Mizerska-Wasiak Małgorzata, Starczyński Miłosz, Wasiak Wojciech, Małdyk Jadwiga, Płatos Emilia, Pańczyk-Tomaszewska Małgorzata
Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland.
Student's Scientific Group, Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland.
J Clin Med. 2024 Dec 2;13(23):7316. doi: 10.3390/jcm13237316.
: The aim of this study was to evaluate the efficacy of 1-year treatment in children with IgAN and IgAVN using azathioprine, prednisone, and enalapril (AZA+PRED+E) combined with a control kidney biopsy. : This study consists of 68 children diagnosed via kidney biopsy with Oxford classification. The study group included 36 children (15 IgAN, 21 IgAVN) treated with AZA+PRED+E (according to the protocol with a control kidney biopsy); and the control group included 32 children (21 IgAN, 11 IgAVN) who were treated with enalapril alone during one year after kidney biopsy. : After 1 year of combined therapy, a significant reduction in both proteinuria (proteinuria = 0 in 35 patients from the study group) and hematuria in the study group was found. It was confirmed that the Δ proteinuria between the start and end of treatment in IgAN and IgAVN patients from the study group was significantly higher than the Δ proteinuria between the start and end of treatment in the control IgAN and IgAVN group treated with enalapril (30.7 ± 43.6 vs. 8.7 ± 8.7; = 0.015; 68.2 ± 58.3 vs. 19.3 ± 20.3; = 0.008 respectively). In the Oxford classification a high frequency of improvement in E and T in the study group after treatment was observed. : Patients with higher proteinuria and a higher MESTC score require consideration of the strategy of immunosuppressive treatment so that therapy with AZA+PRED+E may be used as a personal treatment plan for children with these diseases.
本研究的目的是评估硫唑嘌呤、泼尼松和依那普利（AZA+PRED+E）联合对照肾活检对儿童IgA肾病（IgAN）和IgA血管炎肾损害（IgAVN）进行1年治疗的疗效。
本研究包括68例经肾活检按牛津分类法确诊的儿童。研究组包括36例儿童（15例IgAN，21例IgAVN），接受AZA+PRED+E治疗（根据方案进行对照肾活检）；对照组包括32例儿童（21例IgAN，11例IgAVN），在肾活检后1年内仅接受依那普利治疗。
联合治疗1年后，研究组蛋白尿（研究组35例患者蛋白尿=0）和血尿均显著减少。证实研究组IgAN和IgAVN患者治疗开始与结束时的蛋白尿差值显著高于依那普利治疗的对照IgAN和IgAVN组治疗开始与结束时的蛋白尿差值（分别为30.7±43.6对8.7±8.7；P=0.015；68.2±58.3对19.3±20.3；P=0.008）。在牛津分类中，观察到研究组治疗后E和T改善的频率较高。
蛋白尿较高和MESTC评分较高的患者需要考虑免疫抑制治疗策略，以便AZA+PRED+E治疗可作为这些疾病儿童的个体化治疗方案。
