摘要
目的探讨活性维生素D(1,25-二羟维生素D3)联合厄贝沙坦治疗IgA肾病的疗效及其安全性,并探讨其对T细胞亚群的影响。方法选取2009—2010年在我科住院治疗的45例IgA肾病患者,将其随机分为厄贝沙坦组(口服厄贝沙坦150 mg/次,1次/d)、活性维生素D组(口服骨化三醇胶丸0.25μg/次,1次/d)、联合治疗组(口服厄贝沙坦150 mg/次+骨化三醇胶丸0.25μg/次,均1次/d),每组15例,治疗12周。比较3组患者治疗前后尿蛋白、血肌酐、血钙水平及T淋巴细胞亚群变化。结果治疗前3组患者尿蛋白、血肌酐、血钙及CD4+、CD8+、CD4+/CD8+比较,差异均无统计学意义(P>0.05)。治疗12周后,厄贝沙坦组、联合治疗组患者尿蛋白均较本组治疗前下降〔(570±66)mg/24 h与(977±116)mg/24 h;(286±72)mg/24 h与(931±140)mg/24 h〕,且联合治疗组患者尿蛋白均低于厄贝沙坦组和活性维生素D组〔(607±143)mg/24 h〕,差异有统计学意义(P<0.05);治疗12周后,3组患者血肌酐、血钙水平比较,差异均无统计学意义(P>0.05);但联合治疗组患者血钙水平较本组治疗前升高〔(2.30±0.06)mmol/L与(2.28±0.12)mmol/L〕,差异有统计学意义(P<0.05)。治疗过程中所有患者无明显不良反应,且未出现高钙血症。治疗12周后,联合治疗组患者CD4+、CD4+/CD8+较本组治疗前下降,差异有统计学意义(P<0.05)。结论活性维生素D联合厄贝沙坦能有效降低IgA肾病患者的尿蛋白,且安全性好;下调CD4+及CD4+/CD8+可能为其作用机制之一。
Objective To prospectively observe the clinic efficacy and safety of 1,25（OH） 2D3 combined with irbesartan for IgA nephropathy,and discuss its effect on T cell subset.Methods Forty-five IgA nephropathy inpatients in our department between 2009 and 2010 were randomly divided into irbesartan group（irbesartan 150 mg / d）,1,25（OH） 2D3 group 〔1,25（OH） 2D3 0.25 μg / d〕,and combined treatment group 〔irbesartan 150 mg / d ＋ 1,25（OH） 2D3 0.25 μg / d〕.Proteinuria,blood creatinine（Cr）,blood calcium（Ca）,and T cell subset of three groups were detected before and after the treatment.Results No significant differences were observed in proteinuria,blood Cr,blood Ca,CD4＋,CD8＋,and CD4＋ / CD8＋ among the three groups before the treatment（P〈 0.05）.After treatment for 12 weeks,level of proteinuria in irbesartan group and combined treatment group significantly decreased compared to that before the treatment 〔（570 ± 66） mg /24 h vs.（977 ±116） mg/24h,（286 ± 72） mg/24 h vs.（931 ± 140） mg/24 h;P〈 0.05〕.The level of proteinuria in combined treatment group was significantly lower than that in irbesartan group and 1,25（OH） 2D3 group 〔（607 ± 143） mg /24 h,P〈 0.05〕.No significant differences were observed in levels of blood Cr and blood Ca among the three groups after treatment for 12 weeks（P〈 0.05）.The level of blood Ca in combined treatment group was higher after the treatment than before 〔（2.30 ± 0.06） mmol / L vs.（2.28 ± 0.12） mmol / L;P〈 0.05〕.All patients had no side effects or hypercalcemia.After treatment for 12 weeks,level of CD4＋ and CD4＋ / CD8＋ significantly descended in combined treatment group（P〈 0.05）.Conclusion 1,25（OH） 2D3 combined with irbesartan can reduce proteinuria in patients with IgA nephropathy effectively and safely,in which down-regulation of CD4＋ and CD4＋ / CD8＋ may be one of the mechanisms.
出处
《中国全科医学》
CAS
CSCD
北大核心
2013年第20期2327-2330,共4页
Chinese General Practice
基金
广西壮族自治区卫生厅科研课题(Z2009160)
2012年中国医师协会中西部优秀青年资助基金
