肾炎康复片联合来氟米特治疗尿检异常型IgA肾病的临床研究

目的：观察肾炎康复片联合来氟米特治疗尿检异常型IgA肾病的临床疗效和安全性。方法：将90例尿检异常型IgA肾病患者,随机分为治疗组45例和对照组45例。治疗组肾炎康复片联合来氟米特治疗,对照组单纯应用来氟米特,观察时间均为12月。试验中监测治疗前和治疗后3个月、6个月和12个月的尿沉渣红细胞计数（尿RBC计数）、24h尿蛋白定量、血浆白蛋白（Alb）、肝肾功能和全血细胞计数的变化以及药物治疗的副作用。结果：与实验开始时相比,治疗组在治疗第3个月时即表现出明显的疗效,尿RBC计数与尿蛋白定量明显下降（P〈0.01）;随着疗程的延长,治疗组患者尿检进一步改善。而对照组治疗3个月及6个月后尿RBC计数、尿蛋白定量与治疗前相比无统计学差异（P〉0.05）,仅治疗12个月后才明显下降（P〈0.05）。两组间同期相比均有统计学差异（P〈0.01）。不良反应治疗组无1例发生,对照组发生3例（6.6%）。结论：肾炎康复片联合来氟米特治疗尿检异常型IgA肾病疗效显著,与单用来氟米特相比可有效减少尿蛋白和镜下血尿,且耐受性较好。     

益肾化湿颗粒联合来氟米特治疗无症状尿检异常型IgA肾病的临床观察

目的:探讨益肾化湿颗粒联合来氟米特治疗无症状尿检异常型IgA肾病(IgAN)的临床效果。方法:选取我院于2014年1月~2015年12月收治的确诊为无症状尿检异常型IgAN患者共84例,随机分为对照组与治疗组,每组各42例,两组患者均给予来氟米特片口服,治疗组患者在此基础上加用口服益肾化湿颗粒,每2个月为一疗程,治疗3个疗程,每个疗程后观察两组患者尿红细胞(RBC)计数、24 h尿蛋白定量的变化,同时比较两组患者的治疗有效率及不良反应发生率。结果:治疗组患者在治疗2个月时疗效显著,尿RBC计数和24 h尿蛋白定量较治疗前均显著下降(P0.05);随着疗程的延长,至6个月时,治疗组患者的尿RBC计数和24 h尿蛋白定量较治疗前进一步显著下降(P0.05);与治疗前比较,在治疗2个月时,对照组患者的尿RBC计数和24 h尿蛋白定量差异均无统计学意义(P0.05),在治疗4个月时才显著下降(P0.05);与同期对照组比较,在治疗2月、4月和6月时,治疗组患者的尿RBC计数和24 h尿蛋白定量均显著下降(P0.05),治疗总有效率均显著升高(P0.05);治疗组患者不良反应发生的总频数比对照组显著降低(7.1%vs 23.8%,P0.05);所有患者治疗前后肾功能均保持稳定。结论:益肾化湿颗粒联合来氟米特对无症状尿检异常型IgAN有显著疗效,可有效减轻血尿和蛋白尿,稳定肾功能,且不良反应少。     

来氟米特联合小剂量强的松治疗对IgA肾病临床疗效、肾功能以及尿蛋白的影响

目的观察分析来氟米特联合不同剂量强的松(泼尼松)治疗对IgA肾病临床疗效、肾功能以及尿蛋白的影响。方法将2016年2月至2018年2月于陕西省核工业二一五医院肾内科就诊治疗的86例IgA肾病患者作为研究对象,根据治疗方式的不同分为对照组和观察组各43例。对照组在IgA肾病基础治疗上给予口服泼尼松治疗,观察组予以来氟米特联合小剂量泼尼松治疗,治疗后比较两组患者临床疗效、肾功能和尿蛋白水平以及不良反应。结果对照组的临床总有效率明显低于观察组(P0.05)。治疗后,两组患者Scr、24 h尿蛋白定量和BUN水平与治疗前比较都明显降低,而eGFR水平则明显升高(P0.05);治疗后观察组患者eGFR水平则明显高于对照组,Scr、24 h尿蛋白定量、BUN水平较对照组明显低(P0.05)。观察组不良反应发生率(6.97%)显著低于对照组(39.53%)。结论来氟米特联合小剂量泼尼松治疗IgA肾病患者其临床有效率更高,能更大程度的改善其肾功能指标水平和有效降低患者24 h尿蛋白定量,提高eGFR至正常水平,且具有一定的安全性,更值得临床推广和广泛应用。     

缬沙坦联合大黄治疗糖尿病肾病的临床研究

目的探讨缬沙坦联合大黄治疗糖尿病肾病的疗效。方法将128例糖尿病肾病（DN）患者随机分为缬沙坦对照组和缬沙坦联合大黄治疗组，疗程均为6个月。结果①与治疗前比较，治疗组治疗后血清总胆固醇（TC）、血清甘油三酯（TG）明显下降（P〈0．05，P〈0．01），血清高密度脂蛋白（HDL-C）明显上升（P〈0．05），对照组上述指标变化不明显（P〉0．05）；②治疗组与对照组均能显著改善早期DN患者尿白蛋白（MA）、尿α1微球蛋白（α1，MG）、尿β2微球蛋白（β2-MG）（P〈0．05），而治疗组较对照组疗效显著（P〈0．05）。③对临床DN患者的尿蛋白定量、尿α1-MG、尿β2-MG、血白蛋白（ALB）、血尿素氮（BUN）、血肌酐（Scr），治疗组均改善显著，而对照组除尿蛋白定量、尿α1，MG、尿β2-MG改善显著外，其余指标改善均不明显。结论缬沙坦联合大黄治疗糖尿病肾病疗效确切。     

黄葵胶囊联合缬沙坦治疗非IgA系膜增生性肾小球肾炎轻中度蛋白尿的临床研究

目的:观察黄葵胶囊联合缬沙坦治疗非IgA系膜增生性肾小球肾炎轻中度蛋白尿的疗效。方法:将96例非IgA系膜增生性肾小球肾炎患者随机分为黄葵胶囊联合缬沙坦组(治疗组)和单用缬沙坦组(对照组),分别检测两组治疗前后24 h尿蛋白定量、血清白蛋白、血肌酐,并进行组间比较。结果:治疗组临床疗效总有效率显著高于对照组(P<0.01)。治疗组与对照组均能显著降低24 h尿蛋白(P<0.01),两组比较差异有统计学意义(P<0.01)。治疗组与对照组均能显著提高血清白蛋白(P<0.05),但两组比较差异无统计学意义(P>0.05)。结论:黄葵胶囊联合缬沙坦治疗非IgA系膜增生性肾小球肾炎比单用缬沙坦能更显著地降低尿蛋白排泄量,未见明显不良反应。     

中医及中西医结合方案治疗150例IgA肾病的疗效分析

目的：分析中医及中西医结合方案治疗IgA肾病的疗效。方法：回顾性分析2005年～2011年间收治的150例IgA肾病患者的临床资料,并分为中药及中西医结合两组,对相关临床指标、疗效及病理类型进行分析。结果：从基线比较中西医结合组在尿蛋白及病理类型上较中药组为重,两组治疗前后的血肌酐、肾小球滤过率（GFR）、24h尿蛋白、尿红细胞及中药组治疗前后的尿素氮有明显改善,差异有统计学意义（P均〈0.05）;但两组治疗起始时肌酐正常与升高患者总缓解率的组间差异并无统计学意义（P〉0.05）;按病理划分,两组中局灶节段增生、系膜增生及系膜增生伴硬化三组治疗前后的24h尿蛋白明显下降,中西医结合组局灶增生伴硬化与FSGS组的24h尿蛋白也明显下降,差异有统计学意义（P均〈0.05）。结论：本研究表明中医及中西医结合方案对IgA肾病均有一定疗效,均能改善疾病相关临床指标,单纯中药治疗亦可改善部分病理类型患者的24h尿蛋白。但由于中西医结合组尿蛋白基线水平更高,病理类型更重,提示中西医结合方案适用于较重的IgA肾病,而单纯中医方案则适用于相对较轻的IgA肾病。     

来氟米特联合缬沙坦及胰激肽原酶治疗糖尿病肾病的疗效观察

目的：探讨来氟米特联合缬沙坦及胰激肽原酶对2型糖尿病肾病的治疗效果.方法：将60例糖尿病肾病患者随机分为两组：治疗组和对照组各30例,在常规降糖、降压、降蛋白等治疗的基础上,对照组加用缬沙坦、胰激肽原酶口服,治疗组在对照组基础上给予来氟米特治疗.结果：两组治疗后总有效率相比,差异有统计学意义（P＜0.05）.两组经治疗后24h尿蛋白定量下降（P＜0.05）,但治疗组下降更为明显,与对照组相比差异有统计学意义（P＜0.05）;治疗组血尿素氮及肌酐下降较对照组明显（P＜0.05）.结论：来氟米特联合缬沙坦和胰激肽原酶可有效减少2型糖尿病肾病患者的蛋白尿水平.     

血尿康胶囊治疗IgA肾病血尿的临床疗效观察

目的：观察血尿康胶囊治疗IgA肾病血尿的临床疗效。方法：100例IgA肾病随机分为血尿康胶囊组（治疗组）50例,雷公藤多苷片组（对照组）50例,观察患者临床症状,中医症候积分,尿红细胞,24h尿蛋白定量,尿ANG、尿β2微球蛋白,血TGF-β1改善情况及疗效,辨证分型与疗效的关系。结果：血尿康胶囊有减轻IgA肾病血尿、蛋白尿作用,控制血尿疗效优于雷公藤多苷（P〈0.05）。改善中医临床症候积分、改善腰膝酸软等症状方面优于雷公藤多苷（P〈0.05）。降低血TGF-β1、尿NAG方面优于对照组（P〈0.05）。治疗组、对照组均能稳定BUN、Scr、Ccr水平,两组差异无统计学意义（P〉0.05）。治疗组中医症候、西医疗效有效率分别为98%,88%;对照组有效率74%,70%,治疗组优于雷公藤对照组（P〈0.05）。阴虚火旺、瘀血阻络两证型治疗组疗效亦优于对照组P〈0.05）。结论：血尿康胶囊可能通过多种调节机制,具有一定的减轻IgA肾病血尿的作用,值得进一步研究。     

环孢素A干预IgA肾病进展的研究

目的研究环孢素A干预IgA肾病进展的效果。方法选取2012年4月至2016年3月在青海省第五人民医院接受治疗的154例IgA肾病患者为研究对象,随机分为对照组(n=77)及观察组(n=77)。对照组采用甲泼尼龙片联合阿司匹林治疗,观察组在对照组基础上加用环孢素A治疗。比较治疗前、后2组24h尿蛋白定量、血浆白蛋白、血肌酐、血尿酸水平的变化情况及不良反应,并评价2组临床疗效。结果治疗后1、3、6个月2组24h尿蛋白定量与治疗前相比均明显降低,而血浆白蛋白明显上升,且24h尿蛋白定量随着治疗时间增长而逐渐降低,血浆自蛋白逐渐上升,差异具有统计学意义(P0.05);治疗后1、3、6个月观察组24h尿蛋白定量较对照组明显降低,而血浆白蛋白明显上升,差异具有统计学意义(P0.05);治疗后,2组血肌酐、血尿酸水平、不良反应发生率较治疗前未发生明显变化,且两组相比,差异无统计学意义(P0.05);观察组临床疗效明显优于对照组,差异具有统计学意义(P0.05)。结论对IgA肾病患者采用环孢素A与甲泼尼龙片联合阿司匹林治疗,可显著提高治疗效果,降低尿蛋白水平,延缓病情的进展,促进患者身体恢复,优势较为显著,值得进一步推广应用。     

肾炎康复片联合氯沙坦钾治疗原发性IgA肾病（气阴两虚证）的临床观察

目的观察肾炎康复片联合氯沙坦钾治疗原发性IgA肾病（气阴两虚证，IgAN）的临床疗效。方法回顾性分析62例IgAN患者，治疗组32例采用肾炎康复片联合氯沙坦钾治疗，对照组30例单纯应用氯沙坦钾治疗，观察时间为8周。分别监测治疗前0周、治疗后4周和8周的24h尿蛋白定量、IgA、Alb、SCr和中医主症积分，继而进行中西医疗效评价。结果对照组治疗4周后尿蛋白定量下降，Alb升高，SCr、IgA水平降低，中医主症积分减少，与治疗前相比无统计学差异（P〉0．05）；治疗8周后尿蛋白定量明显减少，SCr明显下降，Alb明显升高，与治疗前相比有统计学意义（P〈0．05）。治疗组治疗4周后尿蛋白定量明显下降（P〈0．05）。治疗8周后尿蛋白定量显著下降，Alb显著升高，SCr显著下降，与治疗前相比有统计学意义（P〈0．01）；IgA水平明显降低，中医主症积分明显减少，与治疗前相比有统计学差异（P〈0．05）。治疗组治疗后8周和对照组治疗后8周比较，尿蛋白定量显著下降，Alb显著升高，有统计学意义（P〈0．01）。IgA水平明显降低，中医主症积分明显减少，有统计学意义（P〈0．05）。在西医和中医总的疗效方面，治疗组比对照组有更加确切的疗效，经卡方检验有统计学意义（P〈0．05）。结论肾炎康复片联合氯沙坦钾治疗IgAN（气阴两虚证）疗效显著，与单用氯沙坦钾相比可更有效减少24h尿蛋白定量，提升Alb水平，降低IgA及SCr浓度，改善患者临床症状，从而保护肾功能，延缓IgAN的进展。     

益气滋肾颗粒控制IgA肾病血尿的多中心临床疗效评价

目的:客观评价益气滋肾颗粒治疗IgA肾病血尿(气阴两虚证)的临床疗效.方法:通过多中心、随机、平行对照的临床试验,观察益气滋肾颗粒对IgA肾病血尿、蛋白尿、肾功能、中医证候的干预效果,观察临床病例211例,治疗组109例,对照组102例.结果:治疗组IgA肾病患者血尿恢复正常的比率,与治疗时间呈正相关性.治疗12周后,血尿恢复正常率、改善1级以上的比率,治疗组显著优于对照组.治疗12周时,治疗组蛋白尿的完全缓解率35%,减少50%者为23.33%,尿蛋白定量平均下降52.54%,明显优于对照组.治疗8周、12周时治疗组中医症状积分减少优于对照组,具有统计学差异.结论:益气滋肾颗粒在控制IgA肾病血尿、减少蛋白尿、改善患者症状等方面具有良好的作用.     

移植肾IgA肾病三例报告及文献复习

目的 探讨移植肾IgA肾病的病理特征、临床表现及预后。方法 回顾分析移植肾穿刺活检病理及临床资料。结果 3例IgA肾病,1例为复发性膜增殖型,2例为复发／发性系膜增殖型,临床表现主要是镜下血尿、轻度蛋白尿、或／和高血压、高脂血症;病理改变与普通人群的IgA肾病相同,此外存在多灶性肾小管萎缩及间质纤维化;其对治疗的反应与病理改变密切相关,以双嘧达莫、小剂量华法林及雷公藤多甙治疗2年,2例系膜增殖型者肾功能稳定,膜增殖型的1例治疗2年半后血肌酐上升。结论 移植肾IgA肾病复发迅速,其进展速度及治疗效果与病理分型和病变程度密切相关,无特效治疗方法。     

School urinalysis screening in Korea: prevalence of chronic renal disease

Since 1998, mass urine screening tests have been performed on Korean school children. We have analyzed those patients who showed abnormal urinary findings in the school screening program. Between January 1998 and January 2000, 452 children with abnormal urinary findings visited the Pediatric Kidney Center, Kyung-Hee University Hospital. Sex, age, 24-h urine creatinine clearance, ultrasonography, Doppler scans and renal biopsies were reviewed retrospectively. Results of initial urinalysis are divided into three groups: solely hematuria group (228 cases, 50.4%), solely proteinuria group (98 cases, 21.7%), and combined hematuria and proteinuria group (79 cases, 17.5%). Among the biopsied cases, the proportions representing renal parenchymal diseases were as follows: IgA nephropathy 11.3%, mesangial proliferative glomerulonephritis 21.9%, others 3.8%. Among the three groups, the combined hematuria and proteinuria group had more frequent chronic renal disease (57.7%) than the other groups. Chronic renal disease was detected in 36.9% of all visiting subjects. In the school screening program a significant number of patients showed abnormal urinary findings, which were associated with chronic renal diseases especially in the combined hematuria and proteinuria group. In conclusion, mass urine screening tests should be mandatory to detect asymptomatic chronic renal disease in school children. Received: 12 December 2000 / Revised: 9 July 2001 / Accepted: 12 July 2001     

Randomised controlled trial of leflunomide in the treatment of immunoglobulin A nephropathy

AIM: To investigate the effect of leflunomide for treatment of immunoglobulin A (IgA) nephropathy. METHODS: Sixty IgA nephropathy patients were divided into two groups at random. Patients in the test group received leflunomide and patients in the control group received fosinopril. Clinical data were obtained at weeks 2, 4, 6, 8, 12, 16, 20, 24 and 28. RESULTS: The complete remission rate was 62.1% and the total effectiveness rate was 72.4%. In the leflunomide group, proteinuria significantly decreased from 1.66 +/- 0.42 g to 0.60 +/- 0.68 g (P < 0.05). The efficacy rate of leflunomide compared with fosinopril in treating IgA nephropathy was not statistically different (P > 0.05). Side-effects were mild in both treatment groups. CONCLUSION: These preliminary results are encouraging, but further randomised studies are required before leflunomide can be recommended for the treatment of IgA nephropathy.     

尿激酶联合苯那普利治疗IgA肾病的随访对照研究

目的 观察联合应用尿激酶(UK)和血管紧张素转换酶抑制剂(ACEI)苯那普利治疗IgA肾病(IgAN)的效果。方法 将71例Lee分级≥Ⅲ级的IgAN患者随机分为两组:UK+ACEI组及ACEI组,随访观察两组的疗效。结果 (1)12个疗程后,UK+ACEI组24h尿蛋白定量明显下降(P<0.01),血白蛋白(AIb)水平升高(P<0.05),疗效优于ACEI组。(2)治疗前应用Katafuchi IgA肾病积分系统进行IgAN的病理评分,在肾小球积分≥7分的患者中,治疗至12个疗程时,UK+ACEI治疗效果优于ACEI组(P<0.05)。(3)UK+ACEI组中有10例患者进行了重复肾活检,经治疗后多数患者病理改变保持稳定。结论 UK联合ACEI治疗中重度IgAN安全有效,疗效优于单用ACEI者。肾小球硬化及间质炎细胞浸润的程度可作为估计UK治疗IgAN效果的指标。     

Analysis of clinical and pathological features of HIV associated renal disease

Objective To describe the presentation, pathology, and outcome of biopsy proved renal disease in HIV infected patients. Methods This retrospective study included all HIV infected patients who underwent renal biopsy during the course of their clinical care at PUMC hospital from 2002 to 2012. The pathology and clinical information were abstracted from each patient’s clinical record. Results Eight HIV infected patients had biopsy confirmed renal disease. The commonest presentation was proteinuria in eight patients, and microscopic hematuria in six patients. Two patients had serum creatinine levels abnormal. Renal pathologies included IgA nephropathy in four patients, and lupus-like nephropathy, non-specific focal segmental glomerulosclerosis, membranous nephropathy and Henoch-Schonlein purpura nephritis in one patient each. All 8 patients received highly active antiretroviral treatment (HAART). Urinary protein was decreased significantly in one of them. Another was relieved with ACEI/ARB in addition to HAART. Corticosteroid was given to the other 6 patients. Among them, two got remission. one presented no reaction and was given cyclosporine. One, whose urinary protein didn't decrease with ACEI/ARB, received corticosteroid and needed further observation. One had continued aggravation of the renal disease. One case died of AIDS. One case companied with IgA nephropathy whose proteinuria recurrence was considered having association with tenofovir renal toxicity relieved after adjustment of HAART. Conclusions Classical HIVAN is uncommon in Chinese HIV infected population, a variety of other pathologies were seen in HIV infected patients, renal biopsy can help confirm the diagnosis. In HIV infected patients with evidence of nephropathy should be treated with HAART at diagnosis. Addition of prednisone should be considered if HAART alone does not result in improvement of renal disease.     

原发性膜性肾病合并IgA肾病两例报告并文献复习

目的 探讨原发性膜性肾病合并IgA肾病的临床表现以及病理特点,并指导临床治疗.方法 分析本院经过临床以及肾脏病理(包括光镜、免疫荧光和电镜)确诊的2例原发性膜性肾病合并IgA肾病患者的临床和病理资料,并进行文献复习.结果 两例患者均为青壮年男性,年龄分别为44岁和38岁,血压及肾功能均正常.例1表现为肾病综合征伴镜下血尿;例2表现为无症状性蛋白尿.两例患者临床上均除外继发性肾脏病,根据蛋白尿程度选用不同的治疗方案,效果良好.结论 原发性膜性肾病合并IgA肾病发病率较低,临床表现无特异性,兼具有膜性肾病和IgA肾病的病理特点.临床表现更似于膜性肾病,治疗方面则需要进行个体化的治疗.     

Urinary liver-type fatty acid-binding protein: discrimination between IgA nephropathy and thin basement membrane nephropathy

BACKGROUND: Microscopic hematuria without proteinuria is a common clinical finding in cases of immunoglobulin A (IgA) nephropathy and of thin basement membrane nephropathy. Liver-type fatty acid-binding protein (L-FABP) is expressed in renal proximal tubules and is reported to be a useful marker of the progression of chronic glomerulonephritis. AIM: To assess urinary L-FABP levels for differential diagnosis in patients with microscopic hematuria but without proteinuria. METHODS: This was a multi-center retrospective study. Thirty adult patients who underwent renal biopsy for microscopic hematuria and 20 healthy adult volunteers were included in this study. Urinary L-FABP levels were measured by enzyme-linked immunosorbent assay and compared, particularly between those diagnosed with IgA nephropathy and those diagnosed with thin basement membrane nephropathy. RESULTS: Twelve (40%) patients had IgA nephropathy, 6 (20%) had thin basement membrane nephropathy and 12 (40%) had normal biopsy findings. The urinary L-FABP level was significantly higher in patients with IgA nephropathy (38.4 +/- 26.8 microg/g Cr) than in healthy subjects (5.8 +/- 4.0 microg/g Cr) (p < 0.01); however, the level in patients with thin basement membrane nephropathy or normal biopsy results was comparable to that in healthy subjects. Follow-up data were available for 11 of the 12 patients with IgA nephropathy who initially had no proteinuria. After 24 months, 4 of the 11 were found to have proteinuria, and the urinary L-FABP level had increased from 40.6 +/- 30.5 microg/g Cr to 58.8 +/- 40.5 microg/g Cr (p < 0.01). CONCLUSIONS: Our data suggest that the urinary L-FABP level can be used to discriminate between IgA nephropathy and thin basement membrane nephropathy in patients with microscopic hematuria.     

Steroid pulse therapy combined with tonsillectomy in IgA nephropathy associated with diabetes mellitus.

Ten patients with biopsy-confirmed IgA nephropathy associated with diabetes mellitus underwent dietary weight control and three courses of intravenous pulses of methylprenisolone followed by prednisolone for 6-12 months and tonsillectomy. The average length of the follow-up period was 47.8 (range 30-96) months. As compared with pretreatment values, hematuria, proteinuria, body mass index, and hemoglobin A(1c) were significantly improved after treatment. There were no significant differences with regard to blood pressure and glycemic blood glucose control. There was no worsening of diabetic retinopathy and nephropathy. During steroid pulse therapy, the patients who were treated with insulin needed a higher dosage of insulin; after steroid pulse therapy, the dosage returned to baseline. Even patients with IgA nephropathy and diabetes mellitus could be treated with combined therapy and showed beneficial responses, it they succeeded in reducing body mass index.     

针灸治疗IgA肾病的作用

目的观察针灸治疗对IgA肾病患者蛋白尿、血肌酐（SCr）、血浆内皮素（ET）的影响，探讨针灸对IgA肾病的治疗作用。方法IgA肾病患者30例，随机分为两组，针灸联合激素组15例，接受针灸联合口服泼尼松龙治疗；针灸组15例仅接受针灸治疗，疗程均为2个月。测定治疗前、后24h尿蛋白定量、SCr、血浆ET浓度。结果治疗后两组患者24h尿蛋白定量、SCr、血浆ET浓度均较治疗前显著降低，针灸联合激素组降低的幅度显著高于单纯针灸治疗组（P〈0．01）。结论针灸治疗IgA肾病有减少蛋白尿、保护肾功能的作用，此可能与降低血浆ET水平有一定关系，针灸联合激素治疗IgA肾病的效果优于单纯使用针灸。