Yagi Kazuro, Okada Mitsuru, Yanagida Hidehiko, Kuwajima Hiroaki, Ikeda Masaru, Sugimoto Keisuke, Takemura Tsukasa
Department of Pediatrics, Kinki University School of Medicine, 377-2 Ohno-higashi, Osaka-sayama 589-8511, Japan.
Clin Exp Nephrol. 2003 Dec;7(4):270-4. doi: 10.1007/s10157-003-0255-x.
Because moderate or severe proteinuria is a representative factor indicative of longterm poor prognosis in IgA nephrology, an anti-proteinuric treatment which can be administered longterm with few side effects is necessary. We report here a comparison of antiproteinuric effects in two patient groups treated with different combination therapies.
Group A comprised 12 patients with IgA nephropathy, who had 24-h proteinuria of 0.5 gm(2) or more, moderately severe renal histology, and normal renal function, and were treated with a combination of drugs, i.e., prednisolone, an immunosuppressant (mizoribine), an anti-platelet drug (dipyridamole), and an angiotensin-converting enzyme inhibitor. Group B consisted of 18 patients who had baseline characteristics similar to those of the patients in group A and were treated with our previous protocol (a combination of prednisolone, cyclophosphamide, and dipyridamole). Twenty-four-hour proteinuria and creatinine clearance were measured every 6 months. The primary endpoint was reduction of 24-h proteinuria by less than 25% compared with the baseline value.
The proportion of patients that exhibited the primary endpoint, as assessed by the Kaplan-Meier method, was found to be significantly higher in group A than in group B (logrank test; P = 0.024). None of the patients in the two groups experienced serious adverse effects.
The results suggested that the use of drugs in combination with cyclophosphamide was beneficial for patients with moderately severe IgA nephropathy. Because moderate or severe proteinuria is a representative factor indicative of longterm poor prognosis in IgA nephropathy, an anti-proteinuric treatment which can be administered longterm with few side effects is necessary. We report here a comparison of antiproteinuric effects in two patient groups treated with different combination therapies.
由于中度或重度蛋白尿是IgA肾病长期预后不良的一个代表性因素，因此需要一种能长期使用且副作用较少的抗蛋白尿治疗方法。我们在此报告了两组接受不同联合治疗的患者的抗蛋白尿效果比较。
A组包括12例IgA肾病患者，他们的24小时蛋白尿为0.5克或更多，肾组织学为中度严重，肾功能正常，并接受了药物联合治疗，即泼尼松龙、一种免疫抑制剂（咪唑立宾）、一种抗血小板药物（双嘧达莫）和一种血管紧张素转换酶抑制剂。B组由18例患者组成，他们的基线特征与A组患者相似，并接受了我们之前的方案（泼尼松龙、环磷酰胺和双嘧达莫联合使用）治疗。每6个月测量一次24小时蛋白尿和肌酐清除率。主要终点是与基线值相比，24小时蛋白尿减少不到25%。
通过Kaplan-Meier方法评估，发现A组出现主要终点的患者比例显著高于B组（对数秩检验；P = 0.024）。两组患者均未出现严重不良反应。
结果表明，联合使用环磷酰胺的药物对中度严重IgA肾病患者有益。由于中度或重度蛋白尿是IgA肾病长期预后不良的一个代表性因素，因此需要一种能长期使用且副作用较少的抗蛋白尿治疗方法。我们在此报告了两组接受不同联合治疗的患者的抗蛋白尿效果比较。
