雷公藤多甙联合苯那普利和大黄素治疗IgA肾病的前瞻性临床研究  

Prospective clinical study of a combined regime of tripterygium wilfordii plus benazepril and emodin in treatment of IgA nephropathy

作　　者：徐明中[1] 胡伟新[1] 刘志红[1] 唐政[1] 陈惠萍[1] 黎磊石[1] 

机构地区：[1]南京军区南京总医院解放军肾脏病研究所,南京210002

出　　处：《肾脏病与透析肾移植杂志》2004年第1期19-24,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的：观察雷公藤多甙联合苯那普利和大黄素(三联疗法)对IgA肾病(IgAN)的临床疗效及肾组织病理改变的影响。方法：经肾活检并结合临床确诊为原发性IgAN的患者24例，年龄14-55岁，尿蛋白≥1.0g／d，血肌酐(SCr)≤267μmoI／L，肾活检病理Lee胱氏Ⅲ级以上。根据尿蛋白、SCr及肾病理配对分为治疗组(n=12)和对照组(n=12)，治疗组接受雷公藤多甙、苯那普利和大黄索三联治疗，对照组接受强的松和苯那普利治疗。疗效分为缓解(尿蛋白<0．4g／d，血浆白蛋白>35．0g／L，SCr<110μmol／L)、部分缓解(尿蛋白>0．4g／d，但下降>基础值的50％，肾功能稳定，SCr上升<基础值的25％)及无效(尿蛋白>1．0g／d，或SCr上升>基础值的50％)。治疗12个月后9例治疗组和4例对照组患者接受重复肾活检，利用Scion Image4．02B软件进行病理图像分析肾小球指数(GI)、肾小管间质慢性化病变指数(TD)以及问质血管病变指数(VI)。结果：治疗6个月时治疗组5例(42％)缓解，6例(50％)部分缓解，1例(8％)无效，对照组分别为2例(17％)、7例(58％)和3例(25％)。治疗组尿蛋白下降快于对照组，治疗0、1、3、6、9、12个月时治疗组尿蛋白分别为(2．04+0．76)g／d,(0．76±0．45)g／d,(0．51±0．31)g／d、(0．57±0．31)g／d,(0．55+0．43)g／d,(0．81±1．09)g／d，对照组分别为(1．88±0．67)g／d,(1．43±0．74)g／d,(0．79±0．58)g／d、(0．68±0．34)g／d,(2．03±1．90)g／d,(1．27±1．45)g／d。治疗组6例肾功能不全患者治疗12个月后SCr保持稳定[(140．6±19．0)μmol／L vs (134．1±24．1)μmol／L，P>0．05]，对照组5例5肾功能不全患者SCr无变化[(126．6±19．6)μmol／L vs (129．5±26．6)μmol／L，P>0．05]。重复肾活检病理定量分析发现治疗组GI显著降低(0．314±0．054 vs 0．243±0．042，P<0．05)，对照组GI则增加(0．274±0．065±0．304±0．056，P>0．05)。治疗组TI由0．183±0Objective: The prognosis of IgA nephropathy patients with proteinuria and/or alimierated renal function fares much worse than those without. And no consensusized regime is available clinically for this groups of patients besides symptomatic approaches with respect of proteinuria and hypertension. In this paper, we reported a combined regime with tripterygium wilfordii plus benazepril and emodin for IgA nephropathy (IgAN), and prospectively observe the effects in both clinic and pathology. Methodology: Twenty-four patients who underwent renal biopsy and diagnosed as IgAN before enrolment in the study. Further criteria for inclusion are 24-hour proteinuria excretion over 1.0g/d, serum creatinine (SCr) level below 3mg/dl, grade Ⅲ or Ⅳ tubulointerstitial damages(Lees histologic grading systems). 12 patients (the treatment group) received the combined regime ( TW at dosage of 60mg/d, ACEI And Emodin) and the other 12 patients ( the control group) received treatment with prednisone and benazepril. The responses of the patients were classified as complete remission (CR, defined as proteinuria <0.4 g/24hr, SCr<110 mmol/L), partial remission (PR, defined as proteinuria decreased to less than 50% of baseline, SCr kept stable) and No-response (NR, defined as elevated SCr or proteinuria >1.0 g/24hr). A second renal biopsy was performed in 13 patients (9 in the treatment group and 4 in the control group) after 12 months of treatment. Glomerular index (GI), tubular-interstitial index (TI) and vascular index (VI) were quantitatively analyzed by Scion Image Beta 4.0.2 Win software. Results: After six months treatment, there were 5 patients (42%) got to CR, 6 (50%) to PR and 1 (8%) remained refractory to treatment in the treatment group. While there were 2 patients (17%) got to CR, 7 (58%) to PR and 3 (25%) as refractory in the control group. At the end of the 12 months treatment, proteinuria significantly decreased in both groups [(2.04±0.76)g/d vs (0.81±1.09)g/d in the treatment group, P<0.05; (1.88±0.67)g/d vs (1.

关 键 词：雷公藤多甙 苯那普利 大黄素 IGA肾病 临床研究 尿蛋白 肾功能 肾脏纤维化 

分 类 号：R692.3[医药卫生—泌尿科学]