泻肾凉血法对IgA肾病患者血SIgA和尿IL-6的影响  

Study of Urinary IL-6 and Serum Secretory IgA in IgA Nephropathy Treated with Purging Kidney and Cooling Blood

作　　者：李国华 张铎 张莉 关亚明 高云霞 周志 任睿 LI Guohua;ZHANG Duo;ZHANG Li(Inner Mongolia Autonomous Region Traditional Chinese Medicine Hospital, Hohhot （010200)

机构地区：[1]内蒙古自治区中医医院,呼和浩特010200

出　　处：《中国中西医结合肾病杂志》2018年第4期311-314,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：内蒙古自治区自然科学基金资助项目(No.2015MS08156)

摘　　要：目的:观察泻肾活血法对IgAN患者血SIgA和尿IL-6的影响,探讨泻肾凉血法治疗IgAN的作用机制和依据。方法:采用前瞻、随机、对照的试验方法,将77例IgAN肾经实热证患者分为治疗组和对照组,均给予福辛普利片治疗,治疗组同时应用泻肾凉血方。治疗12周,观察疗效指标(尿蛋白定量、Scr、Urea、CCr、中医证候积分等)和研究指标(血SIgA和尿IL-6)以及肝功能、不良事件等安全性指标。结果:治疗组39例,男14例,女25例;年龄16岁~58岁,平均(42.08±9.71)岁;病程1个月~25年,平均(24.78±48.05)个月。对照组38例,男13例,女25例;年龄16岁~65岁,平均(42.20±10.89)岁;病程1个月~11年,平均(21.36±23.59)个月。两组性别、年龄、病程、基线平均动脉压、ALT、24 h尿蛋白定量、血肌酐水平、尿素水平、肾脏病理Lee分级、肾小球、肾小管、血管积分和Katafuchi总积分、中医证候积分差异均无显著性。治疗12周后,治疗组和对照组与基线比较,24 h尿蛋白定量、中医证候积分均下降(P<0.05),治疗组下降幅度优于对照组(P<0.05);Scr、Urea、CCr均无明显变化(P>0.05);尿IL-6水平有明显下降(P<0.05),治疗组的下降幅度优于对照组(P<0.05);SIgA水平只在治疗组有明显下降(P<0.05)。观察过程中两组不良事件发生率差异无显著性,且均未发生严重不良事件。结论:泻肾凉血法治疗IgAN近期疗效确切,对IgA肾病血SIgA和尿IL-6有调节作用,提示了泻肾凉血法治疗IgAN可能的作用机制和依据。Objective： To evaluate the mechanism and evidence in IgA nephropathy treated with purging kidney and cooling blood and its relation to serum secretory IgA and urinary IL-6. Methods： Adopting prospective,randomized,controlled trial design,77 patients with IgA nephropathy of Nephrosthenia pyrosyndrome type were assigned to treatment group and control group. Patients in both groups were treated with fosinopril for 12 weeks. In addition patients treatment group received prescription of purging kidney and cooling blood. The indexes of efficacy,including TCM syndrome scores,urinary protein,serum creatinine,urea and endogenous creatinine clearancerate,the research indexes of urinary IL-6 and serum secretory IgA,as well as the indexes of safety,including liver function and occurrence of adverse events were observed. Results： After 12 weeks of treatment,compared with baseline,the content of24-hour urinary protein,the scores of TCM syndromes,significantly decreased in the two groups（P〈0. 05）,showing significant difference between the two groups（P〈0. 05）. No significant change in levels of serum creatinine,urea,endogenous creatinine clearance rate in both groups was found（P〉0. 05）. The levels of urinary IL-6 was decreased in the two groups（P〈0. 05）,showing significant difference between the two groups（P〈0. 05）,while only serum secretory IgA level was decreased in the treatment group（P〈0. 05）. No severe adverse event occurred during treatment,and the occurrence in the two groups was similar. Conclusion： IgA nephropathy treated with purging kidney and cooling blood has definite short-term clinical effect,and may regulate the level of urinary IL-6 and serum secretory IgA,which the mechanism and evidence of purging kidney and cooling blood in treating IgAN may be showed.

关 键 词：IGA肾病 泻肾凉血法 肾实证 作用机制 

分 类 号：R277.5[医药卫生—中医学]