霉酚酸酯联合布地奈德肠溶胶囊治疗高风险进展IgA肾病的临床观察OA

OBJECTIVE To observe the clinical efficacy of mycophenolate mofetil(MMF)combined with Budesonide enteric capsules in the treatment of high-risk progressive immunoglobulin A nephropathy(IgAN).METHODS A total of 150 adult patients with high-risk progressive IgAN who attended the Department of Nephrology,Chongqing University Three Gorges Hospital,between August 1,2024 and March 1,2025 were enrolled in this study.The control group(n=94)received MMF combined with glucocorticoid,while the observation group(n=56)received MMF combined with Budesonide enteric capsules.The 24-hour urine protein(24 h UP),estimated glomerular filtration rate(eGFR),and albumin(ALB)levels of patients in both groups were compared at 1,2,3,and 6 months post-treatment.The complete response(CR)rate and overall response rate were calculated for both groups at 1,2,3,and 6 months post-treatment.Adverse reactions occurring during treatment were compared between the two groups.RESULTS Compared with before treatment,24 h UP decreased significantly in both groups at different time points after treatment(P＜0.05),and ALB increased significantly(P＜0.05).However,there was no significant change in eGFR(P＞0.05).The 24 h UP in the observation group at 1,2,and 3 months after treatment was significantly lower than that of the control group(P＜0.05),while the ALB level was significantly higher(P＜0.05).However,at 6 months after treatment,there was no statistically significant difference in these two indicators between the two groups(P＞0.05).There was no statistically significant difference in eGFR between the two groups at different time points after treatment(P＞0.05).The overall response rates in the observation group at 1 and 2 months after treatment were significantly higher than those in the control group(P＜0.05).There was no statistically significant difference in the overall response rate at the remaining treatment time points and the CR rate at all time points between the two groups(P＞0.05).Patients in the observation group had significantly lower rates of skin abnormalities,elevated blood glucose,and overall adverse reactions compared with the control group(P＜0.05).CONCLUSIONS Compared with MMF combined with glucocorticoids,MMF combined with Budesonide enteric capsules for the treatment of high-risk progressive IgAN patients can reduce proteinuria and improve serum ALB levels more quickly,significantly increase the early overall response rate,and significantly reduce glucocorticoid-related skin adverse reactions,blood glucose elevation,and the overall incidence of adverse reactions,demonstrating a better short-term benefits.