他克莫司联合加味黄芪赤风汤治疗老年特发性膜性肾病的临床疗效研究

发布时间：2018-08-05 19:02

【摘要】：目的探讨他克莫司联合加味黄芪赤风汤治疗老年特发性膜性肾病(IMN)的临床疗效。方法选取2011年6月—2014年6月就诊于郑州交通医院门诊或病房的老年IMN患者57例,根据治疗方案分为对照组(n=20)和观察组(n=37)。对照组患者口服他克莫司联合甲波尼龙,观察组患者口服他克莫司联合加味黄芪赤风汤。分别于治疗前及治疗8、12、24周后检测两组患者的24 h尿蛋白定量、血清蛋白、尿沉渣红细胞、血糖和血脂指标、肝肾功能指标,并记录两组治疗24周的临床疗效及治疗期间的不良反应发生情况。结果两组患者24 h尿蛋白定量、尿沉渣红细胞比较,差异有统计学意义(P0.05);不同时间点比较,差异有统计学意义(P0.05);治疗方法与时间在24 h尿蛋白定量、尿沉渣红细胞上存在交互作用(P0.05)。两组患者血清蛋白比较,差异无统计学意义(P0.05);不同时间点比较,差异有统计学意义(P0.05);治疗方法与时间在血清蛋白上存在交互作用(P0.05)。两组患者空腹血糖(FPG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)比较,差异有统计学意义(P0.05);不同时间点比较,差异有统计学意义(P0.05);治疗方法与时间在FPG、TC、LDL、HDL上存在交互作用(P0.05)。两组患者血肌酐(SCr)、ALT比较,差异无统计学意义(P0.05);不同时间点比较,差异有统计学意义(P0.05);治疗方法与时间在SCr、ALT上无交互作用(P0.05)。两组患者尿酸(UA)比较,差异有统计学意义(P0.05);不同时间点比较,差异有统计学意义(P0.05);治疗方法与时间在UA上无交互作用(P0.05)。两组患者肾小球滤过率估计值(e GFR)、谷氨酰转肽酶(GGT)比较,差异无统计学意义(P0.05);不同时间点比较,差异无统计学意义(P0.05);治疗方法与时间在e GFR、GGT上无交互作用(P0.05)。两组患者临床疗效比较,差异无统计学意义(P0.05)。观察组患者不良反应发生率低于对照组,差异有统计学意义(P0.05)。结论他克莫司联合加味黄芪赤风汤治疗老年IMN与他克莫司联合激素治疗方案有近似疗效,且患者耐受性较好,更适合于有糖皮质激素禁忌证老年IMN患者的临床治疗。
[Abstract]:Objective to investigate the clinical effect of tacrolimus combined with modified Huangqi Chifeng decoction in the treatment of senile idiopathic membranous nephropathy (IMN). Methods from June 2011 to June 2014, 57 elderly patients with IMN were divided into two groups: control group (n = 20) and observation group (n = 37). The patients in the control group were treated with tacrolimus combined with methyl-polyamide, and the patients in the observation group were given tacrolimus combined with Huangqi Chifeng decoction. 24 h urine protein, serum protein, urine sediment erythrocyte, blood glucose, blood lipid, liver and kidney function were measured before treatment and after 812 weeks. The clinical efficacy and adverse reactions during 24 weeks of treatment were recorded in both groups. Results there were significant differences between the two groups in 24 h urinary protein quantification and urine sediment erythrocyte (P0.05), the difference at different time points was statistically significant (P0.05), the treatment method and time were 24 h urinary protein quantitative. There was interaction on erythrocytes in urine sediment (P0.05). Two groups of patients serum protein comparison, the difference was not statistically significant (P0.05); at different time points, the difference was statistically significant (P0.05); treatment methods and time on the serum protein interaction (P0.05). There was significant difference in fasting blood glucose, total cholesterol, (TC), low density lipoprotein, (LDL), high density lipoprotein (HDL) between the two groups (P0.05); at different time points, the difference was statistically significant (P0.05); there was an interaction between treatment methods and time on (FPG), TCC LDLL-HDL (P0.05). There was no significant difference in serum creatinine (SCr) alt between the two groups (P0.05); at different time points, the difference was statistically significant (P0.05); there was no interaction between treatment methods and time on SCRL-ALT (P0.05). The difference of uric acid (UA) between the two groups was statistically significant (P0.05); at different time points, the difference was statistically significant (P0.05); there was no interaction between treatment methods and time on UA (P0.05). Two groups of patients with glomerular filtration rate estimated value (e GFR), glutamyl transpeptidase (GGT) comparison, the difference was not statistically significant (P0.05); at different time points, the difference was not statistically significant (P0.05); treatment methods and time on the eGFRGGT no interaction (P0.05). There was no significant difference in clinical efficacy between the two groups (P0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group (P0.05). Conclusion tacrolimus combined with modified Huangqi Chifeng decoction has similar therapeutic effect on elderly patients with IMN and tacrolimus combined with steroid, and it is more suitable for clinical treatment of elderly IMN patients with glucocorticoid contraindication.
【作者单位】：郑州交通医院肾内科;郑州交通医院老年病科;中国中医科学院西苑医院肾病科;
【分类号】：R692

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