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目的观察小剂量尿激酶联合激素和福辛普利治疗中重型IgA肾病(IgAN)的临床疗效和安全性。方法单中心前瞻性临床研究。选择经肾活检并结合临床确诊为原发性IgAN的患者43例,年龄15～55岁,尿蛋白≥1.0g/24h,血肌酐(Scr)≤265μmol/L,肾活检病理Hass分型Ⅲ型以上,随机分为治疗组(UK组,n=20)和对照组(Control组,n=23),治疗组接受尿激酶、激素和福辛普利治疗,对照组接受激素和福辛普利治疗。观察期限为6个月。结果(1)临床缓解率:UK组的完全缓解率和部分缓解率分别为52.6%及42.1%,Control组分别为21.7%及56.6%。两组疗效比较差异有统计学意义(P<0.05)。(2)与治疗前相比,UK组血肌酐明显下降[(107±20)μmol/L vs(94±10)μmol/L,P<0.05],Control组血肌酐则上升[(111±20)μmol/Lvs(136±16)μmol/L,P<0.05]。(3)两组患者尿蛋白均较治疗前下降,治疗0、3、6个月时UK组尿蛋白分别为(1.98±0.62)g/24 h、(1.08±0.17)g/24 h、(0.60±0.11)g/24 h,Control组分别为(1.79±0.57)g/24 h、(1.32±0.20)g/24 h、(1.21±0.14)g/24 h,UK组尿蛋白下降快于Control组,差异有统计学意义(P<0.05)。结论小剂量尿激酶联合激素和福辛普利能有效改善中重型IgAN患者的肾功能,减少蛋白尿,治疗效果显著。
Objective To observe the clinical efficacy and safety of low-dose urokinase combined with fosinopril in the treatment of middle-heavy IgA nephropathy (IgAN). Methods Single center prospective clinical study. Thirty-three patients with primary IgAN who underwent renal biopsy and were clinically diagnosed as primary IgAN were enrolled in this study. Patients were aged 15-55 years with urinary protein≥1.0g / 24h, serum creatinine (Scr) ≤265μmol / L, Were randomly divided into treatment group (UK group, n = 20) and control group (Control group, n = 23). The treatment group was treated with urokinase, hormone and fosinopril. The control group received hormone and fosinopril treatment. The observation period is 6 months. Results (1) Clinical remission rate: The complete remission rate and partial remission rate in the UK group were 52.6% and 42.1%, respectively, in the Control group were 21.7% and 56.6% respectively. The difference between the two groups was statistically significant (P <0.05). (2) Serum creatinine was significantly decreased in the UK group (107 ± 20 μmol / L vs 94 ± 10 μmol / L, P <0.05) ) μmol / Lvs (136 ± 16) μmol / L, P <0.05]. (3) Urine protein in both groups decreased compared with that before treatment. Urinary protein in UK group was (1.98 ± 0.62) g / 24 h and (1.08 ± 0.17) g / 24 h respectively at 0, 0.60 ± 0.11) g / 24 h in the control group and (1.79 ± 0.57) g / 24 h in the Control group (1.32 ± 0.20 g / 24 h, 1.21 ± 0.14 g / 24 h, respectively) Control group, the difference was statistically significant (P <0.05). Conclusions Low-dose urokinase combined with fosinopril can effectively improve renal function and reduce proteinuria in patients with moderate-severe IgAN. The therapeutic effect is remarkable.