The Therapeutic Effect Of Mycophenolate Mofetil In The Treatment Of Primary Immunoglobulin A Nephropathy

Objective:To further evaluate the therapeutic effect and safety of mycophenolate mofetil(MMF) in the treatment of primary immunoglobulin A nephropathy through comparing the efficacy of forty-nine cases primary immunoglobulin A nephropathy in my center who use glucocorticoid combined with MMF compared with only glucocorticoid therapy, in order to provide the basis for clinic decision making. Method:49 cases of the second hospital of Jilin university from January 2012 to June 2015 during the hospitalization of who were diagnosed as primary immunoglobulin A nephropathy by the renal biopsy tissue were collected, all patients met the required that: 1) 24-hour urinary protein excretion>1.0g; 2) serum creatinine <2mg/dl(176μmol/L); 3) the first time for treatment. According to the patients’ medication, 49 patients were divided into two groups. The treatment group(n=21) was administered with a combination therapy of glucocorticoid and MMF, and the control group(n=28) with only glucocorticoid, statistical analysis before and after treatment 1,2,3,6 months clinical data. The dosage regimen of MMF: the MMF initial dose was 1.0-1.5g/d twice a day for 6 months. The dosage regimen of prednisone: the prednisone initial dose was 0.6-1.0mg/(kg·d), highest do not exceed 80mg/d, rule reduction. If the renal biopsy in patients check by histopathological lens to see fibrinoid necrosis or a large number of crescents, given intravenous methyl prednisone dragon 0.5-1.0g/d impact therapy, three days was a course of treatment. According to the patient’s condition may give the second impact treatment. Result:According to whether including impact application of glucocorticoid treatment, we divided the test result into two parts. Containing cases who received impact application of glucocorticoid treatment: after 6 months of treatment, in the treatment group, 11 cases had complete remission and 4 cases had partial remission, the total efficacy rate was 71.4%; in the control group, 9 cases had complete remission and 10 cases had partial remission, the total efficacy rate was 67.8%; There were no significant differences between the results for the two groups(P>0.05). In the treatment group, 24-hour urinary protein excretion is lower than the control group [(1.22±1.52) g/d vs(1.43±1.67) g/d], there were no significant differences between the results for the two groups(P>0.05). Not containing cases who received impact application of glucocorticoid treatment: after 6 months of treatment, in the treatment group, 10 cases had complete remission and 4 cases had partial remission, the total efficacy rate was 87.5%; in the control group, 8 cases had complete remission and 10 cases had partial remission, the total efficacy rate was 66.6%; There were no significant differences between the results for the two groups(P>0.05). In the treatment group, the complete remission rate is higher than the control group(62.5% vs 29.6%), there were significant differences between the results for the two groups(P<0.05). In the treatment group, 24-hour urinary protein excretion is lower than the control group [(0.62±0.77) g/d vs(1.49±1.67) g/d], there were significant differences between the results for the two groups(P<0.05). The incidence of adverse effects in the two groups was no significant differences between the results for the two groups(P>0.05). Conclusion:1. For the primary immunoglobulin A nephropathy that without pathologic results with fibrinoid necrosis or a large number of cellular crescents(≥25%), the curative effect of glucocorticoid combining with MMF is superior to only glucocorticoid.2. MMF was no obvious adverse effects in the process of treatment of primry immunoglobulin A nephropathy.