Controlled, prospective trial of steroid treatment in IgA nephropathy: A limitation of low-dose prednisolone therapy
Controlled, prospective trial of steroid treatment in IgA nephropathy: A limitation of low-dose prednisolone therapy
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DOI：
10.1016/s0272-6386(03)00194-x
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发表时间：
2003-05-01
影响因子：
13.2
通讯作者：
Fujimi, S
中科院分区：
文献类型：
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作者：
Katafuchi, R;Ikeda, K;Fujimi, S
背景对于进行性免疫球蛋白A（伊加）肾病，尚无公认的治疗方法。研究方法：在具有中度组织学特征的伊加肾病患者中进行了一项低剂量泼尼松龙治疗的前瞻性、随机、对照试验。类固醇组中的43名患者和对照组中的47名患者被纳入研究。泼尼松龙的初始剂量为20 mg/d，2年内逐渐减至5 mg/d。结果：类固醇组基线尿蛋白肌酐比值（UP-UCR）显著高于对照组。类固醇组的随访时间为65 +/- 25个月，对照组为64 +/- 23个月。UP-UCR较基线的变化，即末次随访时的UP-UCR减去基线时的UP-UCR，类固醇组显著低于对照组（类固醇组，-0.84 +/- 1.78;对照组，0.26 +/- 1.65; P = 0.0034）。两组的肾脏存活率相似。根据临床病程将患者分为两个亚组。激素组好转28例，未好转15例;对照组好转27例，未好转20例。在类固醇组中，未改善亚组的UP-UCR显著高于改善亚组（3.1 +/- 2.6 vs 1.8 +/- 1.5）。结论：这些数据表明，我们的方案具有抗蛋白尿的作用，但不能提高肾脏存活率。由于类固醇治疗预防伊加肾病进展的效果被认为与尿蛋白减少密切相关，因此我们方案中泼尼松龙剂量不足可能是对蛋白尿和肾存活效果不一致的原因。
Background. No accepted therapy has been established for progressive immunoglobulin A (IgA) nephropathy. Methods: A prospective, randomized, controlled trial of low-dose prednisolone therapy was performed in patients with IgA nephropathy with moderate histological characteristics. Forty-three patients in the steroid group and 47 patients in the control group were included in the study. The initial dose of prednisolone was 20 mg/d, gradually tapered to 5 mg/d during 2 years. Results: Baseline urine protein-creatinine ratio (UP-UCR) was significantly greater in the steroid group than in controls. Follow-up duration was 65 +/- 25 months in the steroid group and 64 +/- 23 months in controls. Changes in UP-UCR from baseline, le, UP-UCR at last follow-up minus UP-UCR at baseline, were significantly lower in the steroid group than in controls (steroid group, -0.84 +/- 1.78; controls, 0.26 +/- 1.65; P = 0.0034). Kidney survival was similar in both groups. Patients were divided into two subgroups according to clinical course. There were 28 improved patients and 15 unimproved patients in the steroid group and 27 improved patients and 20 unimproved patients in the control group. In the steroid group, UP-UCR was significantly greater in the unimproved than improved subgroup (3.1 +/- 2.6 versus 1.8 +/- 1.5). Conclusion: These data suggest that our protocol had an antiproteinuric effect, but could not improve kidney survival. Because the effect of steroid therapy to prevent the progression of IgA nephropathy is believed to be linked closely to reduction in urinary potein, an insufficient dose of prednisolone in our protocol may be the reason for the discrepancy between the effect on proteinuria and kidney survival.