大黄泄浊方对高风险特发性膜性肾病患者的影响  

Impact of Dahuang Xiezhuo Decoction on High-Risk Patients with Idiopathic Membranous Nephropathy

作　　者：肖卫灵 王乐川 王晟菡 樊佳鑫 胡金焕[2] 吴慧敏 袁国栋[2] 张丽娇 王刚[2] XIAO Wei-ling;WANG Le-chuan;WANG Sheng-han;FAN Jia-xin;HU Jin-huan;WU Hui-min;YUAN Guo-dong;ZHANG Li-jiao;WANG Gang(Hebei University of Chinese Medicine,Shijiazhuang,050091,China;Hebei Provincial Traditional Chinese Medicine Hospital,Shijiazhuang,050011,China;Shexian Hospital,Handan,Hebei,056400,China)

机构地区：[1]河北中医药大学,石家庄050091 [2]河北省中医院,石家庄050011 [3]涉县医院,河北邯郸056400

出　　处：《河北中医药学报》2024年第6期19-23,共5页Journal of Hebei Traditional Chinese Medicine and Pharmacology

基　　金：河北省中医药管理局科研计划项目:No.2021046。

摘　　要：目的:探讨大黄泄浊方对高风险特发性膜性肾病(Idiopathic membranous nephropathy, IMN)患者及其免疫指标的影响。方法:将90例高风险IMN浊瘀互结证患者,随机分为观察组和对照组,每组各45例(各脱落1例)。对照组在基础对症治疗上,加予醋酸泼尼松片和他克莫司胶囊口服,观察组在对照组治疗基础上,加予大黄泄浊方口服。2组患者均治疗12 w后,对比其疗效、中医证候积分、血清B细胞活化因子(BAFF)、尿膜攻击复合物C5b-9(MAC C5b-9,以下简称C5b-9)、尿免疫球蛋白G4(IgG4)、血肌酐(Scr)、24 h尿蛋白定量(24 hUTP)、血清白蛋白(Alb)以及不良反应发生情况。结果:治疗后,观察组临床有效率为88.64%,高于对照组70.45%(P<0.05);2组患者治疗后中医证候积分、血清BAFF、尿C5b-9、尿IgG4、Scr、24 hUTP均降低(P<0.05),观察组优于对照组(P<0.05);Alb均升高(P<0.05),观察组优于对照组(P<0.05)。治疗期间,2组患者不良反应发生率无统计学意义(P>0.05)。结论:大黄泄浊方可以改善高风险IMN患者的临床症状,降低血清BAFF、尿C5b-9、尿IgG4水平,改善患者免疫失衡状态,保护肾功能,延缓肾脏病进展。Objective:To investigate the impact of Dahuang Xiezhuo Decoction on high-risk patients with Idiopathic Membranous Nephropathy(IMN)and their immune indicators.Methods:Ninety high-risk IMN patients with the syndrome of combined turbidity and blood stasis were randomly divided into an observation group and a control group,with 45 patients in each group(one case dropped out in each group).The control group received basic symptomatic treatment plus oral prednisone acetate tablets and tacrolimus capsules.The observation group received Dahuang Xiezhuo Decoction orally on the basis of the control group's treatment.After 12 weeks of treatment for both groups,comparisons were made in terms of efficacy,traditional Chinese medicine(TCM)syndrome scores,serum B-cell activating factor(BAFF),urinary membrane attack complex C5b-9(MAC C5b-9,hereinafter referred to as C5b-9),urinary immunoglobulin G4(IgG4),serum creatinine(Scr),24-hour urine total protein(24 hUTP),serum albumin(Alb),and the occurrence of adverse reactions.Results:After treatment,the clinical effective rate in the observation group was 88.64%,higher than the 70.45%in the control group(P<0.05).The TCM syndrome scores,serum BAFF,urinary C5b-9,urinary IgG4,Scr,and 24 hUTP all decreased in both groups after treatment(P<0.05),with the observation group showing better improvement than the control group(P<0.05).The serum albumin(Alb)levels increased in both groups(P<0.05),with the observation group showing superior improvement(P<0.05).During the treatment period,there was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Dahuang Xiezhuo Decoction can improve the clinical symptoms of high-risk IMN patients,reduce the levels of serum BAFF,urinary C5b-9,and urinary IgG4,improve the immune imbalance state,protect renal function,and delay the progression of kidney disease.

关 键 词：大黄泄浊方 膜性肾病 慢性肾脏病 肾风 膜攻击复合物 

分 类 号：R259[医药卫生—中西医结合]