益肾活血祛风湿联合西药治疗IgA肾病远期疗效的临床研究  

Long-term Effect of the Treatment of IgA Nephropathy by Tonifying Shen,Activating Blood Stasis,Dispelling Wind-Dampness Combined with Western Medicine

作　　者：李洁[1,2] 俞东容[1] 陈洪宇[1] 朱彩凤[1] 程晓霞[1] 王宇晖[1] 倪军[1] 王向晶 姜飞[1] 

机构地区：[1]浙江中医药大学附属广兴医院肾病科,杭州310007 [2]浙江省嵊州市中医院内科,浙江312400

出　　处：《中国中西医结合杂志》2017年第1期28-33,共6页Chinese Journal of Integrated Traditional and Western Medicine

摘　　要：目的观察益肾活血祛风湿联合西药治疗IgA肾病的远期疗效。方法采用回顾性病例对照研究,从杭州市中医院IgA肾病随访登记数据库中获取2008年1月1日—12月31日在本院进行肾穿刺活检确诊的原发性IgA肾病患者的临床、实验室检查、肾活检病理、治疗方案等资料,根据治疗方案分为A组(基础治疗+中药)和B组(基础治疗+中药+糖皮质激素和/或免疫抑制剂)。以肾活检病理确诊为原发性IgA肾病为起始点计算,随访结束时间为2015年12月31日,随访时间≥12个月,终点事件定义为进入ESRD或e GFR下降50%以上,或血肌酐翻倍,比较其在治疗1年后及至随访结束时与治疗前相比在临床表现、实验室指标等方面的差异,利用Kaplan-Meier法计算患者的累积肾脏生存率,并绘制肾脏累积生存曲线。结果共纳入病例219例,A组49例,B组170例。A组中肾虚证7例(14%),肾虚血瘀证21例(43%),肾虚风湿证8例(16%),肾虚血瘀风湿证13例(27%)。B组分别为12例(7.1%)、47例(27.6%)、22例(12.9%)、89例(52.4%)。两组患者的年龄、性别、随访时间,差异无统计学意义(P>0.05)。与A组比较,B组的病程更短,24 h尿蛋白定量更多,血肌酐、血清尿素氮更高,血浆白蛋白更低(P<0.05)。与治疗前比较,治疗1年后两组患者24 h尿蛋白定量及尿红细胞计数下降,并进一步下降至随访结束(P<0.05)。219例患者总有效率为89.0%(195/219),A组总有效率为89.8%(44/49),无患者进入终点事件。B组总有效率为88.8%(151/170)。至随访结束,共5例患者到达终点事件,均在B组,其中有4例进入ESRD,1例血肌酐翻倍或e GFR下降>50%。与B组比较,A组的完全缓解率更高(P<0.01)。利用Kaplan-Meier法计算219例患者的1、3、5、7年肾脏累积生存率分别为100%、100%、98%、96.1%。结论对IgA肾病根据不同病情可以采用基于肾病风湿理论的中医及中西医结合治疗方案,远期观察显示该方案能显著改善患者的病情,7�Objective To observe the long-term effect of tonifying Shen, activating blood stasis, dispelling wind-dampness （TSABSDWD） combined with Western drugs （WD）for IgA nephropathy, Methods A single center retrospective case-control study was used. The clinical and laboratory examinations, pa- thology of renal biopsy, and treatment programs of IgA nephropathy were obtained from primary IgA ne- phropathy patients （confirmed from renal biopsy at authors＇ hospital） from Jan 1st, 2008 to Dec 31,2008. Patients were assigned to Group A （basic treatment ＋ Chinese herbs ） and Group B （basic treatment ＋ Chi- nese herbs ＋ glucocorticoid and/or immune inhibitors）. A follow-up visit started from the confirmation of re- nal biopsy to Dec 31,2008, for at least 12 months. The end point event was defined as entering end stage renal disease （ESRD）, estimated glomerular filtration rate （eGFR） decreased by more than 50%, or SCrwas doubled. The differences in clinical manifestations, lab indicators and etc. were compared between be- fore treatment and after 1 year of treatment/till the end of follow-ups. The accumulative kidney survival rate was calculated using Kaplan-Meier method. The curve for accumulative kidney survival rate was drawn. Re- sults A total of 219 cases were included, 49 in Group A and 170 in Group B. In Group A, there were 7 pa- tients （14.0%） with Shen deficiency syndrome, 21 cases （43.0%） with Shen deficiency blood stasis syn- drome, 8 （16.0%） with Shen deficiency wind-dampness syndrome, 13 cases （27.0%） with Shen deficien- cy blood stasis wind-dampness syndrome. In Group B there were 12 patients （7.1%） with Shen deficiency syndrome, 47 cases （27.6%） with Shen deficiency blood stasis syndrome, 22 （12.9%） with Shen defi- ciency wind-dampness syndrome, 89 cases （52.4%） with Shen deficiency blood stasis wind-dampness syndrome. No statistical difference in age, sex, or follow-up period between the two groups （P 〉 0.05）. Compared with Group A, the dis

关 键 词：IGA肾病 中西医结合 益肾活血祛风湿 远期疗效 

分 类 号：R692.31[医药卫生—泌尿科学]