参芪地黄汤联合羟氯喹治疗IgA肾病的疗效观察及对Th1/Th2平衡的影响  

Effect of Shenqi Dihuang Decoction(参芪地黄汤)Combined with Hydroxychloroquine in Treatment of IgA Nephropathy and Effects on Th1/Th2

作　　者：樊伶俐[1] 黄益麒 沈伟钢[1] FAN Lingli;HUANG Yiqi;SHEN Weigang(Shaoxing Second Hospital,Shaoxing,Zhejiang 312000)

机构地区：[1]绍兴第二医院,浙江绍兴312000

出　　处：《中国中医药科技》2024年第4期590-593,711,共5页Chinese Journal of Traditional Medical Science and Technology

基　　金：浙江省中医药优秀青年人才基金项目(2021ZQ089);浙江省医药卫生科技计划项目(2023XY059);绍兴市柯桥区社发类经费自筹科技计划(2020KZ50)。

摘　　要：目的:观察参芪地黄汤联合羟氯喹(HCQ)治疗气阴两虚型IgA肾病(IgAN)的临床疗效及其对Th1/Th2平衡的影响。方法:将42例气阴两虚型IgA肾病患者随机分成观察组和对照组,各21例,对照组给予口服HCQ,观察组在对照组基础上另予参芪地黄汤,两组均连续干预8周。比较两组患者的临床疗效和治疗前后中医症状评分、常规生化指标[血肌酐(SCr)、白蛋白(Alb)]、24 h尿蛋白定量(24 h-uPQ)、细胞因子[γ干扰素(INF-γ)、白细胞介素-4(IL-4)、白细胞介素-10(IL-10)]及辅助性T淋巴细胞(Th)水平。结果:观察组临床总有效率(81.0%)高于对照组(57.1%)(P<0.05);治疗后两组患者各项中医症状评分均较治疗前降低,且观察组低于对照组(P<0.05);治疗后两组患者SCr、24 h-uPQ、INF-γ、Th1和Th1/Th2水平均较治疗前降低,且观察组低于对照组(P<0.05);治疗后两组患者Alb、IL-4、IL-10及Th2水平均较治疗前升高,且观察组高于对照组(P<0.05);结论:参芪地黄汤联合HCQ能明显改善气阴两虚型IgAN患者的临床症状,有效控制尿蛋白和延缓肾功能衰竭,调节免疫功能及缓解微炎症状态,临床疗效确切。Objective:To evaluate the clinical efficacy of combining Shenqi Dihuang Decoction with Hydroxychloroquine(HCQ)in treatment of Qi-Yin deficiency type IgA nephropathy(IgAN)and its impact on Th1/Th2 balance.Methods:A total of 42 IgA nephropathy patients with Qi and Yin deficiency were randomly divided into observation group and control group,21 cases in each group.The control group was given oral HCQ,and the observation group was treated with Shenqi Dihuang Decoction on the basis of the control group.The clinical efficacy,TCM symptoms score,biochemical indexes[Serum creatinine(SCr),albumin(Alb)],24-hour urinary protein quantitation(24 h-uPQ),cytokines[interferon-γ(INF-γ),interleukin-4(IL-4),interleukin-10(IL-10)]and helper T lymphocytes(Th)were compared between the two groups.Results:The total effective rate of the observation group(81.0%)was found to be significantly higher than that of the control group(57.1%)(P<0.05).Following treatment,both groups exhibited a decrease in TCM symptom scores related to shortness of breath,fatigue,night sweats,waist and knee soreness,as well as feverish sensation in the palms and soles;however,these reductions were more pronounced in the observation group compared to the control group(P<0.05).Additionally,post-treatment levels of SCr,24 h-uPQ,INF-γ,Th1 and Th1/Th2 were lower in both groups compared to pre-treatment levels;nevertheless,these reductions were significantly greater in the observation group when compared with the control group(P<0.05).Furthermore,post-treatment levels of Alb,IL-4,IL-10 and Th2 showed an increase in both groups relative to pre-treatment levels;notably though,the observation group demonstrated significantly higher increases compared to the control group(P<0.05).Conclusion:Shenqi Dihuang Decoction combined with HCQ can significantly improve the clinical symptoms of IgAN patients with Qi and Yin deficiency,effectively control urinary protein,protect renal function,correct immune dysfunction and reduce micro-inflammatory state,and has a definite clinical

关 键 词：参芪地黄汤 羟氯喹 气阴两虚型 IGA肾病 INF-Γ IL-4 IL-10 TH1/TH2 

分 类 号：R692.31[医药卫生—泌尿科学]