目的：对TGF-β1的G-800A，C-509T，T869C和G915C多态性位点与IgA肾病及其临床表现之间的相关性进行了分析。方法：纳入119例经肾活检证实为IgA肾病的患者和116例健康正常成人作为对照组。采用多聚酶链式反应-限制片段长度多态性分析和多聚酶链式反应-扩增受阻突变体系方法测定TGF-β1的G-800A，C-509T，T869C和G915C多态性位点的基因型，分析其与IgA肾病发病以及临床表现的相关性。结果：研究对象中G-800A和G+915C这两个位点没有多态性。IgAN患者C-509T位点的等位基因型分布与正常对照具有显著性差异（Ｐ＜0.05），且IgAN患者TT纯合子的频率显著高于对照组（33% vs 20%,Ｐ=0.02）。C869T位点等位基因的分布无显著性差异。C-509T和C869T位点等位基因分布和患者临床表现无明显的相关性。结论：TGF-β1基因C-509T位点的T等位基因携带可能与IgA肾病的发病易感性具有相关性。
Objective To systematically evaluate the effectiveness and safety of mycophenolate mofetil (MMF) for IgA Nephropathy (IgAN). Methods Databases including CNKI, CBM, MEDLINE, PubMed, The Cochrane Library and SCI were searched from January 1997 to January 2012, and the domestic conference data and relevant published articles were also searched manually. All randomized controlled trials (RCTs) on MMF in treating IgAN were independently collected and screened according to the inclusion and exclusion criteria by two reviewers. The data were extracted, the quality of the included studies was assessed and cross-checked, and then meta-analysis was conducted using RevMan 5.0 software. Results A total of 8 RCTs involving 272 patients with IgAN were included. The results of meta-analyses showed that: a) There were no significant differences in the overall effective rate (RR=0.72, 95%CI 0.21 to 2.52, P=0.61) between the MMF group and the placebo group, but the overall effective rate was higher in the MMF+hormone group than the CTX+hormone group (RR=4.21, 95%CI 1.86 to 9.53, Plt;0.000 1) and other immunosuppressants +hormone groups (RR=3.03, 95%CI 1.47 to 6.25, P=0.003); and b) Adverse reaction: The overall incidence rate of adverse reaction in the MMF+hormone group was lower than the CTX+hormone group (RR=0.16, 95%CI 0.07 to 0.37, Plt;0.000 1). There were no significant differences in the elevated serum creatinine rate (RR=2.28, 95%CI 0.65 to 7.94, P=0.20) and the case number of developing end-stage renal disease (ESRD) (RR=2.37, 95%CI 0.44 to 12.83, P=0.32) between the MMF group and the control group. Conclusion MMF combined with hormone in treating IgAN can increase the overall effective rate and decrease the overall incidence rate of adverse reaction, but its effectiveness of improving long-term survival rate has to be further proved by conducting more high-quality, multi-center and large-scale clinical trials. MMF alone has the same effect as the placebo dose, and it shows no differences in elevated serum creatinine after the treatment compared with conventional therapies.
Objective To assess the efficacy and safety of okra capsule for IgA nephropathy. Methods All randomized or quasi-randomized controlled trials (RCTs or quasi-RCTs) of okra capsule for IgA nephropathy were collected from CENTRAL, MEDLINE, EMbase, PubMed, WanFang Data, CNKI and CBM. Two reviewers independently screened the included studies, extracted the data, assessed the quality, and cross-checked then. Then RevMan 5.07 software was used for meta-analysis. Results Five RCTs were included. The results of meta-analyses showed that: compared with the control group, okra capsule was more effective in decreasing urinary protein (P≥0.05), but had no significant difference in improving renal function, reducing urine red blood cells and blood lipid (Plt;0.05). No research reported the adverse effects of okra capsule. Conclusion Current evidence reveals that okra capsule can reduce urinary protein and improving therapeutic effect for IgA nephropathy. However, further studies are needed to test its safety. Because of the small sample size and low methodological quality of the included studies, these results require more high-quality RCTs for further verification.
目的 回顾性观察糖皮质激素联合小剂量吗替麦考酚酯（MMF）对IgA肾病的临床疗效及安全性。 方法 2010年9月－2012年9月在我科门诊就诊的28例IgA肾病患者接受了小剂量MMF联合激素治疗。醋酸泼尼松起始剂量为0.6 mg/（kg·d），MMF起始剂量为0.5～1.0 g/d，2～4周内调节药物剂量使血药浓度（MPA-AUC）维持在30～60 mg·h/L。治疗前及治疗后每月随访观察血清肌酐、血清白蛋白、尿蛋白定性、24 h尿蛋白定量及药物不良反应等指标。诱导期初定为6个月，若6个月未完全缓解（CR）则延长至9个月，总疗程至少12个月，主要评价指标为诱导治疗期的完全缓解率。 结果 全部患者均完成了12个月的随访观察，全组28例中CR 8例（28.6%），部分缓解（PR）14例（50.0%），未缓解（NR）6例（21.4%），总有效率78.6%。随访过程中，3例患者出现呼吸道感染，其中2例住院治疗；2例患者出现尿路感染，1例患者出现腹泻。 结论 小剂量MMF治疗IgA肾病安全、有效且能在一定程度上节省患者费用，可作为其他免疫抑制方案治疗无效或复发时的一种治疗选择。
目的 探讨抗核抗体（ANA）在IgA肾病中的阳性率及其对临床的意义。 方法 回顾性分析2007年1月－2009年12月间进行ANA检测的115例IgA肾病患者及59例非IgA肾病慢性肾炎患者的临床资料。统计分析ANA阳性与阴性的临床指标。 结果 IgA肾病患者中有12例（10.4%）存在ANA阳性，与非IgA肾病慢性肾炎中的阳性率比较差异无统计学意义（P＞0.05），ANA阳性的IgA肾病血浆IgG水平较高，病理改变较轻。 结论 IgA肾病ANA阳性的机体免疫有增强，肾功、尿蛋白及病理损害较轻，其对IgA肾病预后的影响仍需进一步研究。
目的 总结反复黏膜感染的IgA肾病的临床病理特点。 方法 采用单中心流行病学调查及回顾性研究，收集2006年1月－2009年12月253例经肾活检确诊为IgA肾病的住院患者的临床病理资料，对114例反复黏膜感染的IgA肾病患者（A组）及139例偶发或从未发生黏膜感染的IgA肾病患者（B组）的临床病理指标进行比较。 结果 A组患者年龄较B组小（t=2.913，P=0.004），临床表现无明显症状者比例较B组多，临床分型以反复发作肉眼血尿型为多，病理分级较B组轻（Z=?2.042，P=0.041），IgA+IgM+C3沉积率高（P＜0.001）；B组IgA+IgG+C3沉积率高（P＜0.001），纤维连接蛋白沉积率高（P＜0.001）。 结论 反复黏膜感染的IgA肾病组患者年龄小，反复发作肉眼血尿型多，临床表现及病理分级较轻；两组FN沉积及免疫球蛋白沉积的主要类型不同，提示两组发病机制可能有所不同。
目的 探讨不同性别IgA肾病患者合并高尿酸血症的临床及肾脏病理特点。 方法 采用回顾性研究方法，将2008年1月－2010年12月收治的226例经肾活检确诊的原发性IgA肾病患者分为男性高尿酸血症组、男性尿酸正常组、女性高尿酸血症组及女性尿酸正常组4组，统计分析4组的临床指标及病理指标。 结果 高尿酸血症患病率男性（21.7%）高于女性（11.9%），差异有统计学意义（P＜0.01），尿检异常型患病率男性（14.6%）高于女性（4.0%），差异有统计学意义（P＜0.01），女性LeeⅢ级的患病率（7.1%）高于男性（5.8%），差异有统计学意义（P＜0.01）；男性高尿酸血症组的尿素氮高于尿酸正常组（P＜0.05），女性高尿酸血症组的血尿素氮、血肌酐、胱抑素C、舒张压、甘油三酯比尿酸正常者明显增高（P＜0.01），女性高尿酸血症组的高密度脂蛋白明显高于男性组（P ＜0.01）。 结论 高尿酸血症是IgA肾病的危险因素，可导致更严重的肾功能损害及肾脏病理损害，这种影响在不同性别中存在差异。
【摘要】 目的 探讨IgA肾病肾血管病变的危险因素。 方法 回顾性分析2000年1月－2009年6月间经肾活检确诊的175例IgA肾病患者资料，其中有肾血管病变者93例，无肾血管病变者82例，进行对照研究。采用多因素非条件logistic回归模型分析影响IgA肾病肾血管病变的危险因素。 结果 高血压[OR=11.593，P=0.001，95%CI（2.800，47.991）]、24 h尿蛋白定量[OR=1.754，P=0.001，95%CI（1.270，2.424）]、血肌酐[OR=1.005，P=0.001，95%CI（1.002，1.008）]、肾小球硬化[OR=8.341，P=0.000，95%CI（2.716，25.610）]、肾间质纤维化[OR=4.880，P=0.014，95%CI（1.385，17.199）]对IgA肾病肾血管病变的影响有统计学意义。 结论 高血压、24 h尿蛋白定量、血肌酐、肾小球硬化和肾间质纤维化可能是影响IgA肾病肾血管病变的独立危险因素。积极控制以上危险因素对延缓IgA肾病病变的进展具有重要意义。【Abstract】 Objective To explore the risk factors for renal vascular lesions in patients with immunoglobulin A (IgA) nephropathy. Methods We retrospectively analyzed the clinical data of 175 IgA nephropathy patients diagnosed through renal biopsy from January 2000 to June 2009. Among them, there were 98 cases of renal vascular lesions and 82 cases without renal vascular lesion. Controlled study between the two groups of patients were carried out. A multivariate unconditional logistic regression model was employed to analyze the risk factors for renal vascular lesions in IgA nephropathy patients. Results The following factors had significant correlations with renal vascular lesions in IgA nephropathy patients: hypertension [OR=11.593,P=0.001,95%CI (2.800, 47.991)], 24-hour urine protein level [OR=1.754,P=0.001, 95%CI (1.270, 2.424)], serum creatinine [OR=1.005,P=0.001, 95%CI (1.002, 1.008)], glomerulosclerosis [OR=8.341,P=0.000,95%CI (2.716, 25.610)], and renal interstitial fibrosis [OR=4.880,P=0.014, 95%CI(1.385,17.199)]. Conclusion Hypertension, 24-hour urine protein, serum creatinine, glomerulosclerosis and renal interstitial fibrosis were risk factors for renal vascular lesions in IgA nephropathy patients. It will be very significant to actively control all the above risk factors to prevent occurrence of renal vascular lesions.
目的：回顾性分析不同年龄组IgA肾病患者的病理改变特点，以利于早期诊断和治疗。方法：将我院280例(2005~2007年)经皮肾活检确诊为原发性IgA肾病的患者按不同年龄分为儿童组、青少年组和成人组，逐项分析病例组织光镜和免疫荧光检查的相关资料。结果：在280例病理资料中，儿童组患者病理学分级以Ⅰ～Ⅱ级为主，免疫荧光检查以单纯IgA 和或C3沉积多见；青少年组患者病理学分级以Ⅰ～Ⅲ级为主，免疫荧光检查也是以单纯IgA 和或C3 沉积多见；成人组病理学改变从Ⅰ～Ⅳ级均可见到，主要以Ⅲ ～Ⅳ级为主，免疫荧光检查以单纯IgA 、IgA + IgM和或C3沉积较多。结论：IgA肾病的病理改变有随着年龄增大，病理改变越明显肾脏损害越严重的趋势，早期进行经皮肾活检有利于明确诊断及尽早治疗。
ObjectiveTo systematically review the efficacy and safety of tripterygium wilfordii Hook F (TwHF) in treatment of IgA nephropathy. MethodsThe Cochrane Library (Issue 4, 2014), PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched up to April 28th, 2004 to collect randomized controlled trials (RCTs) about the efficacy and safety of TwHF in treatment of IgA nephropathy. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Metaanalysis was then conducted using RevMan 5.2 software. ResultsA total of 10 RCTs involving 521 patients were finally included. The results of meta-analysis showed that:a) compared with MMF group, TwHF group had better outcomes in complete remission (CR) (OR=2.01, 95%CI 1.04 to 3.87, P=0.04), total remission (TR) (OR=3.17, 95%CI 1.22 to 8.23, P=0.02), 24-hour urinary protein content (MD=2.61, 95%CI 1.34 to 3.88, P<0.000 1), and level of serum albumin (MD=-6.42, 95%CI -9.13 to -3.71, P<0.000 01); and b) compared with ACEI (ARB) group, TwHF group had better outcomes in complete remission (CR) (OR=4.25, 95%CI 2.63 to 6.86, P<0.000 01), total remission (TR) (OR=4.15, 95%CI 2.33 to 7.40, P<0.000 01), 24-hour urinary protein content (MD=1.15, 95%CI 0.63 to 1.66, P<0.000 1), and level of serum albumin (MD=-5.18, 95%CI -8.96 to -1.41, P=0.007), all with significant differences. ConclusionTwHF has favourable therapeutic efficacy and safety in treatment of IgA nephropathy. Due to limited quantity and quality of the included studies, the above conclusion should be verified by further conducting more high quality, large-scale, multicentre RCTs.