摘要
目的 :回顾性分析雷公藤多甙、大黄素和苯那普利联合治疗重型IgA肾病的疗效。 方法 : 44例原发性IgA肾病 ,肾活检肾小球及小管间质有严重慢性化病变 ,组织学评分≥ 7分 ,尿蛋白 >1 0g/d ,血肌酐 (SCr)<2 6 7μmol/L。采用雷公藤多甙片、大黄素 (2 0 0mg/d)及苯那普利 (10mg/d)治疗。治疗第 1个月雷公藤剂量为 2mg/ (kg·d) ,以后减量至 1mg/ (kg·d) ,或雷公藤 2mg/ (kg·d)服 2周 ,停 2周间歇给药。为使血压控制在 17 3/ 10 7kPa(130 / 80mmHg)以下 ,部分患者加用钙拮抗剂治疗。随访时间 6个月～ 3年。疗效判断 :①缓解 :尿蛋白定量持续 <0 4g/ 2 4h ,SCr正常。②部分缓解 :尿蛋白定量较基础值减少 5 0 %以上 ,SCr上升 <基础值 5 0 %。③无效 :尿蛋白定量减少未达基础值的 5 0 %以上或SCr上升超过基础值的 5 0 %。 结果 :① 35例患者治疗初期SCr正常 ,治疗 6、12、2 4个月时尿蛋白由 (2 5 7± 1 5 7)g/ 2 4h分别降至 (1 12± 0 83)g/ 2 4h、(1 10± 0 85 )g/ 2 4h、(1 10± 0 83)g/ 2 4h ,累计完全缓解率分别为 14 3%、31 4 %和 40 %。治疗 2年时总有效率达 80 %(2 8/ 35 )。 7例患者在随访结束时SCr升高 ,但无一例SCr上升超过基础值的 5 0 %。② 9例患者治疗前SCr>130 μmol/L ,治疗后尿蛋?
Objective:To investigate the efficacy of a combined regime with tripterygium,emodin and benazepril in patients with advanced IgAN. Methodology:In this retrospective study,44 patients with advanced IgAN who received this combined regime between 1997-1999 were included in this investigation.Advanced IgAN was defined as:① Renal histological score ≥7,② Urinary protein excretion >1.0 g/24h,③ Serum creatinine (SCr) <267 μmol/L.The combined regime consisited of tripterygium wilfordii Hook.f(TW) at a dosage of 2 mg/(kg·d) at the first month and thereafter decreased to 1 mg/(kg·d) or 2 mg/(kg·d) for alternate 2 weeks,benazepril at a dosage of 10 mg/d,emodin at 200 mg/d.Calcium channel blockades(CCB) was given in patients with uncontrolled hypertension.The patients were followed-up for 6 months to 3 years,with a mean follow-up of 17.52 months.Patient response was grouped as ① Complete remission (CR,defined as urine protein excretion <0.4 g/24hr,normal SCr),② Partial remission(PR,defined as urine protein excretion decreased to less than 50% of baseline),③ Non-responsive(NR,defined as elevated SCr,persistent urine protein excretion >1.0 g/24hr). Results:① In patients with normal serum creatinine (n=35),urinary protein excretion decreased from 2.57±1.57 g/24hr(pretreatment level) to 1.12±0.83 g/24hr,1.10±0.85 g/24hr,1.10±0.83 g/24hr at the end of the 6th month,the 12th month,the 24th month.Cumulative CR were observed in 14.3%,31.4%,40% of the patients at the end of the 6th month,the 12th month,the 24th month.In 7 of the 35 patients,serum creatinine were found elevated (>130 μmol/L)at the end of the observation,with an increment below 50% of the baseline level.② In the other 9 patients with initial elevated serum creatinine,urinary protein excretion decreased from 4.51±4.47 g/24hr (pretraeatment level)to 1.18±0.86 g/24hr after the treatment.In 6 of the 9 patients,serum creatinine level remained stable after two years treatment,while in the other 3 patients serum creatinine were found increased
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2002年第3期223-227,共5页
Chinese Journal of Nephrology,Dialysis & Transplantation
关键词
IGAN
雷公藤多甙
苯那普利
大黄素
治疗
IgA nephropathy tripterygium wilfordii Hook.f, benazepril emodin
