本文關(guān)鍵詞： 福辛普利 纈沙坦 IgA 腎病 轉(zhuǎn)化生長因子β1　出處：《安徽醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的IgA腎病(Immunoglobulin A glomerulo-nephritis,IgAN)是一組免疫病理特征以腎小球系膜區(qū)IgA沉積為主的臨床綜合征,臨床上以血尿最為常見,此外還通常伴有蛋白尿,以及高血壓、腎功能衰竭等,疾病呈慢性進(jìn)展過程。目前,IgA腎病成為導(dǎo)致終末期腎病(End-stage renal disease,ESRD)的主要疾病之一。因此,近年來IgAN的治療一直受到重視。然而其發(fā)病具體原因目前尚不知曉,也沒有特異性治療措施。當(dāng)前對治療IgA腎病合并蛋白尿的患者多在綜合治療基礎(chǔ)上加用血管緊張素轉(zhuǎn)換酶抑制劑(Angiotensin converting enzyme inhibitor,ACEI)藥物,而將ACEI和血管緊張素II受體拮抗劑(AngiotensinII receptor antagonist,ARB)聯(lián)合應(yīng)用治療IgAN的臨床研究尚不多,然而我們臨床上發(fā)現(xiàn),聯(lián)合應(yīng)用ACEI和ARB不僅能減少單用ACEI藥物所致副作用,而且臨床療效也顯著改善。為此我們前瞻性觀察了福辛普利與纈沙坦聯(lián)合應(yīng)用對IgA腎病患兒的治療效果,并通過檢測患兒尿轉(zhuǎn)化生長因子β1(Transforming growth factor-beta,TGF-β1)水平的變化對該治療機(jī)制進(jìn)行了探討。方法選取30例符合診斷標(biāo)準(zhǔn)及納入標(biāo)準(zhǔn)的住院IgA腎病患兒,按照患兒家長知情同意后將其隨機(jī)分為對照組和治療組各15例;對照組采用綜合治療(按分級標(biāo)準(zhǔn)及臨床表現(xiàn)給予包括糖皮質(zhì)激素、雙嘧達(dá)莫等)基礎(chǔ)上加福辛普利治療,治療組在對照組的基礎(chǔ)上加用纈沙坦治療,隨訪終點(diǎn)為6個(gè)月;分別于治療前、治療后15天、1月、3月、6月檢測血肌酐、血生化、血脂、尿敏感腎功能、24小時(shí)尿蛋白定量,同時(shí)檢測尿TGF-β1水平。同時(shí),選取我院同期體檢的健康兒童15例為正常組,測定尿TGF-β1水平。結(jié)果1.治療15天后,兩組分別與治療前相比較,尿蛋白定量與尿TGF-β1含量均無下降。2.治療1個(gè)月后,對照組與治療前相比較,尿蛋白定量及尿TGF-β1含量有下降,但差異無統(tǒng)計(jì)學(xué)意義(P0.05);治療組與治療前相比較,尿蛋白定量下降明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.05),尿TGF-β1含量雖有下降,但差異無統(tǒng)計(jì)學(xué)意義(P0.05)。3.治療3個(gè)月后,兩組與治療前相比較,尿蛋白定量與尿TGF-β1含量均有明顯下降(P0.05),且治療組與對照組相比較,下降更顯著(P0.05)。4.治療6個(gè)月后,兩組與治療前相比較,尿蛋白定量與尿TGF-β1含量均有明顯下降(P0.05),且治療組與對照組相比較,下降更顯著;但與同組治療3個(gè)月相0比較,僅尿蛋白定量的下降差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論福辛普利合纈沙坦有較好的降低IgA腎病患兒尿蛋白的作用,可能與其早期改善腎纖維化作用有關(guān)。
[Abstract]:Objective Immunoglobulin A glomerulo-nephritis-IgANA is a group of clinical syndrome characterized by IgA deposition in glomerular Mesangial area. Hematuria is the most common clinical syndrome, in addition to proteinuria, hypertension, renal failure and so on. At present, IgA nephropathy is one of the major diseases leading to End-stage renal disease. Therefore, the treatment of IgAN has been paid more attention in recent years. However, the specific causes of the disease have not been known yet. There is also no specific treatment. Currently, patients with IgA nephropathy complicated with proteinuria are treated with angiotensin converting enzyme inhibitor ACEI on the basis of comprehensive therapy. However, there are few clinical studies on the combination of ACEI and angiotensin II receptor antagonist, Angiotensin II receptor antagonistritin, in the treatment of IgAN. However, we have found that the combination of ACEI and ARB can not only reduce the side effects of ACEI alone. For this reason, we prospectively observed the efficacy of fosinopril combined with valsartan in the treatment of children with IgA nephropathy. The therapeutic mechanism of TGF- 尾 1 was studied by detecting the level of transforming growth factor-beta1 in children. Methods 30 hospitalized children with IgA nephropathy who met the diagnostic criteria and were included in the criteria were selected. According to their parents' informed consent, they were randomly divided into control group (n = 15) and treatment group (n = 15). The control group was treated with fosinopril on the basis of comprehensive treatment (including glucocorticoid, dipyridamole, etc.) according to grading criteria and clinical manifestations. The treatment group was treated with valsartan on the basis of the control group and followed up for 6 months. Before treatment, 15 days after treatment, January, March and June, serum creatinine, blood biochemistry, blood lipids and urinary sensitive renal function were measured respectively. Urine TGF- 尾 1 level was measured simultaneously. Meanwhile, 15 healthy children in our hospital were selected as normal group, and urine TGF- 尾 1 levels were measured. Results 1.After 15 days of treatment, the two groups were compared with those before treatment. After one month of treatment, the urine protein and urine TGF- 尾 1 levels in the control group decreased, but there was no significant difference between the two groups (P 0.05). The quantity of urine protein decreased obviously, the difference was statistically significant (P 0.05), the content of urine TGF- 尾 1 decreased, but the difference was not statistically significant. After 3 months of treatment, the two groups were compared with those before treatment. Urine protein and urine TGF- 尾 1 content were significantly decreased in the treatment group compared with the control group, and the decrease was more significant than that in the control group. After 6 months of treatment, the two groups were compared with those before treatment. Urine protein quantity and urine TGF- 尾 1 content were significantly decreased in the treatment group than in the control group, but were significantly decreased in the treatment group than in the control group, but compared with that in the same group for 3 months. Conclusion fosinopril combined with valsartan has a better effect on reducing urinary protein in children with IgA nephropathy, which may be related to the early improvement of renal fibrosis in children with IgA nephropathy.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R726.9

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相關(guān)期刊論文 前1條

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本文編號：1548526