霉酚酸酯联合小剂量糖皮质激素治疗IgA肾病的回顾性分析内科学;肾脏病学专业毕业论文.docx

广州医学院硕士学位论文 广州医学院硕士学位论文 PAGE PAGE 5 MMF 联合小剂量糖皮质激素治疗 IgA 肾病 3 个月即能显著缓解尿蛋白，完成 12 个月治疗的患 者尿蛋白较完成 3 个月治疗的患者显著减少，但超过 3 月增加肺部感染的并发症。本组病例 肺部感染与肾功能状态和甲基泼尼松龙治疗密切相关。研究结果表明，本组霉酚酸酯联合小 剂量糖皮质激素治疗 IgA 肾病可显著缓解尿蛋白排泄，稳定肾功能，疗程宜在 12 个月以上。 合理评估肾功能减退与相关的治疗风险、合理使用皮质激素（尤其应避免联合使用甲泼尼龙） 可减少肺部感染等严重并发症。 关键词：IgA 肾病 霉酚酸酯 小剂量糖皮质激素 回顾性分析 联合治疗 论文类型：应用研究 研究报告 A Retrospective Analysis of Mycophenolate Mofetil Immunosuppression Combined with Small Doses Glucocorticoids Therapy in Patients with IgA Nephropathy Graduate:Dongli Qi Supervisor: Professor Yongcheng He Professor Shaodong Luan Professor Qijun Wan ABSTRACT Objective：To retrospective analysis the clinical efficacy and complications of using mycophenolate mofetil immunosuppression combined with small doses Glucocorticoids therapy in patients with IgA nephropathy.Methods: 33 patients with IgA nephropathy diagnosed by renal biopsy in Shenzheng 2nd people’s hospital,as Scr442μmol/L with urinary protein 1.0 g/d ,were treated with MMF combined with low dose glucocorticoid. The initial dosage of MMF was 30mg/kg/d,1.5～2.0g/d. The dosage was reduced to half after 6 months treatment and maintenance treatment for six months.The initial dosage of glucocorticoid was 0.5mg/kg/d. The dosage was reduced to half after 8 weeks treatment.The total course of treatment lasted at least 12 months.Urinary protein excretion, serum creatinine concentration, endogenous serum creatinine clearance, serum albumin, lipids, white blood cells and complications etc of patients were performed before and 3 6 12months after treatments.The primary endpoint were a proteinuria complete remission,doubling of serum creatinine concen- tration or dialysis, death, severe infection.Results:There were 24 male and 9 female patients in the analysis group. 31 patients complete 3 months of treatment, and 1 patient for renal deterioration into the hemodialysis, 1 patient lost to follow-up.21 patients completed 6 months of treatment,6 patients suffering from severe pneumonia termination of tr