Tang Sydney, Leung Joseph C K, Chan Loretta Y Y, Lui Yun Hoi, Tang Colin S O, Kan Chi Hang, Ho Yiu Wing, Lai Kar Neng
Nephrology Division, Department of Medicine, University of Hong Kong and Queen Mary Hospital, Hong Kong, China.
Kidney Int. 2005 Aug;68(2):802-12. doi: 10.1111/j.1523-1755.2005.00460.x.
Mycophenolate mofetil (MMF) is increasingly used to treat primary glomerulopathies. Its effectiveness in IgA nephropathy (IgAN) remains unclear.
Forty IgAN patients with persistent proteinuria (>1 g/24 hours) despite conventional treatment with blockers of the renin-angiotensin system were randomized to receive MMF for 24 weeks (group 1) or continue conventional therapy (group 2), and followed for 72 weeks. The primary end point was reduction of proteinuria by 50% or more over entry level.
Sixteen patients (80%) in group 1 versus six patients (30%) in group 2 reached the primary end point (P= 0.0019). Time-averaged change in proteinuria showed a significant decline in group 1, while control subjects displayed a modest rise (P= 0.003). By 72 weeks, the mean proteinuria was 62.0 +/- 7.7% (P= 0.003) and 120.5 +/- 14.1% (P= 0.351) that of the corresponding baseline value in group 1 and group 2, respectively. There was concomitant increase in serum albumin and decrease in serum IgA levels in group 1 but not group 2 patients. Baseline histologic grades, blood pressure control, and the rates of change in serum creatinine and creatinine clearance were not different between the two groups. Normalization in binding of polymeric IgA to cultured mesangial cells and serum interleukin-6 (IL-6) levels, which sustained to study end, was observed in group 1 but not group 2 subjects.
In selected patients with IgAN, MMF is effective in lowering proteinuria and ameliorating some of the putative pathogenetic abnormalities.
霉酚酸酯（MMF）越来越多地用于治疗原发性肾小球疾病。其在IgA肾病（IgAN）中的有效性尚不清楚。
40例尽管接受了肾素 - 血管紧张素系统阻滞剂常规治疗但仍有持续性蛋白尿（>1 g/24小时）的IgAN患者被随机分为两组，一组接受MMF治疗24周（第1组），另一组继续接受常规治疗（第2组），并随访72周。主要终点是蛋白尿较基线水平降低50%或更多。
第1组16例患者（80%）达到主要终点，而第2组为6例患者（30%）（P = 0.0019）。蛋白尿的时间平均变化显示第1组显著下降，而对照组则略有上升（P = 0.003）。到72周时，第1组和第2组的平均蛋白尿分别为相应基线值的62.0±7.7%（P = 0.003）和120.5±14.1%（P = 0.351）。第1组患者血清白蛋白增加，血清IgA水平降低，而第2组患者则无此变化。两组间基线组织学分级、血压控制以及血清肌酐和肌酐清除率的变化率无差异。第1组患者观察到聚合IgA与培养的系膜细胞结合及血清白细胞介素 - 6（IL - 6）水平在研究结束时持续正常化，而第2组未观察到。
在选定的IgAN患者中，MMF可有效降低蛋白尿并改善一些假定的致病异常。
