摘要
目的:比较泼尼松联合霉酚酸酯(MMF)结合中药汤剂与泼尼松联合环磷酰胺(CYC)治疗重症IgA肾病的临床疗效。方法:84例重症IgA肾病患者根据入院先后顺序按随机原则分别给予泼尼松联合MMF结合中药汤剂治疗(MMF组,n=42),或采用泼尼松联合CYC治疗(CYC组n=42),持续12个月。两组患者基础病情无差异,随访时间18个月,观察两组患者临床缓解率以及相应实验室指标如24 h尿蛋白定量、血肌酐、血浆白蛋白、总蛋白、血脂变化,并比较两组治疗的不良反应。结果:1)临床缓解率:治疗18个月时MMF组临床总有效率高于CYC组,分别为85.7%VS 61.8%(P<0.05);2)观察期末,MMF组患者24 h尿蛋白定量(0.6±0.3)明显低于CYC组(1.4±0.5)(P<0.05),血浆白蛋白和总蛋白(43.2±4.3和70.2±8.1)均显著高于CYC组患者(36.9±3.6和60.3±7.6)(P<0.05);3)血脂变化:MMF组血脂较治疗前明显降低,而CYC组无变化(P<0.05);4)不良反应发生率:MMF组不良反应发生率(4.76%)明显低于CYC组(19.0%)。结论:泼尼松联合MMF治结合中药汤剂疗重症IgA肾病,临床缓解率高于泼尼松联合CYC静脉滴注疗法,能更有效降低患者24 h尿蛋白定量,改善患者血脂和血浆白蛋白水平,维持患者肾功能稳定,并且MMF不良反应发生率显著低于CYC疗法。
Objective: To compare efficacy of 1) Prednisone and mycophenolate mofetil(MMF) and herbal decoctions with 2) prednisone and cyclophosphamide(CYC) for treating severe IgA nephropathy.Methods: Eighty-four patients with severe IgA nephropathy were randomly given prednisone and MMF and herbal decoction(MMF group,n = 42),or treated with prednisone and CYC(CYC group n = 42),for 12 months.Patients were of no difference in terms of basic illness severity.In 18-month followups,observe clinical effective rate and the corresponding laboratory indicators such as 24-hour urine protein quantitative,serum creatinine,serum albumin,total protein,serum lipid levels,and adverse event.Results: 1) Effective rate: Total effective rate of MMF group was higher than that of the CYC group,85.7% vs.61.8%(P 0.05);2) 24 h proteinuria in MMF group(0.6 ± 0.3) was significantly lower than that of the CYC Group(1.4 ± 0.5)(P 0.05),serum albumin and total protein(43.2 ± 4.3 and 70.2 ± 8.1) are substantially higher than those of the CYC Group(36.9 ± and 3.6 ± 7.6)(P 0.05);3) Lipids: MMF group lipids significantly reduced after treatment,CYC groups showed no significant change(P 0.05);4) Adverse event: AE incidence of MMF Group(4.76%) was significantly lower than that of CYC Group(19%).Conclusion: Compared with prednisone and intravenous infusion of CYC therapy,Prednisone and MMF combined with TCM treatment is more effective to treat severe IgA nephropathy,reduce the 24 h urinary protein,improve serum lipids and serum albumin level,maintain renal function,and have less adverse reaction.
出处
《世界中医药》
CAS
2013年第9期1067-1070,共4页
World Chinese Medicine
关键词
重症IgA肾病
霉酚酸酯
环磷酰胺
中西医结合
Severe IgA nephropathy
Mycophenolic acid ester
Effects of glutamine
Integrated Western and Chinese Medicine