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目的:探讨环孢素A联合中/低剂量泼尼松治疗进展性IgA肾病的临床疗效和安全性.方法:进展性IgA肾病患者120例随机分为观察组和对照组每组60例.对照组晨起顿服大剂量泼尼松,起始剂量1.0mg·kg-1·d-1,最大量60mg·d-1,6周后(或尿蛋白转阴后2周)逐渐减量,至12周时减至0.5 mg·kg-1·d-1,维持治疗;观察组给予环孢素A+泼尼松治疗,环孢素A起始剂量100mg·d-1,根据血药浓度调整用量,最大不超过5.0 mg·kg-1·d-1,使环孢素A谷浓度维持在100～200 mg·ml-1;波尼松起始剂量0.5 mg· kg-1·d-1,最大量30 mg·d-1.两组均治疗6个月以上.分别于治疗2,4,6,8,12,24周观察两组患者24h尿蛋白、血白蛋白、肌酐、尿酸等指标变化,评价两组的临床疗效和药品不良反应.结果:观察组治疗4,8,12,24周时的总缓解率均显著高于对照组(P＜0.05).治疗2,4,8,12,24周时,两组24h尿蛋白均显著下降(P＜0.05),且观察组明显低于对照组(P＜0.05).观察组治疗4,8,12,24周时血白蛋白较治疗前显著上升(P＜0.05),且显著高于对照组同期(P＜0.05);而对照组治疗期间血白蛋白无明显变化(P＞0.05).治疗前后两组患者血肌酐和尿酸水平比较,差异无统计学意义(P＞0.05).两组药品不良反应发生率比较,差异无统计学意义(P＞0.05).结论:环孢素A联合中/低剂量泼尼松治疗进展性IgA肾病临床疗效好,安全性高,值得临床推广.“,”Objective:To discuss the curative effects and clinical safety of cyclosporine A combined with union/ low-dose prednisone on the treatment of progressive IgA nephropathy.Methods:120 cases of progressive IgA nephropathy patients were randomly divided into observation group and control group (60 cases in each group).The control group were given large doses of prednisone and a starting dose of 1.0mg · kg-1 · d-1,with the maximum amount of 60mg · d-1;And after 6 weeks of (or urine protein was negative after two weeks) tapering,when reduced to 12 weeks 0.5 mg· kg-1 · d-1,all patients were given maintenance treatment.The observation group received cyclosporine A with a starting dose of 100 mg · d-1,and adjusted according to the amount of cyclosporine A,with the maximum not exceeding 5.0 mg · kg-1 · d-1,so that concentration of cyclosporin A was maintained at 100-200 mg · ml-1,besides prednisone with a starting dose of 0.5mg · kg-1 · d-1,with the maximum amount of 30mg · d-1,which were treated for 6 months.2,4,6,8,12 and 24 weeks after treatment,24 h urinary protein,serum albumin,creatinine,uric acid,and the clinical efficacy and adverse reactions of the two groups were evaluated and compared.Results:In the observation group,4,8,12 and 24 weeks after treatment,the overall response rate was significantly higher than that in the control group (P ＜0.05).2,4,8,12 and 24 weeks after treatment in the two groups,24 h urinary protein was all decreased significantly (P ＜0.05),while observation group was decreased more significantly than control group at the same time(P ＜ 0.05).In 4,8,12 and 24 weeks after treatment,serum albumin of observation group was significantly increased than before treatment (P ＜ 0.05),and was much higher than control group (P ＜ 0.05).There was no significant change on serum albumin of control group during treatment.There were no statistically significant differences on creatinine and uric acid between the two groups before and after treatment (P ＞ 0.05).There also has no statistically significant differences on the incidence of adverse reactions between the two groups (P ＞ 0.05).Conclusion:Using cyclosporine A combined with union/low-dose prednisone to treat progressive IgA nephropathy has better clinical efficacy and higher clinical safety,worthy of promotion.