰ,Ⅱ组停药半年内未见复发,对照组复发率明显高于治疗Ⅰ,Ⅱ组（P〈0.05）.结论：激素联合缬沙坦治疗IgA肾病有效.开始使用强的松,待维持剂量时改用甲泼尼龙组副作用及复发率均最低.
AIM：To observe the clinical efficacy and side effects of methylprednisolone tablets combined with valsatan in the treatment of IgA nephropathy. METHODS： Sixty cases of IgA nephropathy with degree Ⅲ Lee＇ s classification, 24-hour urine protein excretion more than 1.0 g, and normal serum level of creatinine, were divided into 3 groups at random, with 20 in each group. Patients took methyprednisolone 1 mg/（kg · d） plus valsatan 80 mg/d for 1 year in treatment group Ⅰ , or prednisone 1 mg/（kg · d） followed by methyprednisolone plus valsatan in treatment group Ⅱ, or prednisone 1 mg/（ kg. d） plus valsatan in control group. The patients were followed up for 18 months. Indices for therapy effect included clinical remission rate, 24-hour urine protein excretion and changes of blood lipid. RESULTS： Clinical total efficiency rate was more than 70% in all 3 groups （P 〈 0.05 ）, and there was no significant difference between the 3 groups. The 24-hour urine protein level and blood lipid decreased significantly in all 3 groups（ P 〈 0.05 ） , and there was no significant difference between the 3 groups. Five cases in treatment group Ⅰ complained edema so that they took prednisone instead. There was no significant side effects in treatment group Ⅱ and control group. Five cases relapsed after withdrawal in control group while there was no relapse in treatment group Ⅰ and Ⅱ within half a year of withdrawal. There was higher recurrence rate in control group than in two treatment groups （P 〈 0. 05 ）. CONCLUSION： Methylprodnisolone combined with valsatan is effective for IgA nephropathy. Prednisone is taken initially till keeping the dose, and then replaced by methylprednisolone to get the lowest side effect and recurrence rate.
出处
《第四军医大学学报》
北大核心
2008年第21期1997-1999,共3页
Journal of the Fourth Military Medical University
关键词
IgA肾小球肾炎
甲泼尼龙片
缬沙坦
治疗
glomerulo nephropathy, IgA
methylprednisolone tablets
valsatan
treatment
作者简介
刘晓渭．硕士，副主任医帅，副教授．Tel：（029）84775195803 E-mail：liuxiaow@fmmu．edu．cn
