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目的 观察甲基强的松龙冲击治疗合并部分新月体形成的IgA肾病的疗效及其对尿蛋白肾功能的影响。方法 经肾活检符合 1982年WHO诊断标准的IgA肾病患者 93例 ,均伴有新月体的形成 ,随机分成对照组和治疗组 ,对照组用强的松 1mg·kg-1·d-1+环磷酰胺 2mg·kg-1·d-1口服治疗 ,治疗组在对照组治疗方案基础上加甲基强的松龙 0 5～ 1 0g( 2 0mg·kg-1·d-1)加入生理盐水中静脉滴注 ,共观察 8周。两组治疗前后均观察浮肿程度、血压和 2 4h尿量 ,并检测 2 4h尿蛋白定量、尿红细胞计数 (uRBC)、尿肌酐、血肌酐 (Cr)、血尿素氮 (BUN)、血清白蛋白 (ALB) ,计算内生肌酐清除率 (Ccr) ,同时观察两组的副作用。结果 治疗 8周后两组患者 2 4h尿蛋白定量、尿RBC、血Cr、BUN明显下降 (P <0 0 1) ,ALB、Ccr明显升高 (P <0 0 1) ,但治疗组上述指标的改变均显著大于对照组 ( P <0 0 1)。治疗组治疗IgA肾病的总有效率和显效率均显著高于对照组 ( 81 3 %vs 62 2 % ,2 5 %vs 8 9% ,P 均 <0 0 5 ) ,两组病人治疗过程中的副反应无显著差别。结论 在口服强的松、环磷酰胺基础上加用甲基强的松龙冲击治疗合并部分新月体的IgA肾病可显著提高疗效 ,改善肾功能 ,而副作用无明显增加。
Objective To observe the effect of methylprednisolone therapy on the IgA nephropathy with crescent formation and its effect on urinary protein and renal function. Methods Ninety-three patients with IgA nephropathy who were diagnosed by WHO in 1982 according to the renal biopsy were randomly divided into control group and treatment group. The control group was treated with prednisone 1 mg · kg-1 · d-1 + Cyclophosphamide 2mg · kg-1 · d-1 oral treatment, the treatment group in the control group based on the treatment program plus methylprednisolone 0 5 ~ 1 0g (20mg · kg-1 · d-1) added to the physiology Saline intravenous infusion, were observed for 8 weeks. The degree of edema, blood pressure and 24 h urinary excretion were observed before and after treatment in both groups. Urinary creatinine, urinary creatinine, serum creatinine (Cr), blood urea nitrogen (BUN), serum albumin (ALB), calculated creatinine clearance rate (Ccr), while observing the two groups of side effects. Results After 24 weeks of treatment, urinary protein excretion, urinary RBC, blood Cr and BUN were significantly decreased (P <0.01) and ALB and Ccr were significantly increased in both groups (P <0.01) Were significantly greater than the control group (P <0.01). The total effective rate and markedly effective rate of IgA nephropathy patients in the treatment group were significantly higher than those in the control group (81.3% vs 62.2%, 25% vs 89%, P <0.05) No significant difference in side effects. Conclusions The oral administration of prednisone and cyclophosphamide combined with methylprednisolone shock treatment of IgA nephropathy combined with part of the crescent can significantly improve the efficacy and improve renal function, and no significant increase in side effects.