大剂量环磷酰胺冲击疗法联合右归丸治疗激素耐药型脾肾阳虚证原发性肾病综合征疗效观察  

Efficacy of high-dose cyclophosphamide pulse therapy combined with Yougui Pill in the treatment of hormone-resistant primary nephrotic syndrome patients with spleen and kidney yang deficiency syndrome

作　　者：袁小强[1] 张献朝 赵丽萍[1] YUAN Xiaoqiang;ZHANG Xianchao;ZHAO Liping(Department of Nephrology,Rheumatology and Immunology,the First People′s Hospital of Pingdingshan,Pingdingshan 467099,Henan Province,China)

机构地区：[1]平顶山市第一人民医院肾脏病风湿免疫科,河南平顶山467099

出　　处：《新乡医学院学报》2022年第6期566-572,共7页Journal of Xinxiang Medical University

摘　　要：目的探讨大剂量环磷酰胺冲击疗法联合右归丸治疗激素耐药型脾肾阳虚证原发性肾病综合征(PNS)的疗效。方法选择2018年3月至2019年9月平顶山市第一人民医院收治的激素耐药型脾肾阳虚证PNS患者94例为研究对象,采用随机数字表法将患者分为观察组和对照组,每组47例。2组患者均给予降压、利尿、抗凝等基础治疗,在此基础上,对照组患者静脉滴注环磷酰胺10 mg·kg^(-1),每日1次,连续2 d,每隔14 d重复1次,尿蛋白转阴后可1~3个月用药1次,累计最大剂量≤150 mg·kg^(-1);观察组患者在对照组治疗基础上口服右归丸9 g,每日3次;所有患者治疗12个月。治疗12个月后评估2组患者的治疗效果。分别于治疗前和治疗6、12个月后评估2组患者的中医证候(神疲倦卧、面色无华、小便短少不利、全身水肿)。治疗前和治疗6、12个月后,采用流式细胞仪检测2组患者免疫功能指标(CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)),采用全自动生物化学分析仪检测2组患者肾功能指标,采用电化学发光法检测2组患者血清促肾上腺皮质激素(ACTH)、皮质醇(CORT)水平。记录2组患者不良反应发生情况。结果观察组和对照组患者治疗总有效率分别为91.49%(43/47)、76.60%(36/47),观察组患者的治疗总有效率显著高于对照组(χ^(2)=3.887,P<0.05)。治疗前2组患者神疲倦卧、面色无华、小便短少不利、全身水肿评分比较差异均无统计学意义(P>0.05)。治疗6、12个月后,2组患者神疲倦卧、面色无华、小便短少不利、全身水肿评分均低于治疗前(P<0.05);2组患者治疗12个月后的神疲倦卧、面色无华、小便短少不利、全身水肿评分均显著低于治疗6个月后(P<0.05)。治疗6、12个月后,观察组患者的神疲倦卧、面色无华、小便短少不利、全身水肿评分均显著低于对照组(P<0.05)。治疗前2组患者全血CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)比值比较差异无统计�Objective To investigate the efficacy of high-dose cyclophosphamide pulse therapy combined with Yougui Pill in the treatment of hormone-resistant primary nephrotic syndrome(PNS)patients with spleen and kidney yang deficiency syndrome.Methods A total of 94 hormone-resistant PNS patients with spleen and kidney yang deficiency syndrome in the First People′s Hospital of Pingdingshan City from March 2018 to September 2019 were selected as subjects.The patients were divided into observation group and control group,with 47 cases in each group.All patients were given basic treatment such as reducing blood press,diuresis and anticoagulation and so on;on this basis,the patients in the control group were intravenously injected with cyclophosphamide 10 mg·kg^(-1),once daily for 2 days and repeated every 14 days;if the urine protein turned negative,the drug could be administered once every 1-3 months,with a cumulative maximum dose≤150 mg·kg^(-1).On the basis of treatment of the control group,the patients in the observation group tool Yougui Pill 9 g orally,3 times a day.All patients were treated for 12 months.The therapeutic effect of patients in the two groups was evaluated after 12 months of treatment.The traditional Chinese medicine syndromes(tiredness,bleak complexion,lack of urine,systemic edema)of patients in the two groups were evaluated before treatment and after 6,12 months of treatment.Before treatment and after 6,12 months of treatment,the immune function indexes(CD3^(+),CD4^(+)levels and CD4^(+)/CD8^(+))of patients in the two groups were detected by flow cytometry;the renal function indexes of patients in the two groups were detected by automatic biochemical analyzer and the serum adrenocorticotropic hormone(ACTH),cortisol(CORT)levels of patients in the two groups were detected by electrochemiluminescence method.The adverse reactions of patients in the two groups were recorded.Results The total effective rate of patients in the observation group and the control group was 91.49%(43/47),76.60%(36/47),respectiv

关 键 词：环磷酰胺 右归丸 激素耐药型 脾肾阳虚证 原发性肾病综合征 

分 类 号：R692[医药卫生—泌尿科学]