越婢汤联合非免疫抑制治疗局灶节段性肾小球硬化的临床疗效及对足细胞损伤的保护作用  

Clinical Efficacy of Yuebi Decoction Combined with Non-immunosuppressive Therapies for Patients with Focal Segmental Glomerulosclerosis and its Protective Effects on Podocyte Injury

作　　者：姚天文[1] 韩世盛[1] 张熙[1] 徐艳秋[1] 王怡[1] YAO Tianwen;HAN Shisheng;ZHANG Xi(Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai(200437))

机构地区：[1]上海中医药大学附属岳阳中西医结合医院,上海200437

出　　处：《中国中西医结合肾病杂志》2025年第1期21-24,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：上海市卫生健康委员会临床研究专项项目(No.20234Y0078);上海市青年科技英才扬帆计划项目(No.21YF1448300)。

摘　　要：目的:观察经典名方越婢汤联合非免疫抑制治疗局灶节段性肾小球硬化(FSGS)的临床疗效及对足细胞的保护作用。方法:将60例原发性FSGS患者按照随机数字表法分为两组,对照组30例(实际完成28例)予西医非免疫抑制治疗(缬沙坦胶囊联合达格列净片),治疗组30例(实际完成29例)在对照组基础上联合越婢汤治疗。两组均治疗24周后统计疗效,比较两组治疗前后24 h尿蛋白定量(24 h UTP)、血清白蛋白(Alb)、肾小球滤过率(eGFR)及尿液足细胞损伤标记蛋白(Nephrin、Podocin)排泄量水平变化情况。结果:治疗组总有效率75.9%(22/29),对照组总有效率57.1%(16/28),治疗组总有效率高于对照组(P<0.05)。与本组治疗前比较,两组治疗后24 h UTP均降低(P<0.05),Alb水平均升高(P<0.05),且治疗组治疗后24 h UTP、Alb水平改善均优于对照组(P<0.05)。两组治疗前后eGFR水平均无明显变化(P>0.05)。与本组治疗前比较,两组治疗后尿Nephrin、Podocin水平均降低(P<0.05),且治疗组治疗后尿Nephrin、Podocin水平均低于对照组(P<0.05)。结论:经典名方越婢汤联合非免疫抑制治疗FSGS临床疗效确切,可有效改善患者蛋白尿,具有良好的有效性和安全性,其作用机制可能与降低尿Nephrin、Podocin水平,改善足细胞损伤密切相关。Objective:To observe the clinical efficacy of Yuebi Decoction(YBD)combined with non-immunosuppressive therapies for patients with focal segmental glomerulosclerosis and its protective effects on podocyte injury.Methods:A total of 60 FSGS patients were randomly assigned into the control group(n=30,2 cases of shedding)and the treatment group(n=30,1 case of shedding).All patients were managed by non-immunosuppressive therapies(valsartan and dapagliflozin),and those in the treatment group were additionally treated with YBD.A 24-week treatment was performed to compare 24-hour urinary total protein(24 h UTP),serum albumin(Alb),glomerular filtration rate(eGFR),and urinary excretion levels of podocyte injury marker proteins Nephrin and Podocin between two groups.Results:The overall effective rate in the treatment group was better than that in the control group[75.9%(22/29)vs 57.1%(16/28),P<0.05,respectively].After treatment,decreased 24 h UTP and increased Alb were detected in both groups(all P<0.05),improvement of which in the treatment group were significantly better(P<0.05).There was no significant difference in eGFR levels between groups before and after treatment(P>0.05).The levels of Nephrin and Podocin in urine of the 2 groups were decreased after treatment(P<0.05),which were decreased in the treatment group compared with the control group(P<0.05).Conclusion:For FSGS patients,YBD combined with non-immunosuppressive therapies has definite clinical efficacy,which can effectively improve proteinuria in patients with good efficacy and safety.Its mechanism may be closely related to reduce the levels of Nephrin and Podocin in urine and improve podocyte injury.

关 键 词：局灶节段性肾小球硬化 足细胞损伤 越婢汤 中西医结合 有效率 

分 类 号：R692[医药卫生—泌尿科学]