Efficacy of multidrug therapy combined with mizoribine in children with diffuse IgA nephropathy in comparison with multidrug therapy without mizoribine and with methylprednisolone pulse therapy
Efficacy of multidrug therapy combined with mizoribine in children with diffuse IgA nephropathy in comparison with multidrug therapy without mizoribine and with methylprednisolone pulse therapy
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DOI：
10.1159/000082202
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发表时间：
2004-01-01
影响因子：
4.2
通讯作者：
Suzuki, H
中科院分区：
文献类型：
--
作者：
Kawasaki, Y;Hosoya, M;Suzuki, H
目的：评价泼尼松龙、华法林、双嘧达莫联合咪唑立宾（PWDM）治疗弥漫性免疫球蛋白A（IgA）肾病的疗效，并与泼尼松龙、华法林、双嘧达莫不加咪唑立宾（PWD）和甲泼尼龙脉冲疗法（PWD脉冲）进行比较。方法：我们收集了 61 例诊断为弥漫性 IgA 肾病的患者的数据，并将这些患者回顾性分为三组，未随机分组。 A组包括1987年之前的21名患者，接受PWD治疗24个月，B组包括1987年至1989年的20名患者，接受PWD脉冲治疗24个月，C组包括1990年以后的20名患者，接受PWDM治疗24个月。回顾性分析各组的临床特征和病理结果。结果：A组、B组和C组从开始治疗的时间分别为8.9±5.2、8.1±3.9和7.7±3.8年。最近一次随访检查时，A组平均尿蛋白排泄量（mg/m(2)/h）为17±10，B组为22±20，C组为6±6，与其他组相比，C组明显下降。所有三组第二次活检时的活动指数均低于第一次活检时的活性指数（A 组为 5.1 +/- 0.8 对比 6.5 +/- 2.1，p < 0.05；B 组为 5.6 +/- 0.9 对比 6.6 +/- 1.7，p < 0.01；A 组为 4.5 +/- 1.0 对比 6.8 +/- 1.9，p < 0.01）。 C 组，p < 0.01）。第二次活检时 A 组和 B 组的慢性指数高于第一次活检时的慢性指数（A 组为 7.3 +/- 1.4 对比 4.8 +/- 1.0，p < 0.01，B 组为 8.1 +/- 2.0 对比 5.3 +/- 0.9，p < 0.01），但 C 组没有变化。在最近一次随访检查中，1 名患者（4.8%） A组、B组3例（15%）、C组无肾功能不全（0%）。结论：这些结果表明，PWDM 在改善 IgA 肾病患者的蛋白尿和组织学严重程度方面似乎比 PWD 或 PWD 脉冲更有效。版权所有 (C) 2004 S. Karger AG，巴塞尔。
Aim: To evaluate the efficacy of prednisolone, warfarin, and dipyridamole therapy combined with mizoribine (PWDM) in the treatment of diffuse immunoglobulin A (IgA) nephropathy in comparison with prednisolone, warfarin, and dipyridamole therapy without mizoribine (PWD) and with methylprednisolone pulse therapy ( PWD pulse). Methods: We collected data on 61 patients diagnosed with diffuse IgA nephropathy, and these patients were retrospectively divided into three groups without randomization. Group A included 21 patients before 1987 who were treated with PWD for 24 months, group B included 20 patients from 1987 to 1989 who were treated with PWD pulse therapy for 24 months, and group C included 20 patients after 1990 who were treated with PWDM for 24 months. Clinical features and pathological findings in each group were analyzed retrospectively. Results: The time from initiation of therapy in group A, group B, and group C was 8.9 +/- 5.2, 8.1 +/- 3.9, and 7.7 +/- 3.8 years, respectively. At the latest follow-up examination, the mean urinary protein excretion (mg/m(2)/ h) was 17 +/- 10 in group A, 22 +/- 20 in group B, and 6 +/- 6 in group C and had decreased signifi cantly in group C as compared with the other groups. The activity index in all three groups was lower at the second biopsy than that at the fi rst biopsy ( 5.1 +/- 0.8 vs. 6.5 +/- 2.1 in group A, p < 0.05; 5.6 +/- 0.9 vs. 6.6 +/- 1.7 in group B, p < 0.01, and 4.5 +/- 1.0 vs. 6.8 +/- 1.9 in group C, p < 0.01). The chronicity index in groups A and B at second biopsy was higher than at fi rst biopsy (7.3 +/- 1.4 vs. 4.8 +/- 1.0 in group A, p < 0.01, and 8.1 +/- 2.0 vs. 5.3 +/- 0.9 in group B, p < 0.01), but was unchanged in group C. At the latest follow-up examination, 1 patient (4.8%) in group A, 3 patients (15%) in group B, and none (0%) in group C had renal insufficiency. Conclusion: These results suggest that PWDM appears to be more effective than PWD or PWD pulse in ameliorating proteinuria and histological severity of patients with IgA nephropathy. Copyright (C) 2004 S. Karger AG, Basel.