环磷酰胺联合糖皮质激素治疗不同血尿程度IgA肾病的疗效分析

苏吉俐; 周晓霜; 范秀照; 郝慧强; 田双双; 惠董娜; 韩秀涛

doi:10.16766/j.cnki.issn.1674-4152.003060

环磷酰胺联合糖皮质激素治疗不同血尿程度IgA肾病的疗效分析

doi: 10.16766/j.cnki.issn.1674-4152.003060

1.
山西医科大学第五临床医学院, 山西太原 030000
2.
山西省人民医院肾内科，山西太原 030000
3.
山西中医药大学第三临床医学院，山西太原 030000

基金项目:

山西省基础研究计划优秀青年培育项目 202103021222013

详细信息

通讯作者:
周晓霜，E-mail：xiaoshuangzhou66@163.com

中图分类号: R692
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出版历程
- 收稿日期: 2022-09-26
- 网络出版日期: 2023-08-28

Efficacy of cyclophosphamide combined with glucocorticoids therapy with different degrees of hematuria IgA nephropathy

3.
The Fifth Clinical College of Shanxi Medical University, Taiyuan, Shanxi 030000, China

摘要

摘要: 目的通过分析环磷酰胺(CTX)联合糖皮质激素(GS)治疗不同血尿程度IgA肾病(IgAN)患者的疗效，以期为IgAN的治疗提供参考。方法回顾性分析2015年1月—2021年12月于山西省人民医院确诊并接受CTX联合GS治疗的原发性IgAN患者的临床资料。根据治疗前血尿严重程度将纳入的患者分为2组：轻度血尿组[尿红细胞计数(URBC)＜30/高倍视野(HPF)]、重度血尿组[URBC≥30/HPF]。比较2组患者治疗前和治疗后1、3、6个月时的肾功能变化。主要结局：蛋白尿缓解率、估算肾小球滤过率(eGFR)斜率；次要结局：血肌酐(Scr)、eGFR、尿素氮(BUN)及不良反应。结果共纳入132例患者，轻度血尿组95例，重度血尿组37例。治疗后, 重度血尿组各随访节点蛋白尿缓解率和eGFR斜率均高于轻度血尿组，组间比较差异有统计学意义(均P＜0.05)。重度血尿组Scr呈下降趋势，轻度血尿组呈上升趋势，组间比较差异有统计学意义(P＜0.05)。2组eGFR均呈先降后升趋势。重度血尿组eGFR变化较明显，组间比较差异有统计学意义(P＜0.05)。2组BUN均呈先升后降趋势，重度血尿组BUN在各随访节点均较轻度血尿组低，组间比较差异有统计学意义(P＜0.05)。结论 CTX联合GS对于重度血尿组IgAN患者疗效较好，治疗前血尿程度可能是IgAN患者治疗决策的潜在依据。
- IgA肾病 /
- 环磷酰胺 /
- 糖皮质激素 /
- 血尿 /
- 临床疗效
Abstract: Objective To evaluate the effect of cyclophosphamide (CTX) combined with glucocorticoids (GS) in the treatment of primary IgA nephropathy (IgAN) with different degrees of hematuria, and provide reference for therapy of IgAN. Methods The clinical data of the primary IgAN patients treated with CTX and GS at the Shanxi Provincial People's Hospital from January 2015 to December 2021 were retrospectively collected. According to the degree of baseline hematuria, they were divided into mild hematuria group [urinary red blood cell count (URBC) < 30/high-power field (HPF)] and severe hematuria group (URBC≥30/HPF). The changes of renal function before therapy and 1st, 3rd and 6th month after therapy were compared between the two groups. The main outcomes were proteinuria remission rate, estimated glomerular filtration rate (eGFR) slope. The secondary outcomes were serum creatinine (Scr), blood urea nitrogen (BUN), eGFR and adverse reactions. Results A total of 132 IgAN patients were included, 95 cases in the mild hematuria group and 37 cases in the severe hematuria group. After therapy, proteinuria remission rate and eGFR slope in the severe hematuria group were higher than those in the mild hematuria group, and the difference between the two groups was statistically significant (all P < 0.05). Scr in the severe hematuria group showed a downward trend, while that in the mild hematuria group showed an upward trend, and the difference between the groups was statistically significant (P < 0.05). eGFR in both groups showed a trend of decreasing first and then increasing. The change of eGFR in the severe hematuria group was more obvious than that in the mild hematuria group (P < 0.05). BUN in both groups showed a trend of increasing first and then decreasing. The level of BUN in the severe hematuria group was lower than that in the mild hematuria group at all time points (P < 0.05). Conclusion The combination of CTX and GS has a good therapeutic effect on IgAN patients with severe hematuria. The level of hematuria before therapy may be latent basis for the selection of therapy decisions for IgAN.
- IgA nephropathy /
- Cyclophosphamide /
- Glucocorticoids /
- Haematuria /
- Clinical efficacy

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图 1 2组IgA肾病患者治疗后eGFR斜率

Figure 1. eGFR slope after treatment in IgA nephropathy patients of the two groups

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图 2 2组IgA肾病患者治疗后肾功能指标变化

Figure 2. Changes of renal function indexes after treatment in IgA nephropathy patients of the two groups

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表 1 2组IgAN患者基线资料比较

Table 1. Comparison of baseline data between two groups of patients with IgAN

项目	总计(132例)	轻度血尿组(95例)	重度血尿组(37例)	统计量	P值
年龄[M(P₂₅, P₇₅), 岁]	39.4(29.3, 52.0)	39.0(29.0, 53.0)	40.0(29.5, 44.0)	-0.134^a	0.893
男性[例(%)]	63(47.7)	41(43.2)	22(59.5)	2.836^b	0.092
BMI(x±s)	25.0±4.0	25.0±4.0	25.2±4.0	-0.223^c	0.824
收缩压(x±s, mmHg)	136.8±1.5	137.9±15.4	133.9±21.3	1.209^c	0.229
舒张压(x±s, mmHg)	87.9±1.1	88.0±10.4	87.5±16.0	0.212^c	0.833
高尿酸血症[例(%)]	69(52.3)	53(55.8)	16(43.2)	2.189^a	0.139
激素冲击[例(%)]	40(30.3)	28(29.5)	12(32.4)	0.110^a	0.740
牛津分期[例(%)]
M1	65(49.2)	48(50.5)	17(45.9)	0.224^a	0.636
E1	66(50.0)	45(47.4)	21(56.8)	0.939^a	0.333
S1	114(86.4)	79(83.2)	35(94.6)	3.022^a	0.082
T1~T2	40(30.3)	33(34.7)	7(18.9)	3.155^a	0.076
C1~C2	65(49.2)	42(44.2)	23(62.2)	3.433^a	0.064
Hb(x±s, g/L)	133.8±21.9	136.7±22.7	128.4±18.0	1.993^c	0.048
ALB[M(P₂₅, P₇₅), g/L]	30.0(30.0, 39.0)	34.9(28.8, 40.0)	34.8(21.9, 39.9)	-0.015^a	0.988
BUN[M(P₂₅, P₇₅), mmol/L]	5.9(4.2, 7.3)	5.99(4.3, 7.5)	5.4(4.1, 6.5)	-1.207^a	0.228
Scr[M(P₂₅, P₇₅), μmol/L]	92.8(73.1, 144.9)	93.5(74.3, 144.7)	91.0(67.4, 150.4)	-0.651^a	0.515
eGFR[M(P₂₅, P₇₅), mL/(min·1.73 m²)]	92.7(73.1, 104.3)	74.6(46.3, 103.6)	70.7(44.1, 108.3)	-0.041^a	0.967
尿蛋白量[M(P₂₅, P₇₅)，g/d]	2.9(1.9, 4.5)	2.95(2.0, 4.6)	2.4(1.4, 4.2)	-0.801^a	0.423
注：1 mmHg=0.133 kPa；^a为Z值，^b为χ²值，^c为t值。

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表 2 2组IgAN患者治疗后肾功能变化的多因素分析

Table 2. Multivariate analysis of renal function changes in patients with IgAN after treatment

变量	AIC	BIC	B	SE	t值	P值
Scr	5 130	5 146
截距			209.985	21.162	9.923	＜0.001
轻度血尿组vs. 重度血尿组			19.959	7.543	2.646	0.008
Hb			-0.705	0.157	-4.486	＜0.001
低蛋白尿vs. 高蛋白尿			-18.968	6.934	-2.736	0.006
无激素冲击vs. 有激素冲击			-6.700	7.226	-0.927	0.354
eGFR	4 261	4 278
截距			7.049	8.211	0.858	0.391
轻度血尿组vs. 重度血尿组			-6.721	2.911	-2.309	0.021
Hb			0.507	0.061	8.298	＜0.001
低蛋白尿vs. 高蛋白尿			6.530	2.617	2.495	0.013
无激素冲击vs. 有激素冲击			0.022	2.738	0.008	0.994
BUN	2 553	2 569
截距			17.623	1.520	11.594	＜0.001
轻度血尿组vs. 重度血尿组			1.603	0.521	3.078	0.002
Hb			-0.066	0.011	-5.861	＜0.001
低蛋白尿vs. 高蛋白尿			-2.389	0.485	-4.928	＜0.001
无激素冲击vs. 有激素冲击			-1.181	0.504	-2.342	0.020
尿蛋白缓解	2 327	2 344
截距			0.575	0.622	-0.925	0.355
轻度血尿组vs. 重度血尿组			0.570	0.240	-2.370	0.018
Hb			-0.014	0.005	-2.948	0.003
低蛋白尿vs. 高蛋白尿			-0.283	0.203	-1.391	0.165
无激素冲击vs. 有激素冲击			0.222	0.220	-2.948	0.313
注：低蛋白尿＜3.5 g/d，高蛋白尿≥3.5 g/d。

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