Clinical assessment of low-dose steroid therapy for patients with IgA nephropathy: a prospective study in a single center
Clinical assessment of low-dose steroid therapy for patients with IgA nephropathy: a prospective study in a single center
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DOI：
10.1007/s10157-008-0036-7
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发表时间：
2008-08-01
影响因子：
2.3
通讯作者：
Nitta, Kosaku
中科院分区：
文献类型：
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作者：
Koike, Minako;Takei, Takashi;Nitta, Kosaku
背景/目的进行性伊加肾病（IgAN）尚无公认的治疗方法。本研究的目的是评估低剂量类固醇治疗IgAN.Methods患者的治疗低剂量类固醇治疗的前瞻性试验进行IgAN与轻度组织学活动的患者。本研究纳入了类固醇组24例患者和对照组24例患者。泼尼松龙的初始剂量为0.4 mg/kgBW/天（20-30 mg/天），在24个月内逐渐减少至5-10 mg/天。轻度活动性炎性病变患者给予泼尼松龙治疗。分配到对照组的患者用双嘧达莫或盐酸齐拉西普在150或300 mg/day.Results的剂量治疗，在所有研究的患者，血清肌酐水平没有显着变化超过24个月。然而，在类固醇治疗24个月后，每日蛋白尿显著减少（0.97 +/- 0.75 vs. 0.31 +/- 0.51 g/d，P = 0.0012），即使在抗血小板药物治疗24个月后没有变化（0.89 +/- 0.49 vs. 0.68 +/- 0.69 g/d，P = 0.2289）。此外，在类固醇治疗24个月后，血尿的等级明显降低（35.6 +/- 36.3 RBC/HPF vs. 13.7 +/- 28.4 RBC/HPF，P = 0.0249）和24个月抗血小板药物（30.1 +/- 37.1 RBC/HPF vs. 12.4 +/- 20.3 RBC/HPF，P = 0.0465）。在类固醇或抗血小板药物治疗期间，收缩压和舒张压没有显著变化。血管变化（0.63 ± 0.73），激素组低于对照组对照组（1.08 +/- 0.88）结论小剂量激素治疗轻度炎性病变的IgA肾病可减少尿蛋白排泄量，防止肾功能恶化，前提是肾活检的组织学结果显示轻度血管病变。
Background/aim No accepted therapy has been established for progressive IgA nephropathy (IgAN). The purpose of the present study was to assess low-dose steroid therapy in the treatment of patients with IgAN.Methods A prospective trial of low-dose steroid therapy was performed in patients with IgAN with mild histological activities. Twenty-four patients in the steroid group and 24 patients in the control group were included in this study. The initial dose of prednisolone was 0.4 mg/kgBW/day (20-30 mg/day), gradually tapered to 5-10 mg/day over 24 months. The patients with mild active inflammatory lesions were treated with prednisolone. The patients assigned to the control group were treated with dipyridamole or zilazep hydrochloride in a dose of 150 or 300 mg/day.Results In all of the patients studied, serum creatinine levels did not significantly change over 24 months. However, daily proteinuria significantly reduced after 24 months of steroid therapy (0.97 +/- 0.75 vs. 0.31 +/- 0.51 g/day, P = 0.0012), even if did not change after 24 months of anti-platelet drugs (0.89 +/- 0.49 vs. 0.68 +/- 0.69 g/day, P = 0.2289), respectively. In addition, the grade of hematuria significantly reduced after 24 months of steroid therapy (35.6 +/- 36.3 RBC/HPF vs. 13.7 +/- 28.4 RBC/HPF, P = 0.0249) and 24 months of anti-platelet drugs (30.1 +/- 37.1 RBC/HPF vs. 12.4 +/- 20.3 RBC/HPF, P = 0.0465), respectively. Systolic and diastolic blood pressures did not significantly change during treatment with steroid or anti-platelet drugs. Vascular changes (0.63 +/- 0.73) in the steroid group were lower than those (1.08 +/- 0.88) in the control group ( P = 0.008).Conclusion Our data suggested that low-dose steroid therapy for IgAN patients with mild inflammatory lesions could reduce the amount of urinary protein excretion and prevent deterioration of renal function, provided the histological findings in the renal biopsies showed mild vascular lesions.