真武汤合肾着汤加减治疗特发性膜性肾病合并急性肾损伤临床观察  

Clinical Observation of Modified Zhenwu Decoction and Shenzhuo Decoction on Idiopathic Membranous Nephropathy with Acute Kidney Injury

作　　者：闫俊慧 张乐 刘育硕 李建军 Yan Junhui;Zhang Le;Liu Yushuo;Li Jianjun(Qinhuangdao Hospi-tal of Peking University Third Hospital,Hebei,Qinhuangdao 066000,China)

机构地区：[1]北京大学第三医院秦皇岛医院,河北秦皇岛066000

出　　处：《中国中医急症》2024年第5期852-856,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：秦皇岛市科学技术研究与发展计划项目(202101A185)。

摘　　要：目的观察真武汤合肾着汤加减对特发性膜性肾病(IMN)合并急性肾损伤(AKI)的临床疗效并探讨其作用机制。方法106例患者随机分为对照组与观察组各53例,对照组采用西医综合治疗,观察组在对照组基础上加用真武汤合肾着汤加减内服,连续治疗4周。比较两组治疗前后血肌酐(Scr)、尿素氮(BUN)、肌酐清除率(Ccr)、24 h尿蛋白定量(24 h-UTP)、血清白蛋白(ALB)、三酰甘油(TAG)、总胆固醇(TC)等肾功能和血脂指标。比较治疗前后血液同型半胱氨酸(Hcy)水平、尿液N-乙酰-β-D氨基葡萄糖糖苷酶(NAG)、尿β2-微球蛋白(β2-MG)和肾损伤分子1(Kim-1)水平。比较血清抗磷脂酶A2受体(PLA2R)抗体水平、免疫功能指标外周血T细胞亚群(CD4+、CD8+及CD4+/CD8+)水平、炎症因子白细胞介素-17(IL-17)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)和白细胞介素-35(IL-35)水平以及脾肾阳虚证评分。比较治疗后临床总有效率。结果两组治疗前各项指标比较差别均不大(均P>0.05)。两组治疗后,24 h-UTP、Scr、BUN、TAG、TC、Hcy、NAG、β2-MG、Kim-1和抗PLA2R抗体水平下降(均P<0.05),Ccr和ALB水平升高(均P<0.05),且均以观察组为优(均P<0.05)。两组治疗后脾肾阳虚证各主要症状评分及总积分降低(均P<0.05),且观察组低于对照组(P<0.05)。观察组治疗后IL-35、CD4+、CD4+/CD8+均高于对照组(均P<0.05),TNF-α、IL-1β、IL-17、CD8+水平则均低于对照组(均P<0.05)。观察组总有效率为92.45%,高于对照组的75.47%(P<0.05)。结论真武汤合肾着汤加减治疗IMN合并AKI临床疗效显著,其可调节免疫炎症因子,抑制抗PLA2R抗体,减轻肾损伤和蛋白尿,保护肾功能,改善临床症状。Objective:To evaluate the clinical efficacy and mechanism of Modified Zhenwu Decoction and Shen⁃zhuo Decoction in the treatment of idiopathic membranous nephropathy(IMN)with acute kidney injury(AKI).Methods:A total of 106 patients were randomly divided into control group and observation group,with 53 cases in each group.The control group received comprehensive treatment,while the observation group received oral ad⁃ministration of Modified Zhenwu Decoction and Shenzhuo Decoction on the basis of the control group,taking one dose per day for four consecutive weeks.Scr,BUN,Ccr,24 h-UTP,ALB,TAG,TC,Hcy,NAG,β2-MG,Kim-1 and anti PLA2R antibody titer levels were compared before and after treatment;CD4+,CD8+and CD4+/CD8+,TNF-α,IL-1β,IL-17,IL-35 were measured;spleen and kidney yang deficiency syndrome scores were performed;the overall response rate of the disease after treatment was compared.Results:There were no significant differenc⁃es in these indicators before treatment(all P>0.05).After treatment,24 h-UTP,Scr,BUN,TAG,TC,Hcy,NAG,β2-MG,Kim-1 and anti anti PLA2R antibody levels decreased in both groups(P<0.05),and Ccr and ALB levels increased in both groups(P<0.05),and they were significantly better in the observation group(P<0.05).After treatment,the main symptom score and total score of spleen-kidney yang deficiency syndrome in the two groups decreased(P<0.05),and the observation group was lower than the control group(P<0.05).After treatment,IL-35,CD4+and CD4+/CD8+in the observation group were higher than those in the control group(all P<0.05),and TNF-α,IL-1β,IL-17 and CD8+levels were lower than those in the control group(all P<0.05).The total effec⁃tive rate in the observation group was 92.45%,which was significantly higher than 75.47%in the control group(P<0.05).Conclusion:Modified Zhenwu Decoction and Shenzhuo Decoction in the treatment of IMN with AKI can regulate immune inflammatory factors,inhibit anti PLA2R antibody,reduce renal injury and proteinuria,pro⁃tect renal function,and improve clinical s

关 键 词：特发性膜性肾病 急性肾损伤 真武汤 肾着汤 抗磷脂酶A2受体(PLA2R)抗体 免疫功能 炎症因子 

分 类 号：R692[医药卫生—泌尿科学]