摘要
目的观察来氟米特联合中小剂量糖皮质激素治疗进展性IgA肾病患者的临床效果及其对尿血管细胞黏附分子(VCAM)-1水平的影响。方法符合条件的3个月内接受肾脏活组织检查、蛋白尿>1.0g/d、Lee氏Ⅱ～Ⅳ级的IgA肾病患者随机入组来氟米特+糖皮质激素治疗组(LEF组)和糖皮质激素治疗组(激素组)。LEF组予口服来氟米特联合泼尼松治疗,来氟米特的起始剂量为40mg/d顿服,3d后减量至20mg/d顿服;泼尼松的起始剂量为0.8mg.kg-1.d-1(最大剂量40mg/d)顿服,4～6周后逐步减量,总疗程为1年。激素组予口服泼尼松治疗,起始剂量为1mg.kg-1.d-1(最大剂量60mg/d)顿服,8～12周后逐步减量。采用酶联免疫吸附试验(ELISA)检测治疗前和治疗6个月时尿VCAM-1水平。结果共36例患者入选,LEF组和激素组各18例。LEF组治疗6个月时的尿VCAM-1水平中位数为23.5ng/L(6.1～332.3ng/L),24h尿蛋白中位数为1.1g(0.3～2.0g),显著低于治疗前的44.9ng/L(14.1～560.4ng/L,P=0.017)和2.4g(1.4～4.0g,P<0.01),血清肌酐的差异无统计学意义(P>0.05)。激素组治疗6个月时的尿VCAM-1水平中位数为10.8ng/L(3.8～78.4ng/L),虽低于治疗前的22.6ng/L(4.5～632.9ng/L),但差异无统计学意义(P=0.068),治疗6个月时的24h尿蛋白中位数为0.4g(0.1～1.1g),显著低于治疗前的2.6g(1.7～3.1g,P=0.001),血清肌酐的差异无统计学意义(P>0.05)。Spearman相关分析结果显示,尿VCAM-1水平与血清肌酐值相关(r=0.236,P=0.046)。结论来氟米特联合中小剂量糖皮质激素治疗进展性IgA肾病的临床效果与大剂量激素治疗相仿,抑制VCAM-1的表达可能是其治疗机制之一。
Objective To observe the effect of leflunomide CLEF） in combination with medium/low dose prednisolone in treatment of progressive IgA nephropathy and its influence on the level of vascular cell adhesion molecule-1 （VCAM-1）. Methods A prospective single-center controlled clinical trial was conducted. Patients with biopsy-confirmed IgA nephropathy, with a Lee SMK grade of IV＇--M, daily proteinuria 〉 1.0 g within the latest 3 months were included in the present study. Patients were given either oral LEF CLEF group, 40 mg/d for 3 days followed by 20 mg/d） plus prednisolone （0.6- 0.8 mg·kg-1·d-1, max 40 mg/d, LEF group） or prednisolone C 1 mg·kg-1·d-1 , max 60 mg/d, steroid group）. After 6- 8 weeks of therapy, the dose of prednisolone was reduced. Enzyme-linked immunosorbent assay C ELISA） was used to detect the urinary VCAM-1 excretion level before and 6 months after treatment. Results Totally 36 patients were enrolled C 18 in LEF and 18 in Pre group）. The urinary VCAM-1 was 44.9 ng/L （14.1-560.4 ng/L） in LEF group before treatment and 23.5 ng/L （6.1 - 332.3 ng/L, P= 0.017） 6 months after treatment. And the proteinuria was 2.4 g/d （1.4-- 4.0 g/d） vs. 1.1 g/d （0.3-2.0 g/d, P〈0.01）; serumcreatinine was （101.1 -31.6） mmol/L vs. （93.9± 26.7） mmol/L. In prednisolone group, VCAM-1 was 22.6 ng/L （4.5- 632.9 ng/L） vs. 10.8 ng/L C3.8-78.4 ng/L, P=0.068）; proteinuria was 2.6 g/d （1.7-3.1 g/d） vs. 0.4 g/d （0. 1-1.1 g/d, P=0.001）; and serum creatinine was （97.1 4-38.8） mmol/L vs. （93.0 ± 33.1） mmol/L. Spearman analysis showed that urinary VOAM-1 level was related to serum creatinine level （r = 0.236, P = 0. 046）. Conclusion Our findings may suggest that LEF plus medium or low dose prednisolone has a similar effect as large dose of hormone; one of the mechanism might be the inhibition of VOAM-1. （Shanghai Med J, 2009, 32： 791-795）
出处
《上海医学》
CAS
CSCD
北大核心
2009年第9期791-795,共5页
Shanghai Medical Journal
