目的 探讨尿激酶联合奥美沙坦酯治疗IgA肾病的临床疗效。方法 选择2017年1月—2018年1月京东誉美中西医结合肾病医院收治的IgA肾病轻中度蛋白尿80例，随机分为对照组和治疗组，每组各40例。对照组口服奥美沙坦酯片，20 mg/次，1次/d。治疗组患者在对照组治疗基础上静脉滴注注射用尿激酶，10万U/次，加入5%葡萄糖溶液250 mL中，1次/d。两组均连续治疗15 d。观察两组的临床疗效，比较两组治疗前后血肌酐（Scr）、胱抑素C、24 h尿蛋白定量、微量白蛋白（MA）的变化情况。结果 治疗后，对照组和治疗组的总有效率分别为62.5%、87.5%，两组比较差异具有统计学意义（P<0.05）。两组患者治疗前后Scr、胱抑素C水平无明显差异。治疗后，两组24 h尿蛋白定量、MA水平均显著降低，同组治疗前后比较差异有统计学意义（P<0.05）；治疗后，治疗组24 h尿蛋白定量、MA水平显著低于对照组，两组比较差异有统计学意义（P<0.05）。结论 尿激酶联合奥美沙坦酯治疗IgA肾病疗效显著，能更好地降低患者的蛋白尿，具有一定的临床推广应用价值。

Objective To investigate the clinical efficacy of urokinase combined with olmesartan medoxomil in treatment of IgA nephropathy. Methods Patients (80 cases) with IgA nephropathy in Jingdong Yumei Kidney Disease Hospital from January 2017 to January 2018 were randomly divided into control (40 cases) and treatment (40 cases) groups. Patients in the control group were po administered with Olmesartan Medoxomil Tablets, 20 mg/time, once daily. Patients in the treatment group were iv administered with Urokinase for Injection on the basis of the control group, 1×10⁵ U added to 5% glucose solution 250 mL, once daily. Patients in two groups were treated for 15 d. After treatment, the clinical efficacy was evaluated, and the changes of Scr, cystatin C, 24 h urinary protein quantification, urinary microalbumin (ALB) in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment group were 62.5% and 87.5%, and there were differences between two groups (P < 0.05). There was no significant difference in Scr and cystatin C levels between two groups before and after treatment. After treatment, 24 h urinary protein quantification and ALB were significantly decreased in two groups, and there were differences in the same group (P < 0.05). After treatment, 24 h urinary protein quantification and ALB in the treatment group were lower than those in the control groups, and there were differences between two groups (P < 0.05). Conclusion Urokinase combined with olmesartan medoxomil has significant clinical effect in treatment of IgA nephropathy, and can lower the proteinuria better, which has a certain clinical application value.