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目的 对比研究麦考酚酸酯 (MMF)对IgA肾病的临床疗效、安全性和耐受性。方法 选择病理诊断IgA肾病IV～V级 (Lee分级 ) ,蛋白尿 >2 0g/d ,血肌酐 <35 5 μmol/L的患者共 6 2例 ,分为MMF组和对照组。MMF组初始剂量给MMF1 0g/d(体重 <5 0kg)或 1 5g/d(体重 >5 0kg) ,治疗 6个月后减量至 0 75～ 1 0g/d ,12个月后可减至 0 5～ 0 75g/d ;对照组给予醋酸泼尼松片 0 8mg·kg-1·d-1,规律减量。分别于治疗前及治疗后 3、6、12、18、2 4个月测定尿蛋白定量、尿N 乙酰氨基 β 葡萄糖苷酶酶 (NAG酶 )、内生肌酐清除率、血浆尿素氮、肌酐、白蛋白、甘油三酯、胆固醇及肝功能等多项临床指标。对MMF组 5例重复肾活检患者治疗前后的肾脏病理改变进行半定量分析。结果 (1)治疗3个月时 ,MMF组尿蛋白定量 (1 9g/2 4h± 1 6g/2 4h)较治疗前 (3 2g/2 4h± 1 7g/2 4h)明显减少 (P<0 0 1) ,白蛋白 (41g/L± 6g/L)较治疗前 (37g/L± 7g/L)明显升高 (P <0 0 1) ;但对照组尿蛋白定量(2 3g/2 4h± 1 9g/2 4h)、白蛋白 (30g/L± 7g/L)与治疗前 (2 9g/2 4h± 1 4g/2 4h、37 1g/L± 5 8g/L)比较差异无显著意义 (P >0 0 5 )。治疗 6、12及 18个月时 ,两组尿蛋白定量均较治疗前明显降低 (P<0 0 1) ,白蛋白均明显升高 (
Objective To compare the clinical efficacy, safety and tolerability of mycophenolate mofetil (MMF) on IgA nephropathy. Methods Sixty-two patients with pathological diagnosis of grade IV-V IgA nephropathy (Lee grade), proteinuria> 20g / d and serum creatinine <35 5 μmol / L were divided into MMF group and control group. The initial dose of MMF group was reduced to 0 75 ~ 1 0g / d MMF1 0g / d (body weight <50kg) or 15g / d (body weight> 50kg) 6 months after treatment and 12 months later 0 5 ~ 0 75g / d; control group given prednisone acetate tablets 0 8mg · kg-1 · d-1, regular decrement. Urine proteinuria, urine N-acetylglucosaminidase (NAGase), endogenous creatinine clearance, plasma urea nitrogen, creatinine, creatinine were measured before treatment and at 3,6,12,18,24 months after treatment. Albumin, triglycerides, cholesterol and liver function and many other clinical indicators. Semi-quantitative analysis of renal pathological changes in 5 patients with repeated renal biopsy before and after treatment in the MMF group was performed. Results (1) When treated for 3 months, urinary protein in MMF group was significantly lower than that before treatment (13g / 2 4h ± 1 6g / 2 4h) (P <0 (41g / L ± 6g / L) were significantly higher than those before treatment (37g / L ± 7g / L) (P <0.01) ± 1 9g / 2 4h), albumin (30g / L ± 7g / L) and before treatment (29g / 2 4h ± 1 4g / 2 4h, 37 1g / L ± 58g / L) was no significant difference (P> 0 0 5). At 6, 12 and 18 months after treatment, urinary protein in both groups was significantly lower than that before treatment (P <0.01), albumin was significantly increased