益肾活血祛风湿联合西药治疗IgA肾病远期疗效的临床研究

发布时间：2018-05-09 20:26

本文选题：IgA肾病 + 中西医结合　；参考：《中国中西医结合杂志》2017年01期

【摘要】：目的观察益肾活血祛风湿联合西药治疗IgA肾病的远期疗效。方法采用回顾性病例对照研究,从杭州市中医院IgA肾病随访登记数据库中获取2008年1月1日—12月31日在本院进行肾穿刺活检确诊的原发性IgA肾病患者的临床、实验室检查、肾活检病理、治疗方案等资料,根据治疗方案分为A组(基础治疗+中药)和B组(基础治疗+中药+糖皮质激素和/或免疫抑制剂)。以肾活检病理确诊为原发性IgA肾病为起始点计算,随访结束时间为2015年12月31日,随访时间≥12个月,终点事件定义为进入ESRD或e GFR下降50%以上,或血肌酐翻倍,比较其在治疗1年后及至随访结束时与治疗前相比在临床表现、实验室指标等方面的差异,利用Kaplan-Meier法计算患者的累积肾脏生存率,并绘制肾脏累积生存曲线。结果共纳入病例219例,A组49例,B组170例。A组中肾虚证7例(14%),肾虚血瘀证21例(43%),肾虚风湿证8例(16%),肾虚血瘀风湿证13例(27%)。B组分别为12例(7.1%)、47例(27.6%)、22例(12.9%)、89例(52.4%)。两组患者的年龄、性别、随访时间,差异无统计学意义(P0.05)。与A组比较,B组的病程更短,24 h尿蛋白定量更多,血肌酐、血清尿素氮更高,血浆白蛋白更低(P0.05)。与治疗前比较,治疗1年后两组患者24 h尿蛋白定量及尿红细胞计数下降,并进一步下降至随访结束(P0.05)。219例患者总有效率为89.0%(195/219),A组总有效率为89.8%(44/49),无患者进入终点事件。B组总有效率为88.8%(151/170)。至随访结束,共5例患者到达终点事件,均在B组,其中有4例进入ESRD,1例血肌酐翻倍或e GFR下降50%。与B组比较,A组的完全缓解率更高(P0.01)。利用Kaplan-Meier法计算219例患者的1、3、5、7年肾脏累积生存率分别为100%、100%、98%、96.1%。结论对IgA肾病根据不同病情可以采用基于肾病风湿理论的中医及中西医结合治疗方案,远期观察显示该方案能显著改善患者的病情,7年累积肾脏生存率为96.1%。
[Abstract]:Objective to observe the long-term effect of tonifying kidney and activating blood circulation combined with western medicine on IgA nephropathy. Methods A retrospective case-control study was conducted to investigate the clinical and laboratory findings of primary IgA nephropathy diagnosed by renal biopsy from January 1 to December 31, 2008 in the database of follow-up registration of IgA nephropathy in Hangzhou Hospital of traditional Chinese Medicine. According to the data of renal biopsy and pathology, the patients were divided into two groups: group A (basic Chinese medicine) and group B (basic treatment of glucocorticoid and / or immunosuppressant). Primary IgA nephropathy was diagnosed by renal biopsy and pathology as the starting point. The end time of follow-up was December 31, 2015, and the follow-up time was more than 12 months. The end point event was defined as the entry of ESRD or e GFR decreased by more than 50%, or the blood creatinine doubled. To compare the difference of clinical manifestations and laboratory indexes between the patients after one year's treatment and at the end of follow-up, the cumulative renal survival rate was calculated by Kaplan-Meier method, and the cumulative survival curve of kidney was drawn. Results there were 219 cases in group A, 49 cases in group B, 170 cases in group B. in group A, there were 7 cases with kidney deficiency, 21 cases with syndrome of kidney deficiency and blood stasis, 21 cases with syndrome of kidney deficiency and blood stasis, 8 cases with syndrome of kidney deficiency and rheumatism, 8 cases with syndrome of kidney deficiency and rheumatism, and 13 cases with syndrome of kidney deficiency and blood stasis. There was no significant difference in age, sex and follow-up time between the two groups (P 0.05). Compared with group A, the course of disease in group B was shorter than that in group A, the quantity of urinary protein in 24 h was more, serum creatinine, serum urea nitrogen was higher, and plasma albumin was lower than that in group A (P 0.05). Compared with those before treatment, 24 h urinary protein and urine red blood cell count decreased in both groups after one year of treatment. At the end of follow-up, the total effective rate of group A was 89.0 and the total effective rate of group A was 89.844 / 49, and the total effective rate of group B was 88.8and 15.1 / 1700.The total effective rate of group B was 88.8% / 1700.The total effective rate of group A was 89.8%, and the total effective rate of group B was 88.8%. At the end of follow-up, 5 patients reached the end point, all of them were in group B. among them, 4 cases entered ESRD, 1 case had blood creatinine doubling or e GFR decreased 50%. Compared with group B, the complete remission rate of group A was higher than that of group B (P 0.01). The Kaplan-Meier method was used to calculate the 5-year renal cumulative survival rate in 219 patients. The renal cumulative survival rate in 7 years was 100% and 92.1%, respectively. Conclusion according to different conditions, IgA nephropathy can be treated with traditional Chinese medicine and integrated traditional Chinese medicine and western medicine based on the theory of rheumatism of nephropathy. The long-term observation shows that the regimen can significantly improve the patient's condition, and the 7-year cumulative renal survival rate is 96.1.
【作者单位】：浙江中医药大学附属广兴医院肾病科;浙江省嵊州市中医院内科;
【分类号】：R692.31

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