Mizoribine Combined With Low Dose Corticosteroids In The Treatment Of IgA Nephropathy

Objective:1.To explore the clinical efficacy and adverse reactions of Mizoribine combined with low-dose corticosteroids in the treatment of IgA nephropathy2.To explore the clinical efficacy and adverse reactions of full dose of corticosteroids on IgA nephropathy3.To compare the difference of clinical efficacy between Mizoribine combined with low dose corticosteroids and full dose of corticosteroids on IgA nephropathyMethods:1.Subjects:50 cases of IgA nephropathy?including primary IgA nephropathy and secondary IgA nephropathy HSPN?diagnosed by renal biopsy were selected from August 2013 to August 2018 in the first hospital of Bethune,jilin university nephrology department.All patients have the following conditions:?1?16⁶5 years old?2?estimated glomerular filtration rate?eGFR?is more than or equal to30ml·min^-1·?1.73 m²?^-1?3?quantitative analysis of 24 hours urine protein is more than1.0g?4?the histologic grade was grade II-IV of Lee and the ISKDC grade of II-IV in Henoch-Sch?nlein purpura nephritis2.Methods:According to the situation of drug divided into mizoribine combined with low dose glucocorticoid group?MZR group?25 cases and 25 cases of full dose of glucocorticoid group?glucocorticoid group?.Patients in the MZR group were given mizolibine?50mg/tablet?at 150 mg/d,and combined with prednisone at the initial dose of 0.5 mg/kg.The maximum dose was no more than 40 mg/d.After 8 weeks,the dosage was reduced by 5mg every 2 weeks,and reduced to 5mg by 2.5mg every 2weeks.Patients in the glucocorticoid group were given a starting dose of 0.8-1.0mg/kg·d prednisone,with a maximum dose of no more than 80 mg/d.After 8 weeks,the dosage was reduced by 5mg every 2 weeks,and reduced to 5mg by 2.5mg every 2weeks.The maintenance treatment was stopped after 12 months.We collected the corresponding results of age,sex,weight and other general information.Laboratory indexes and renal pathological classification before treatment were collected.We also collected the results of quantitative analysis of 24 hours urine protein,serum albumin,serum creatinine and the clinical remission rate after the treatment of 3 months,6months,12 months and 18 months,and at the same time observe the related adverse reaction.Results:1.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.2.Until February,2019,all patients in this study completed the 6 months treatment and follow-up.Thirty-one patients were followed up for 12 months?16 in the MZR group and 15 in the glucocorticoid group?.Twenty-six patients were followed up for 18 months?13 in the MZR group and 13 in the glucocorticoid group?.After treatment,both groups of patients achieved satisfactory therapeutic effect,the 24-hour proteinuria in both groups was significantly decreased and the serum albumin level was significantly increased compared with baseline,while serum creatinine and eGFR showed no significant difference between two groups before and after treatment.The 24-hour proteinuria at baseline were?3.49±2.51?g and?3.57±3.11?g in MZR group and steroid group respectively.Compared with baseline,it was decreased in both groups at 3months?1.81±0.36?g and?1.23±1.03?g,significantly lower than those before treatment?P<0.01?.The serum albumin level increased in both groups from the baseline values?33.46±6.19?g/L and?33.32±7.35?g/L to?39.83±4.91?g/L and?39.94±3.40?g/L,significantly higher than those before treatment?P<0.01?.At 6 months,the 24-hour proteinuria of the two groups was further reduced to?1.10±0.93?g and?0.92±0.71?g,while the serum albumin level was further increased to?41.42±4.42?g/L and?41.13±2.12?g/L.After the treatment of12 months,the 24-hour proteinuria of the two groups decreased to?0.54±0.29?g and?0.79±0.76?g,while the serum albumin level increased to?42.48±3.84?g/L and?42.49±3.18?g/L.After the follow-up of 18 months,the 24-hour proteinuria in the two groups were reduced to?0.43±0.27?g and?0.58±0.33?g,and the serum albumin level were increased to?43.35±2.87?g/L and?42.78±3.35?g/L.There was no significant difference was detected in terms of serum creatinine and estimated glomerular filtration rate?eGFR?in both MZR group and steroid group before and after treatment?P>0.05?.At the same treament period,there was no significant difference in terms of 24-hour proteinuria,serum albumin,serum creatinine and eGFR between 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?.During treatment,adverse events in the steroid group were more than those in the MZR group,there was no statistically significant difference in the incidence rate of adverse reactions between groups?P>0.05?.Logistic multivariate analysis showed that the degree of mesangial hyperplasia in renal pathology were independent risk factors for IgA nephropathy.Conclusions:1.Mizoribine plus low dose corticosteroids can reduced the levels of proteinuria,improve hypoalbuminemia and maintain the stability of renal function in the IgA nephropathy patients.2.The patients in MZR group need a longer time period to achieved complete remission than those in steroid group,but the total efficiency was higher than that in steroid group during the hormone reduction process,it has notable long-term efficacy.In addition,it has fewer adverse events.3.The degree of mesangial hyperplasia in renal pathology were independent risk factors for IgA nephropathy.