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目的观察缬沙坦联合骨化三醇治疗IgA肾病(IgAN)的效果,并探讨其机制。方法选取肾穿刺活检病理诊断为原发性IgAN患者60例,随机均分为3组,A组口服缬沙坦胶囊,B组口服骨化三醇胶丸,C组口服缬沙坦胶囊+骨化三醇胶丸,疗程16周。检测各组治疗前后24 h尿蛋白、血清肌酐(Scr)、血磷、血钙及血清转化生长因子β1(TGF-β1)。采用SPSS 17.0统计软件,组内比较采用配对t检验,组间比较采用单因素方差分析。结果治疗16周后,3组24 h尿白蛋白及TGF-β1水平均较治疗前下降,以C组下降最明显,差异均具有统计学意义(P均<0.05)。3组治疗前后血清Scr、钙、磷组间及组内比较差异均无统计学意义(P均>0.05)。结论缬沙坦联合骨化三醇可以减少IgAN患者蛋白尿,效果较缬沙坦或骨化三醇单药优,且对肾功能、血钙、血磷无明显影响;协同降低血清TGF-β1水平可能是作用机制之一。
Objective To observe the effect of valsartan combined with calcitriol on IgA nephropathy (IgAN) and to explore its mechanism. Methods Sixty patients with primary IgAN diagnosed by pathological examination of kidney biopsy were randomly divided into three groups: group A received valsartan capsules, group B received calcitriol capsules, and group C received valsartan capsules plus bone Triol capsules, treatment for 16 weeks. Urine protein, serum creatinine (Scr), serum phosphorus, serum calcium and serum TGF-β1 were measured 24 h before and after treatment. Using SPSS 17.0 statistical software, compared with paired t-test within the group, single-factor analysis of variance was used to compare between groups. Results After treatment for 16 weeks, the levels of 24 h urinary albumin and TGF-β1 in three groups decreased significantly compared with those before treatment, and the difference was statistically significant (P all <0.05). Before and after treatment, the serum levels of Scr, calcium and phosphorus in the three groups showed no significant difference (all P> 0.05). Conclusion Valsartan combined with calcitriol can reduce proteinuria in patients with IgAN, the effect is better than valsartan or calcitriol monotherapy, and renal function, serum calcium, phosphorus did not significantly affect the synergistic reduction of serum TGF-β1 Level may be one of the mechanisms of action.