论文部分内容阅读
目的:观察雷公藤多甙联合大黄素、血管紧张素Ⅱ受体拮抗剂(ARB)(三联疗法)对IgA肾病(IgAN)尿检异常型患者的临床疗效。方法:2004年11月至2006年6月在解放军肾脏病研究所经肾活检并结合临床诊断为原发性IgAN尿检异常型的患者90例。比较雷公藤多甙、大黄素联合ARB治疗(治疗组,n=60),与大黄素联合ARB治疗(对照组,n=30)的疗效。结果:(1)临床缓解率:治疗3个月、6个月及12个月时治疗组完全缓解率分别为:25.9%、44.7%及53.5%,对照组分别为7.7%、8.4%及14.3%。治疗组疗效显著高于对照组。(2)治疗组在治疗3个月时表现出明显的疗效,尿RBC计数较基线下降66.65%,尿蛋白较基线下降55.05%。治疗12个月后,尿RBC计数由基线(84.18±111.29)万/ml显著下降至(17.49±23.27)万/ml(P<0.01),尿蛋白由基线(1.09±0.38)降至(0.36±0.27)g/24h(P<0.01)。对照组尿RBC计数在治疗第3、6个月时反较基线值升高(P>0.05)。治疗第12个月时,尿蛋白方由基线(1.04±0.51)降至(0.56±0.36)g/24h(P<0.01),尿RBC计数与基线相比差异无统计学意义[(87.20±115.74)vs(66.71±85.36)万/ml,P>0.05]。(3)治疗组仅1例出现肝酶升高,无一例出现白细胞减低、感染等不良反应。所有患者治疗前后肾功能均保持稳定。结论:三联疗法能有效减少IgAN尿检异常型患者的蛋白尿及镜下血尿,稳定肾功能。
Objective: To observe the clinical efficacy of tripterygium glycosides combined with emodin and angiotensin Ⅱ receptor antagonist (triple therapy) in patients with IgA nephropathy. Methods: From November 2004 to June 2006, 90 patients with abnormal type of primary IgAN were diagnosed by renal biopsy and combined with clinical diagnosis in the PLA Renal Disease Institute. The efficacy of combination of tripterygium glycosides, emodin and ARB (treatment group, n = 60) with emodin plus ARB (n = 30) was compared. Results: (1) The clinical remission rate: The complete remission rate of treatment group was 25.9%, 44.7% and 53.5% at 3 months, 6 months and 12 months of treatment respectively, 7.7%, 8.4% and 14.3% in control group %. The treatment group was significantly higher than the control group. (2) The treatment group showed obvious curative effect at 3 months of treatment, urinary RBC count decreased 66.65% from baseline and urine protein decreased 55.05% from baseline. After 12 months of treatment, the urinary RBC count decreased significantly from baseline (84.18 ± 111.29) / ml to (17.49 ± 23.27) / ml (P <0.01) and urinary protein decreased from baseline (1.09 ± 0.38) to (0.36 ± 0.27) g / 24h (P <0.01). In the control group, urinary RBC count increased at the 3rd and 6th month after treatment (P> 0.05). Urine protein decreased from baseline (1.04 ± 0.51) to (0.56 ± 0.36) g / 24h (P <0.01) at 12 months of treatment, and there was no significant difference in urine RBC count compared with baseline [(87.20 ± 115.74 ) vs (66.71 ± 85.36) million / ml, P> 0.05]. (3) The treatment group, only one case of liver enzymes increased, no case of leukopenia, infections and other adverse reactions. Renal function remained stable in all patients before and after treatment. Conclusions: Triple therapy can effectively reduce proteinuria and microscopic hematuria and stabilize renal function in patients with abnormal IgAN.