益气养阴中成药治疗IgA肾病疗效及影响因素  

Efficacy and Influencing Factors of Qi-benefiting and Yin-nourishing Chinese Patent Medicines for IgA Nephropathy

作　　者：段姝伟 张守琳[2] 林启展 姚进 邹迪[2] 柯江华 刘林昌 郑颖 董哲毅 陈香美 DUAN Shu-wei;ZHANG Shou-lin;LIN Qi-zhan;YAO Jin;ZOU Di;KE Jiang-hua;LIU Lin-chang;ZHENG Ying;DONG Zhe-yi;CHEN Xiang-mei(Department of Nephrology,First Medical Center of Chinese PLA General Hospital,National Key Laboratory of Kidney Diseases,National Clinical Research Center for Kidney Diseases,Beijing Key Laboratory of Kidney Diseases Research,Beijing,100853;Department of Nephrology,Affiliated Hospital of Changchun University of Traditional Chinese Medicine,Changchun,130021;Department of Nephrology,The Second Affiliated Hospital to Guangzhou University of Traditional Chinese Medicine,Guangdong,510120)

机构地区：[1]中国人民解放军总医院第一医学中心肾脏病医学部,肾脏疾病全国重点实验室,国家慢性肾病临床医学研究中心,肾脏疾病研究北京市重点实验室,北京100853 [2]长春中医药大学附属医院肾病科,长春130021 [3]广州中医药大学第二附属医院肾病科,广州510120

出　　处：《中国中西医结合杂志》2025年第1期42-49,共8页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：国家重点研发计划(No.2019YFC1709903);北京市科技计划课题(No.D181100000118002)。

摘　　要：目的观察益气养阴中成药治疗IgA肾病(IgAN)的长期疗效。方法纳入2000例来自三家医院经肾穿刺活检确诊的原发性IgAN患者,根据是否使用益气养阴类中成药,将患者分为治疗组和对照组。比较两组患者一般资料、病理结果及中医证候差异。为均衡两组的混杂因素,采用1:1倾向性评分分配法将患者进行匹配,并运用多因素Logistic回归分析探讨益气养阴法疗效的影响因素。结果在2000例原发性IgAN患者中,使用益气养阴中成药的患者491例,对照组为1509例。经组间倾向性评分匹配后,两组各纳入228例。治疗组患者中位数年龄为35.5(四分位间距:28.0,44.0)岁,尿蛋白定量为1.2(0.7,1.9)g/d,估算肾小球滤过率(eGFR)为84.6(61.2,107.0)mL/(min·1.73m^(2)),随访时间为32.0(12.0,62.0)个月,治疗后肾功能恶化患者共21例(9.2%);对照组患者年龄34.0(27.0,43.0)岁,尿蛋白定量为1.2(0.7,2.1)g/d,eGFR为84.8(56.2,112.2)mL/(min·1.73m^(2)),随访时间为30.5(12.0,54.8)个月,治疗后肾功能恶化患者共35例(15.4%)。两组患者肾功能恶化率差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,气阴两虚证(OR 1.972,95%CI:1.162~3.346)、湿热证(OR 1.862,95%CI:1.093~3.172)以及伴有新月体形成(OR 1.067,95%CI:1.020~1.115)的IgAN患者,使用益气养阴中成药更易获得临床缓解。结论益气养阴类中成药可延缓肾功能恶化。特别对于伴有湿热证和新月体形成的患者,应用益气养阴中成药可促进IgAN患者临床缓解。Objective To observe the long-term efficacy of qi-benefiting and yin-nourishing Chinese patent medicines(QYP)for IgA nephropathy(IgAN).Methods Two thousand patients with primary IgAN diagnosed by renal biopsy at three hospitals were included in this study.Patients were assigned to a treatment group and a control group based on the administration of QYP.Demographic data,pathological outcomes,and differences in Chinese medicine syndromes between the two groups were compared.To control for confounding factors,a 1:1 propensity score matching method was used to match patients,and a multivariate Logistic regression analysis was conducted to explore the factors influencing the efficacy of QYP.Results Among 2000 patients with primary IgAN,491 patients were treated with QYP,while 1509 cases served as the control group.After matching propensity scores between groups,228 cases were included in each group.The median age of patients in the treatment group was 35.5 years(interquartile range:28.0,44.0),urine protein quantification was 1.2(0.7,1.9)g/d,and the eGFR was 84.6(61.2,107.0)mL/min/1.73 m^(2),the follow-up period was was 32.0(12.0,62.0)months,a total of 21 patients(9.2%)experienced deterioration in renal function after treatment.In the control group,the median age was 34.0(27.0,43.0)years,urine protein quantification was 1.2(0.7,2.1)g/d,and eGFR was 84.8(56.2,112.2)mL/min/1.73 m^(2),the follow-up period was 30.5(12.0,54.8)months,a total of 35 patients(15.4%)experienced deterioration in renal function after treatment.The difference in the rate of renal function deterioration between the two groups was statistically significant(P<0.05).Multivariable Logistic regression analysis showed that patients with qi and yin deficiency syndrome(OR 1.972,95%CI:1.162-3.346),damp-heat syndrome(OR 1.862,95%CI:1.093-3.172)and those with crescent formation(OR 1.067,95%CI:1.020-1.115)were more likely to achieve clinical remission with the use of QYP.Conclusions QYP delays the deterioration of renal function.Treatment with the application o

关 键 词：IGA肾病 中成药 益气养阴法 辨证施治 疗效 影响因素 中西医结合 

分 类 号：R277.5[医药卫生—中医学]