【摘要】 目的探讨多靶点疗法治疗慢性进展性中重型IgA肾病的临床疗效。方法选择确诊为慢性进展性中重型IgA肾病患者84例,按随机数字法均分为观察组与对照组。对照组给予贝那普利、缬沙坦及泼尼松治疗,观察组接受尿激酶、霉酚酸酯、泼尼松、贝那普利及缬沙坦等多药联合多靶点治疗,疗程均为12个月。疗程结束后比较两组临床疗效、平均动脉压(MAP)、24 h尿蛋白定量、血清白蛋白(ALB)及内生肌酐清除率(Ccr)等。结果对照组临床疗效总有效率为73.0%,观察组为90.0%,两组临床疗效比较,有显著性差异(Z=2.068,P=0.039)。观察组与对照组治疗前MAP、24 h尿蛋白定量、ALB及Ccr水平之间比较,差异均无统计学意义(P=0.819,P=0.732,P=0.509,P=0.244),治疗后两组之间比较,各指标变化均有显著性差异(P=0.017,P=0.006,P=0.000,P=0.000);对照组及观察组各指标治疗前后自身比较,差异均有统计学意义(均P<0.05)。两组除5例因剧烈咳嗽退出外,无严重不良反应发生。结论多药联合多靶点治疗慢性进展性中重型IgA肾病安全有效。更多还原

【Abstract】 Objective To investigate the clinical effect of multi target therapy in treatment of chronic moderate and severe IgA nephropathy. Methods 84 patients with chronic progressive moderate and severe IgA nephropathy confirmed by biopsy were enrolled and randomly equally divided into observation group and control group. The patients in observation group were treated with urokinase,prednisone,mycophenolate mofetil,benner pury and valsartan,while those in control group were treated with prednisone,benner pury and valsartan. After 12 months treatment,the clinical efficacy,mean arterial pressure( MAP),24h urine protein,serum albumin( ALB) and creatinine clearance rate( Ccr) were analyzed. Results The total clinical effectiveness of control group was 73. 0% and that of observation group was 90. 0%. There was significant difference between two groups( Z = 2. 068,P = 0. 039). About the level of MAP,albumin,24hour urinary protein and Ccr,there were no significant differences before treatment between two groups( P = 0. 819,P = 0. 732,P =0. 509,P = 0. 244),while after treatment there were significant differences between two groups( P = 0. 017,P = 0. 006,P = 0. 000,P =0. 000). There were all significant differences in each index of the two groups after being compared before and after treatment( P < 0. 05).Except for severe cough in two groups,there were no serious adverse reactions. Conclusions Multi target therapy of multi drugs combined is effective and safe in treatment of chronic progressive moderate and severe IgA nephropathy.更多还原