| Objective:Through the comparison of the efficacy of mizoribine combined with medium/low dose glucocorticoid and full dose of glucocorticoid alone therapy in patients with moderate/massive proteinuria IgA nephropathy,to further evaluate the therapeutic effect of mizoribine in IgA nephropathy,so as to provide decision-making basis for the treatment of IgA nephropathy.Methods:Using the retrospective analysis method,we study 24 cases of patients were diagnosed as IgA nephropathy by renal biopsy(including primary IgA nephropathy and secondary IgA nephropathy Henoch Schonlein purpura nephritis),from August2013 to August 2016 in the first hospital of Jilin University nephrology department.All patients have the following conditions:(1)quantitative analysis of 24 hours urine protein is more than 1.0g/l;(2)estimated glomerular filtration rate(e GFR)is more than or equal to 60ml/min;(3)the histologic grade was grade II-IV of Lee,and the ISKDC grade of II-IV in Henoch Schonlein purpura nephritis.According to the situation of drug divided into mizoribine combined with medium/low dose glucocorticoid group(MZR group)12 cases and 12 cases of full dose of glucocorticoid group(glucocorticoid group).We collected the corresponding results of age and sex,weight,duration of disease and other general information.Laboratory indexes and renal pathological classification before treatment were collected.Wecollected the results of quantitative analysis of 24 hours urine protein,serum albumin and serum creatinine of 4 weeks,8 weeks,12 weeks and 24 weeks.All adverse reactions were collected within 24 weeks after treatment.The efficacy evaluation was divided into complete remission,partial remission,and non-remission,complete remission rate is equal to total number of cases divided by the number of complete remission cases,total effective rate is equal to total number of cases divided by the number of complete remission cases and partial remission cases.SPSS 22.0 software was used to analyze the data,the definition of P<0.05 for the difference was statistically significant,P<0.01 for the difference was statistically significant.Logistic multivariate analysis model was used to analyze the risk factors of IgA nephropathy.Results:Before treatment,the two groups of patients with age,gender,course of disease and other general conditions,renal pathology score and laboratory indicators were not statistically significant(P>0.05),with a relatively comparable.The baseline of 24 hours urine protein in MZR group and glucocorticoid group were 3.82±1.83 g and 2.75±1.17 g,after 4 weeks of treatment were 2.81±1.67 g and 1.74±1.13 g,and showed a declining trend,and after 24 weeks of treatment were 0.88±0.59 g and0.67±0.32 g,significantly lower than those before treatment(P<0.01).Baseline albumin levels in MZR group and glucocorticoid group were 32.79 ±5.33 g/l and33.74±8.02 g/l,4 weeks after treatment were 36.41± 5.20 g/l and 37.95±5.54 g/l,and showed a rising trend,after 24 weeks of treatment were 41.87±4.28 g/l and42.87±2.89 g/l,significantly higher than those before treatment(P<0.01).The baseline serum creatinine level in the MZR group and the glucocorticoid group were84.89±27.19 umol/l and 80.37±21.68 umol/l respectively,after 24 weeks of treatmentwere 83.83±28.69 umol/l and 81.28±16.06 umol/l,there was no significant difference before and after treatment(P>0.05).There was no significant difference in the levels of urinary protein,serum albumin and serum creatinine between the two groups(P>0.05).Evaluate the efficacy according to established standards,and after the analysis of Fisher exact probability,it was found that there was no significant difference between the two groups in the complete remission rate and total effective rate(P>0.05).Patients with hyperuricemia in MZR group were higher than those in hormone group,and the difference was statistically significant(P<0.05),the difference of the incidence of liver dysfunction between the two groups was not statistically significant(P>0.05),so did the incidence of impaired fasting glucose,and there were no other adverse reactions.Logistic multivariate analysis showed that baseline creatinine and hypertension were independent risk factors for IgA nephropathy.Conclusion:1.For the patients with moderate/massive proteinuria,mizoribine combined medium/low dose glucocorticoid can effectively reduce urinary protein,increase serum albumin level and maintain kidney function.Its efficacy is similar to the therapy of full dose of glucocorticoid alone.2.Mizoribine combined with moderate/massive dose of glucocorticoid therapy for IgA nephropathy,except for hyperuricemia,no other serious adverse reactions.3.Baseline creatinine level and renal hypertension are independent risk factors for IgA nephropathy. |
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