膜增生性肾小球肾炎患者的循证治疗  

Management of Membranoproliferative Glomerulonephritis:Evidence-Based Recommendations

作　　者：沈昊[1] 张玲[2] 刘修恒[1] 匡幼林[1] 

机构地区：[1]武汉大学人民医院泌尿外科,武汉430060 [2]武汉大学基础医学院病理与病理生理学系,武汉430071

出　　处：《中国医药导刊》2011年第5期759-763,共5页Chinese Journal of Medicinal Guide

摘　　要：目的:针对一例膜增生性肾小球肾炎患者,检索当前最佳证据,为患者选择药物治疗方案提供依据。方法:根据循证临床实践的方法,提出问题,检索证据,对所获证据进行评价,并结合患者意愿制定治疗方案。结果:共纳入12个随机对照试验,5个系统评价/Meta分析和2个临床指南。证据结果表明:(1)稳定而良好的血压控制能有效延缓肾功能衰竭;(2)糖皮质激素能减少肾小球率过滤,改善肾功能;(3)不推荐免疫抑制剂治疗膜增生性肾小球肾炎;(4)阿司匹林与双嘧达莫连用能有效保护肾功能;(5)雷公藤多苷能减少蛋白尿,延缓肾功能衰竭。结合患者情况,应用证据治疗2月后,患者血压控制良好,水肿消失,血肌酐、蛋白尿减少。结论:采用循证治疗的方法:为虞增生性肾小球肾炎患者制定合理的治疗方案,可有效提高治疗效果。Objective：Make the management of the individualized membranoproliferative glomerulonephritis with evidence- based recommendations.Methods：Based on the clinical questions we raised, evidence was collected and evaluated critically.Patient＇ s will was also taken into consideration in the treatment.Results：Finally 12 randomized controlled trials,5 systematic reviews/meta- analysis and 2 clinical guidelines were considered eligible and collected.The evidence indicated that the first step in management of patients with membranoproliferative glomerulonephritis should aim to control blood pressure stably which can effectively relieve renal failure. Glucocorticoid can reduce glomerular filtration rate and improve renal function. Immunosuppressant was not recommended in the treatment of membranoproliferative glomerulonephritis,There was effective resume renal function by combining aspirin with dipyridamole. Tripterysium Glycosides might reduce the proteinuria and relieve renal failure. The individualized treatment plans were developed based on the levels of evidence of the supporting studies. After 2 months of treatment, the patient＇s blood pressure was controlled well and the proteinuria and the serum creatinine were reduced apparently.Conclusion：The management based on evidence recommendations was profit for the individualized membranoproli ferative glomerulonephritis.

关 键 词：膜增生性肾小球肾炎 糖皮质激素 免疫抑制剂 阿司匹林 双嘧达莫 雷公藤多苷 循证治疗 

分 类 号：R692.31[医药卫生—泌尿科学]