Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
Int Immunopharmacol. 2020 Apr;81:106229. doi: 10.1016/j.intimp.2020.106229. Epub 2020 Jan 31.
Suitable and efficient treatments for Henoch-Schönlein purpura nephritis (HSPN) with proteinuria remains unclear. Whether steroids combined with immunosuppressive agents improves prognosis compared to steroid therapy alone also remains controversial. This study explored whether combined therapy reduces proteinuria in HSPN patients with different pathological features. Chinese patients (n = 84) diagnosed with HSPN with proteinuria by renal biopsy between 2010 and 2019 were retrospectively studied. Patients were grouped into the steroid group (control) or the combined steroid and immunosuppressant group. Estimated glomerular filtration rate (eGFR) (mL/min/1.73 m/y) and proteinuria were measured. The primary outcome progression was analyzed using Kaplan-Meier survival curves. The effect of the combined therapy on renal outcome was analyzed by multivariable Cox regression. Propensity score matching and sensitivity analysis were used to explore whether pathological features impacted prognosis. Patients who received combined steroid and immunosuppressant therapy were more likely to recover from HSPN and had proteinuria <3 g/24 h (P = 0.02) or 1 g/24 h (P = 0.03). Multiple Cox regression analysis confirmed that this decrease was independent of renin-angiotensin system blockers. Further sensitivity analysis showed that combined therapy was effective in patients with crescents (P = 0.02). However, combined steroid and immunosuppressant therapy was not more effective in patients with endocapillary hypercellularity (E), tubular atrophy/interstitial fibrosis (T), or segmental sclerosis (S). Combined steroid and immunosuppressant therapy was significantly associated with HSPN remission, and more effectively decreased proteinuria during the initial disease phase.
适用于伴有蛋白尿的过敏性紫癜性肾炎（HSPN）的有效治疗方法仍不明确。与单独使用类固醇治疗相比，类固醇联合免疫抑制剂治疗是否能改善预后也存在争议。本研究旨在探讨联合治疗是否能降低不同病理特征的 HSPN 患者的蛋白尿。
回顾性分析了 2010 年至 2019 年间经肾活检诊断为 HSPN 伴蛋白尿的 84 例中国患者。将患者分为激素组（对照组）或激素联合免疫抑制剂组。检测估算肾小球滤过率（eGFR）（mL/min/1.73 m 2 ）和蛋白尿。采用 Kaplan-Meier 生存曲线分析主要结局进展情况。采用多变量 Cox 回归分析联合治疗对肾脏结局的影响。采用倾向性评分匹配和敏感性分析探讨病理特征对预后的影响。
接受激素联合免疫抑制剂治疗的患者更有可能从 HSPN 中恢复，且蛋白尿<3 g/24 h（P=0.02）或 1 g/24 h（P=0.03）。多变量 Cox 回归分析证实，这种降低与肾素-血管紧张素系统阻滞剂无关。进一步的敏感性分析表明，联合治疗在新月体形成患者中有效（P=0.02）。然而，在毛细血管内细胞增多（E）、肾小管萎缩/间质纤维化（T）或节段性硬化（S）患者中，联合激素和免疫抑制剂治疗并没有更有效。
联合激素和免疫抑制剂治疗与 HSPN 缓解显著相关，并且在疾病初始阶段更有效地降低蛋白尿。
