摘要
目的：分析西医及中西医结合方案治疗IgA肾病的疗效。方法：将67例经肾活检确诊的IgA肾病患者随机分为基础治疗组和基础治疗＋中药治疗组（综合治疗组），治疗随访6~12个月，对相关临床指标、疗效及IgA肾病牛津病理组织学改变进行分析。结果：两组患者治疗前的性别、年龄、血肌酐、尿素氮、估算的肾小球滤过率（ eGFR）、血浆白蛋白、24 h尿蛋白、高血压发生率组间比较差异均无统计学意义（ P＆gt;0．05）。两组患者治疗后eGFR、24 h尿蛋白、尿红细胞均较治疗前有明显改善，差异有统计学意义（ P〈0．05）。两组治疗起始时血肌酐正常与升高患者总缓解率的组间差异无统计学意义（P〉0．05），但肌酐正常患者中，综合治疗组患者完全缓解率＋显著缓解率显著高于基础治疗组（80% vs 50%，P〈0．05）。按牛津肾脏病理组织学改变划分，两组中系膜细胞增生（M1）、节段性肾小球硬化（S1）、肾小球硬化、细胞性新月体组治疗后的24 h尿蛋白明显下降，综合治疗组肾小管萎缩及间质纤维化（ T1／2）组的24 h尿蛋白也明显下降，差异有统计学意义（ P〈0．05）。不同病理组织学改变对两组治疗前后血肌酐水平均无明显改善。结论：西医及中西医结合治疗对于肾脏病理表现为活动性病变及慢性病变的IgA肾病患者均具有疗效，中西医结合治疗可能对于IgA肾病的缓解程度有帮助。结合中药辨证治疗IgA肾病可与西药治疗优势互补，对于慢性病变为主（肾小管萎缩及间质纤维化）的IgA肾病患者，可改善24 h尿蛋白排泄率，从而延缓疾病的进展。
Objective：To compare the different effects between therapies of TCM -WM and WM on IgA nephropathy. Methods：67 cases of IgAN were randomly allocated to cure group and contrast group. Data concerning laboratory examination and the Oxford Classification renal pathology were collected. Therapeutic effect was observed six to twelve months after medication. Results：There were no differences of sex,age,Scr,BUN,eGFR,Alb,rate of hypertension between two groups,24 h proteinuria was lower in TCM-WM group than that in contrast group. EGFR,24 h proteinuria and urine erythrocyte were obviously improved in both groups. There was no difference of total remission rate between normal Scr group and abnormal Scr group（P〉0. 05）. But the rate of completely recover group plus obviously recover group of TCM-WM group was higher than that of contrast group（ 80% vs. 50%, P〈0. 05）. 24 h proteinuria was reduced after treatment in both groups with M1,S1,glomerulosclerosis and cellular crescent. 24 h proteinuria in TCM-WM group was obviously reduced with T1/2. Scr was not changed after treatment in both groups with different renal pathology. Conclusion：The treatments of western medicine as well as combing tradition Chinese and Western medicine are both effective for IgA nephropathy with active and chronic pathology changes. Therapies of TCM-WM exert a better effect of improving re-mission？rate in patients with normal Scr and reducing 24 h proteinuria than the sole therapy of WM in T1/2 patients.
出处
《中国中西医结合肾病杂志》
2015年第4期314-318,共5页
Chinese Journal of Integrated Traditional and Western Nephrology
基金
上海市卫生局中医药科研基金资助项目(No.2012L063B)
上海市"杏林新星"人才计划项目(No.ZYSNXD011-RC-XLXX-20130014)
关键词
IGA肾病
西医
中西医结合
IgA nephropathy
Westernm edicine
Combining traditional
Chinese and western medicine
