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。

Follow-up of the effect of the urokinase combined with benazepril on IgA nephropathy

Objective To observe the effect of urokinase(UK) combined with angiotensin converting enzyme inhibitor (ACEI) on IgA nephropathy(IgAN). Methods Seventy-one cases with IgAN, whose renal pathologic change was no less than grade HI according to Lee's method, were divided into two groups: UK combined with ACEI (benazepril) group and ACEI (benazepril) group. The effect of two groups on IgA nephropathy was followed-up. Results (1) By the end of 12 therapeutic courses, the quantity of urine protein decreased in UK combined with ACEI group, and the level of Alb increased, which were significantly better than those in ACEI group. (2) Katafuchi IgA nephropathy score system was used to evaluate the pathologic changes of the patients. The effect of UK combined with ACEI on the patients whose glomerular scores were more than 7 was markedly better than that of ACEI group. (3)Pathologic changes in most of 10 UK + ACEI patients with the second renal biopsy were stable. Conclusions UK combined with ACEI is an effective method of treating IgAN with moderate or severe pathologic change. Glomerular score and inflammatory cells infiltration can be used as markers to observe the effect of IgAN treatment.