Lai K N, Lai F M, Ho C P, Chan K W
Clin Nephrol. 1986 Oct;26(4):174-80.
A randomized prospective study of 34 patients with IgA nephropathy and nephrotic syndrome was conducted to determine the therapeutic value of corticosteroid therapy. The patients were divided into two groups: Group A, 17 patients receiving oral prednisolone/prednisone for four months; and Group B, 17 patients receiving no corticosteroid therapy and acting as controls. The groups are comparable in age of presentation, sex ratio, and duration of study. No difference in serum creatinine levels, creatinine clearance, serum IgA levels, severity of renal histopathological changes, incidence of hypertension or incidence of impaired renal function could be demonstrated but the Group A patients had significantly heavier proteinuria. During the mean study period of 38 months (range 12-106), no significant difference in serum creatinine levels and creatinine clearance was demonstrated between the two groups. Forty percent of the Group A patients developed complications related to steroid therapy. Despite the overall lack of therapeutic value in IgA nephropathy with nephrotic syndrome as reflected by change in renal function, corticosteroid treatment resulted in excellent remission of nephrotic syndrome in 80% of patients with mild glomerular histopathological changes. Our findings suggest that corticosteroid therapy is only beneficial to selected groups of patients with IgA nephropathy and nephrotic syndrome but its indiscriminate use should be discouraged.
对34例IgA肾病合并肾病综合征患者进行了一项随机前瞻性研究，以确定皮质类固醇疗法的治疗价值。患者被分为两组：A组，17例患者口服泼尼松龙/泼尼松四个月；B组，17例患者不接受皮质类固醇治疗，作为对照组。两组在发病年龄、性别比例和研究时长方面具有可比性。在血清肌酐水平、肌酐清除率、血清IgA水平、肾脏组织病理学改变的严重程度、高血压发病率或肾功能受损发病率方面未显示出差异，但A组患者的蛋白尿明显更严重。在平均38个月（范围12 - 106个月）的研究期间，两组之间在血清肌酐水平和肌酐清除率方面未显示出显著差异。A组40%的患者出现了与类固醇治疗相关的并发症。尽管从肾功能变化来看，皮质类固醇治疗对IgA肾病合并肾病综合征总体缺乏治疗价值，但在80%肾小球组织病理学改变较轻的患者中，皮质类固醇治疗使肾病综合征得到了显著缓解。我们的研究结果表明，皮质类固醇疗法仅对特定组别的IgA肾病合并肾病综合征患者有益，但应避免不加区分地使用。
