發(fā)布時間：2018-08-05 19:02

【摘要】：目的探討他克莫司聯(lián)合加味黃芪赤風(fēng)湯治療老年特發(fā)性膜性腎病(IMN)的臨床療效。方法選取2011年6月—2014年6月就診于鄭州交通醫(yī)院門診或病房的老年IMN患者57例,根據(jù)治療方案分為對照組(n=20)和觀察組(n=37)。對照組患者口服他克莫司聯(lián)合甲波尼龍,觀察組患者口服他克莫司聯(lián)合加味黃芪赤風(fēng)湯。分別于治療前及治療8、12、24周后檢測兩組患者的24 h尿蛋白定量、血清蛋白、尿沉渣紅細胞、血糖和血脂指標、肝腎功能指標,并記錄兩組治療24周的臨床療效及治療期間的不良反應(yīng)發(fā)生情況。結(jié)果兩組患者24 h尿蛋白定量、尿沉渣紅細胞比較,差異有統(tǒng)計學(xué)意義(P0.05);不同時間點比較,差異有統(tǒng)計學(xué)意義(P0.05);治療方法與時間在24 h尿蛋白定量、尿沉渣紅細胞上存在交互作用(P0.05)。兩組患者血清蛋白比較,差異無統(tǒng)計學(xué)意義(P0.05);不同時間點比較,差異有統(tǒng)計學(xué)意義(P0.05);治療方法與時間在血清蛋白上存在交互作用(P0.05)。兩組患者空腹血糖(FPG)、總膽固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)比較,差異有統(tǒng)計學(xué)意義(P0.05);不同時間點比較,差異有統(tǒng)計學(xué)意義(P0.05);治療方法與時間在FPG、TC、LDL、HDL上存在交互作用(P0.05)。兩組患者血肌酐(SCr)、ALT比較,差異無統(tǒng)計學(xué)意義(P0.05);不同時間點比較,差異有統(tǒng)計學(xué)意義(P0.05);治療方法與時間在SCr、ALT上無交互作用(P0.05)。兩組患者尿酸(UA)比較,差異有統(tǒng)計學(xué)意義(P0.05);不同時間點比較,差異有統(tǒng)計學(xué)意義(P0.05);治療方法與時間在UA上無交互作用(P0.05)。兩組患者腎小球濾過率估計值(e GFR)、谷氨酰轉(zhuǎn)肽酶(GGT)比較,差異無統(tǒng)計學(xué)意義(P0.05);不同時間點比較,差異無統(tǒng)計學(xué)意義(P0.05);治療方法與時間在e GFR、GGT上無交互作用(P0.05)。兩組患者臨床療效比較,差異無統(tǒng)計學(xué)意義(P0.05)。觀察組患者不良反應(yīng)發(fā)生率低于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論他克莫司聯(lián)合加味黃芪赤風(fēng)湯治療老年IMN與他克莫司聯(lián)合激素治療方案有近似療效,且患者耐受性較好,更適合于有糖皮質(zhì)激素禁忌證老年IMN患者的臨床治療。
[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.
【作者單位】： 鄭州交通醫(yī)院腎內(nèi)科;鄭州交通醫(yī)院老年病科;中國中醫(yī)科學(xué)院西苑醫(yī)院腎病科;
【分類號】：R692

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