雷公藤多苷片联合ACEI/ARB治疗IgA肾病蛋白尿的回顾性研究  

ARetrospective Study of Tripterygium wilfordii Polyglycoside Tablets Combined with ACEI/ARB in the Treatment of Proteinuria in IgA Nephropathy

作　　者：常美莹 赵明明[1] 余怡 王如梦 马思佳 张昱[1] CHANG Mei-ying;ZHAO Ming-ming;YU Yi;WANG Ru-meng;MA Si-jia;ZHANG Yu(Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091)

机构地区：[1]中国中医科学院西苑医院科室,北京100091

出　　处：《世界中西医结合杂志》2022年第10期2035-2038,2043,共5页World Journal of Integrated Traditional and Western Medicine

基　　金：首都卫生发展科研专项自主创新项目(2018-2-4173);中国中医科学院中央级公益性科研院所基本科研业务费联合创新项目(ZZ11-023)。

摘　　要：目的观察雷公藤多苷片治疗IgA肾病蛋白尿的临床疗效及安全性。方法选取2016年10月—2019年9月期间就诊于中国中医科学院西苑医院门诊的IgA肾病患者62例,按照是否接受雷公藤多苷片治疗分为观察组和对照组,每组各31例。对照组给予常规剂量的血管紧张素转化酶抑制剂(Angiotensin-Converting Enzyme Inhibitor,ACEI)或血管紧张素受体拮抗剂(Angiotensin II Receptor Blocker,ARB)治疗,观察组在常规ACEI/ARB治疗的基础上加用雷公藤多苷片。治疗3个月后,观察比较两组患者治疗前后24 h尿蛋白定量(24 h U-TP)、肾功能指标[血肌酐(Serum Creatinine,Scr)、GFR]、肝功能指标[谷丙转氨酶(Alanine Aminotransferase,ALT)、谷草转氨酶(Aspartate Aminotransferase,AST)]、血常规指标[白细胞(White Blood Cells,WBC)、血红蛋白(Hemoglobin,HGB)、血小板(Platelet,PLT)]及临床疗效。结果治疗后对照组Scr较治疗前降低,GFR较治疗前升高,差异有统计学意义(P<0.05);观察组患者24 h U-TP、Scr均较治疗前明显降低,GFR较治疗前升高,差异有统计学意义(P<0.05);且观察组24 h U-TP治疗前后差值改善明显优于对照组,差异有统计学意义(P<0.05)。治疗后两组患者ALT、AST指标与治疗前比较,差异无统计学意义(P>0.05)。治疗后两组患者WBC、HGB、PLT水平与治疗前比较,差异无统计学意义(P>0.05)。治疗后观察组总有效率83.87%(26/31)明显高于对照组总有效率54.84%(17/31),差异有统计学意义(P<0.05)。治疗期间两组患者均未发生骨髓抑制。结论雷公藤多苷片联合ACEI/ARB,可安全有效降低IgA肾病患者蛋白尿水平,改善患者肾功能。Objective To observe the clinical efficacy and safety of Tripterygium wilfordii polyglycoside tablets in the treatment of proteinuria in IgA nephropathy.Methods A total of 62 patients who were diagnosed as IgA nephropathy and treated in the outpatient clinic of Xiyuan Hospital,China Academy of Chinese Medical Sciences from October 2016 to September 2019 were selected,and they were divided into an observation group(31 cases)and a control group(31 cases)according to the use ofT.wilfordii polyglycoside tablets during treatment.The control group was treated with a routine dose of angiotensin-converting enzyme inhibitor(ACEI)or angiotensinⅡreceptor antagonist blocker(ARB),while the observation group was added with T.wilfordii polyglycoside tablets on the basis of conventional ACEI/ARB treatment.The course of treatment was 3 months.Then the changes in 24-hour urine protein quantification(24 h U-TP),kidney function indexes[serum creatinine(Scr),glomerular filtration rate(GFR)]liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST)],blood routine indexes[white blood cells(WBC),hemoglobin(HGB),platelet(PLT)]and clinical efficacy of the two groups were observed and compared before and after the treatment.Results After treatment,the control group had reduced Scr level and elevated GFR(P<0.05);the 24 hU-TP and Scr level in the observation group were decreased and GFR was increased(P<0.05),in which the 24 hU-TP result was lower than that of the control group(P<0.05).Changes in ALT and AST as well as WBC,HGB,PLT levels in the two groups after treatment were not statistically significant(all P>0.05).The total effective rate of the observation group was 83.87%(26/31),higher than 54.84%(17/31)of the control group(P<0.05).No myelosuppression occurred in the two groups during treatment.Conclusion The combination of T.wilfordii polyglycoside tablets and ACEI/ARB could effectively reduce the level of proteinuria in IgAnephropathy patients and improve their kidney functions.

关 键 词：雷公藤多苷片 ACEI/ARB IGA肾病 蛋白尿 

分 类 号：R692[医药卫生—泌尿科学]