Walker R G, Yu S H, Owen J E, Kincaid-Smith P
Department of Nephrology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Clin Nephrol. 1990 Sep;34(3):103-7.
Of 52 patients with mesangial IgA nephropathy, 25 were allocated to treatment with cyclophosphamide (6 months), and dipyridamole and warfarin (2 years) and 27 to no treatment in a randomized prospective 2-year study. At entry, the treated and untreated groups of patients did not differ in mean serum creatinines, urinary protein excretions, quantitative urinary erythrocyte counts or blood pressure readings. At the end of the trial mean (+/- SEM) serum creatinine values had gone from 0.12 +/- 0.01 to 0.13 +/- 0.01 mmol/l (p less than 0.05) in untreated patients and from 0.10 +/- 0.01 to 0.12 +/- 0.01 mmol/l (p less than 0.05) in treated patients. Mean (+/- SEM) log values of urinary erythrocyte (rbc) counts had not changed significantly from 5.47 +/- 0.09 to 5.21 +/- 0.14 log rbc/ml in untreated patients, from 5.45 +/- 0.11 to 5.49 +/- 0.19 log rbc/ml in treated patients. However, in treated patients, mean (+/- SEM) urinary protein excretions decreased from 1.67 +/- 0.35 to 1.15 +/- 0.31 g/24 h (p less than 0.01) whereas in untreated patients urinary protein was unchanged between initial values of 1.76 +/- 0.34 and follow-up at 1.89 +/- 0.45 g/24 h. No significant changes in blood pressure occurred in either group. This study supports the observation that treatment of IgA nephropathy with cyclophosphamide, dipyridamole and warfarin is associated with a reduction of urinary protein excretion but a significant effect on preservation of renal function, at least as determined by serum creatinine values, could not be confirmed over this two-year study.
在一项为期2年的随机前瞻性研究中，52例系膜IgA肾病患者，25例被分配接受环磷酰胺治疗（6个月），双嘧达莫和华法林治疗（2年），27例未接受治疗。入组时，治疗组和未治疗组患者的平均血清肌酐、尿蛋白排泄量、尿红细胞定量计数或血压读数无差异。试验结束时，未治疗患者的平均（±标准误）血清肌酐值从0.12±0.01升至0.13±0.01 mmol/l（p<0.05），治疗患者从0.10±0.01升至0.12±0.01 mmol/l（p<0.05）。未治疗患者尿红细胞（rbc）计数的平均（±标准误）对数值从5.47±0.09降至5.21±0.14 log rbc/ml，治疗患者从5.45±0.11升至5.49±0.19 log rbc/ml，无显著变化。然而，治疗患者的平均（±标准误）尿蛋白排泄量从1.67±0.35降至1.15±0.31 g/24 h（p<0.01），而未治疗患者尿蛋白在初始值1.76±0.34和随访时1.89±0.45 g/24 h之间无变化。两组血压均无显著变化。本研究支持以下观察结果：环磷酰胺、双嘧达莫和华法林治疗IgA肾病与尿蛋白排泄减少有关，但在这项为期两年的研究中，无法证实对肾功能的保护有显著效果，至少根据血清肌酐值判断是这样。
