| ObjectiveIg A nephropathy(Ig AN, Immunoglobulin A glomerulo-nephritis) is a set of immune pathological characteristics in the clinical syndrome of glomerular mesangial area Ig A deposits, paroxysmal haematuria and persistent microscopic haematuria as common, can be associated with different levels of proteinuria, and combination of high blood pressure, renal failure, etc.Its clinical manifestation with a chronic progress course, Ig AN has become one of the leading cause of ESRD disease. Therefore, the treatment of Ig AN in recent years has been seriously. Ig A nephropathy pathogenesis is unclear until now, no specific treatment. The current treatment of primary Ig A nephropathy with proteinuria used ACEI( Angiotensin converting enzyme inhibitor) drugs on the basis of comprehensive treatment, and ACEI and ARB(Angiotensin II receptor antagonist) combined use of clinical research is few, for the treatment of Ig AN.Yet we found that the combined use of ACEI and ARB can not only reduce the side effects induced by ACEI drugs alone, but also significantly improve the clinical curative effect. We prospectively observe fosinopril with valsartan the therapeutic effect of combined application of Ig A nephropathy patients, and test urinary Transforming growth factor-beta1(TGF-β1) level to explore the treatment mechanism.MethodsSelect 30 cases in line with the diagnostic criteria and inclusion criteria of hospitalized patients, to be divided into treatment group and control group in accordance withthe parents informed consent.Clinical commonly used method is used for the control group( including the adrenal glucocorticoids,dipyridamole and fosinopril were given according to the classification standard and clinical manifestations). The treatment group on the basis of the control group was treated with valsartan, end of follow-up was 6 months, respectively before and after treatment of 15 days, 1 month, 3 months, 6 months to detect serum creatinine, blood biochemistry, blood lipid analysis, six urine sensitive function, at the same time collecting urine to detect protein and TGF- beta 1 level.Results1.After treatment of 15 days, content of urine protein and urine TGF- quantitative beta 1 in both groups respectively compared with before treatment have not decreased at all.2. After one month, the control group compared with before treatment, urine protein and urinary quantitative TGF- there is a decrease in the content of beta 1, but there was no statistically significant difference(P > 0. 05); Treatment group compared with before treatment, urine protein quantitative declined, the difference was statistically significant(P < 0. 05), the urine TGF- beta 1 levels have fallen, but no statistical significance(P > 0. 05).3. the treatment for 3 month, compared with before treatment in both groups, quantitative urine protein and urine TGF- beta 1 levels have significantly decreased(P < 0. 05), and the treatment group decreased more significantly than the control group.4.six month, compared with before treatment in both groups, quantitative urine protein and urine TGF- beta 1 levels have significantly decreased(P < 0. 05), and the treatment group than the control group decreased more obvious; Compared with treatment for 3 month, but only the urine protein quantitative have significantly lowered, the difference was statistically significant(P < 0. 05).ConclusionFosinopril combined with valsartan has a good effect on urinary protein in children’s Ig A nephropathy,.It could be related to its early improvement on renal fibrosis effect. |
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