CAJ | 학술논문

目的：观察应用福辛普利联合缬沙坦治疗IgA肾病患儿的临床疗效以及其对尿转化生长因子β1（TGF-β1）水平的影响，探讨其保护肾脏的可能机制。方法30例IgA肾病患儿知情同意后被随机分为治疗组和对照组各15例；对照组在综合治疗（按分级标准及临床表现给予包括糖皮质激素、双嘧达莫等）基础上加福辛普利治疗，治疗组在对照组治疗方法的基础上加用缬沙坦，随访终点为6个月；分别于治疗前、治疗后15天、1个月、3个月、6个月检测24 h尿蛋白定量，同时检测尿TGF-β1水平。结果①治疗后15天，两组分别与治疗前比较，24 h尿蛋白定量及尿TGF-β1含量均无下降。②治疗后1个月，对照组与治疗前比较，24 h尿蛋白定量及尿TGF-β1含量下降，但差异无统计学意义（P＞0．05）；治疗组与治疗前比较，24 h尿蛋白定量下降明显，差异有统计学意义（P＜0．05），尿TGF-β1含量虽有下降，但差异无统计学意义（P＞0．05）。③治疗后3个月，两组与治疗前比较，24 h尿蛋白定量及尿TGF-β1含量均有明显下降（P＜0．05），且治疗组较对照组下降更显著（P＜0．05）。④治疗后6个月，两组与治疗前比较，24 h尿蛋白定量与尿TGF-β1含量均有明显下降（P＜0．05），且治疗组较对照组下降更显著；但与同组3个月比较，仅24 h尿蛋白定量的下降差异有统计学意义（P＜0．05）。结论福辛普利联合缬沙坦有较好的降低IgA肾病患儿尿蛋白的作用，可能与其早期改善肾纤维化作用有关。
목적：관찰응용복신보리연합힐사탄치료IgA신병환인적림상료효이급기대뇨전화생장인자β1（TGF-β1）수평적영향，탐토기보호신장적가능궤제。방법30례IgA신병환인지정동의후피수궤분위치료조화대조조각15례；대조조재종합치료（안분급표준급림상표현급여포괄당피질격소、쌍밀체막등）기출상가복신보리치료，치료조재대조조치료방법적기출상가용힐사탄，수방종점위6개월；분별우치료전、치료후15천、1개월、3개월、6개월검측24 h뇨단백정량，동시검측뇨TGF-β1수평。결과①치료후15천，량조분별여치료전비교，24 h뇨단백정량급뇨TGF-β1함량균무하강。②치료후1개월，대조조여치료전비교，24 h뇨단백정량급뇨TGF-β1함량하강，단차이무통계학의의（P＞0．05）；치료조여치료전비교，24 h뇨단백정량하강명현，차이유통계학의의（P＜0．05），뇨TGF-β1함량수유하강，단차이무통계학의의（P＞0．05）。③치료후3개월，량조여치료전비교，24 h뇨단백정량급뇨TGF-β1함량균유명현하강（P＜0．05），차치료조교대조조하강경현저（P＜0．05）。④치료후6개월，량조여치료전비교，24 h뇨단백정량여뇨TGF-β1함량균유명현하강（P＜0．05），차치료조교대조조하강경현저；단여동조3개월비교，부24 h뇨단백정량적하강차이유통계학의의（P＜0．05）。결론복신보리연합힐사탄유교호적강저IgA신병환인뇨단백적작용，가능여기조기개선신섬유화작용유관。
Objective To observe the effects of fosinopril and valsartan on clinical role and TGFβ1 in IgA nephropathy children and to explore their renoprotective mechanism. Methods 30 cases of patients with IgA nephropathy after informed consent were randomly dividedinto a treatment group and a control group(n=15);Clinical commonly used method is used for the control group(including the adrenal glu-cocorticoids,dipyridamole and fosinopril were given according to the classification standard and clinical manifestations). The treatment group on the basis of the control group was treated with valsartan,end of follow-up was 6 months,respectively before and after treatment of 15 days, 1 month,3 months,6 months to detect 24 hours urine protein,at the same time collecting urine to detect protein and TGF-beta1 level. Re-sults ①After treatment of 15 days,content of urine protein and urine TGF-quantitative beta 1 in both groups respectively compared with be-fore treatment have not decreased at all.②After one month,the control group compared with before treatment,urine protein and urinary quan-titative TGF-there is a decrease in the content of beta 1,but there was no statistically significant difference(P>0. 05);Treatment group com-pared with before treatment,urine protein quantitative declined,the difference was statistically significant(P<0. 05),the urine TGF-beta 1 levels have fallen,but no statistical significance(P>0. 05).③The treatment for 3 month,compared with before treatment in both groups, quantitative urine protein and urine TGF-beta 1 levels have significantly decreased(P<0. 05),and the treatment group decreased more signif-icantly than the control group.④six month,compared with before treatment in both groups,quantitative urine protein and urine TGF-beta 1 levels have significantly decreased(P<0. 05),and the treatment group than the control group decreased more obvious;Compared with treat-ment for 3 month,but only the urine protein quantitative have significantly lowered,the difference was statistically significant(P<0. 05). Conclusion Fosinopril combined with valsartan has a good effect on urinary protein in children`s IgA nephropathy. It could be related to its early improvement on renal fibrosis effect.