摘要
目的探讨以中医方案治疗伴肾病范围蛋白尿的特发性膜性肾病患者的疗效及相关影响因素。方法收集2000年1月—2018年6月在上海中医药大学附属龙华医院经中医方案治疗的213例表现为肾病范围蛋白尿的特发性膜性肾病患者的临床资料,首先分析患者的总体疗效、肾脏存活率及复发情况,然后将患者分为难治组及初治组进行比较分析,最后按完全缓解、部分缓解及无效进行分组评估影响疗效的相关因素。结果213例患者的总有效率为77.5%(165/213),其中完全缓解率为47.9%(102/213),复发率为20.6%(34/165);3年、5年、10年的肾脏存活率分别为99.4%,98.8%,93.7%;完全缓解复发后,24 h尿蛋白<3.5 g者再次缓解率和女性患者比例高于24 h尿蛋白≥3.5 g者(P均<0.05)。难治组患者的总有效率、完全缓解率、女性比例、基线血浆白蛋白水平与肾小球滤过率(eGFR)均明显低于初治组(P均<0.05),而病程明显长于初治组(P<0.05)。女性、高血压及eGFR是影响患者是否达到完全缓解的重要因素,而血浆白蛋白水平、随访时间则是患者是否有效的原因。结论中医方案为主治疗特发性膜性肾病疗效明确,可有效降低24 h尿蛋白水平,提高血浆白蛋白水平,保护肾功能,对难治性患者亦具有一定的疗效,但不如初治者。女性、高血压、eGFR、血浆白蛋白及随访时间是影响中医方案治疗疗效的因素。
Objective To investigate the efficacy and related influencing factors of Chinese medicine regimen in the treatment of patients with idiopathic membranous nephropathy with nephrotic-range proteinuria.Methods The clinical data of 213 patients with idiopathic membranous nephropathy with nephrotic-range proteinuria who were treated by the TCM regimen in Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2000 to June 2018 was collected.The patient’s overall efficacy,renal survival rate and recurrence were analyzed firstly,then the patients were divided into refractory group and initial treatment group for comparative analysis,and finally they were grouped according to complete remission,partial remission and ineffectiveness to evaluate the relevant factors affecting the efficacy.Results The total effective rate of 213 patients was 77.5%(165/213),in which the complete remission rate was 47.9%(102/213)while the relapse rate was 20.6%(34/165);the 3-year,5-year and 10-year renal survival rates were 99.4%,98.6%and 93.5%respectively;after complete remission,patients with 24 h urine protein<3.5 g had a higher remission rate and a higher proportion of female patients than those with 24 h urine protein≥3.5 g(P<0.05).The total effective rate,complete remission rate,female ratio,baseline plasma albumin and glomerular filtration rate(eGFR)of patients in the refractory group were significantly lower than those in the initial treatment group(all P<0.05),and the course of the disease was significantly longer than that of the initial treatment Group(P<0.05).Female,hypertension and eGFR were important factors that affect whether a patient can achieve complete remission,while plasma albumin level and follow-up time were the reasons for whether the patient was effective.Conclusion The treatment of idiopathic membranous nephropathy based on TCM therapy which can effectively reduce 24-hour urinary protein,improve plasma albumin and protect renal function has a definite therapeutic effect.It
作者
蔡小凡
张晓丹
李雪玲
陈以平
邓跃毅
钟逸斐
韩莉
胡晏珍
CAI Xiaofan;ZHANG Xiaodan;LI Xueling;CHEN Yiping;DENG Yueyi;ZHONG Yifei;HAN Li;HU Yanzhen(Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China;Shanghai Seventh People’s Hospital, Shanghai 200317, China;Lianyungang Higher Vocational Technical College of Traditional Chinese Medicine, Lianyungang 222007, Jiangsu, China;Jiangxi Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Nanchang 330003, Jiangxi, China)
出处
《现代中西医结合杂志》
CAS
2020年第32期3535-3540,3550,共7页
Modern Journal of Integrated Traditional Chinese and Western Medicine
基金
国家自然科学基金资助项目(81573891)
上海市中发办中医药事业发展三年行动计划-创新内涵建设项目(ZY3-CCCX-3-2001)
国家中医临床研究基地业务建设科研专项课题(JDZX2015097)
国家重点研发计划中医药现代化研究重点专项(2019YFC1709403)。
关键词
特发性膜性肾病
中医综合方案
蛋白尿
idiopathic membranous nephropathy
TCM comprehensive therapy
urinary protein
