中医辨证治疗IgA肾病的疗效观察

Therapeutic Effect of TCM Syndrome Differentiation and Treatment for IgA Nephropathy

【目的】探讨中医辨证论治IgA肾病的临床疗效。【方法】对所选病例123例采用数字随机法按3∶1分为中医治疗组(治疗组)和西医治疗组(对照组),治疗组(86例)给予中医辨证分型配合雷公藤多甙片治疗,对照组(37例)给予常规西药治疗(包括抗感染、控制血压和使用糖皮质激素等),2组均以3个月为1个疗程,视病情继续用药,原则上不超过2个疗程。观察2组总疗效、中医证型疗效及毒副作用等,比较2组治疗前后不同证型中医症候计分的变化。【结果】治疗组完全缓解29例,显著缓解30例,好转15例,无效12例,总有效率为86.05%,对照组分别为4例、5例、10例、18例,总有效率为51.35%。治疗组的总疗效优于对照组(P<0.01)。中医证型疗效比较,阴虚证疗效治疗组优于对照组(P<0.01),阳虚证和阴阳两虚证疗效两组相仿(P>0.05)。不同证型患者的中医症候计分的改善情况,治疗组均优于对照组(均P<0.01)。治疗期间,两组均没有出现明显毒性反应。【结论】中医辨证治疗IgA肾病效果良好,特别是对于阴虚证患者,且安全性高,毒副作用少。

[ Objective ] To explore the therapeutic effect of TCM syndrome differentiation and treatment for immunoglobulin A （IgA） nephropathy. [ Methods] The selected 123 patients with IgA nephropathy were divided into two groups （in the proportion of 3 ： 1 ） by number randomization. Group A （ n = 86） was given Tripterygium Glycosides tablets and differential treatment according to syndrome patterns, and Group B （ n = 37） was given routine western medicine including anti-inflammation drugs, drugs for controlling blood pressure and glucocorticoid hormone. The two groups received a 3-month treatment course and received one more course according to individual cases. The total therapeutic effect, effect for TCM syndrome patterns, and toxic and side effects were observed. The changes of TCM syndrome scoring were compared before and after treatment. [ Results] In group A, symptoms were completely relieved in 29, markedly relieved in 30, relieved in 15 and un-relieved in 12 patients, the total effective rate being 86.05%, while respectively in 4, 5, 10 and 18 of patients in group B, the total effective rate being 51.35%. The total effect was better in group A than that in group B （ P 〈 0.01 ）. For yin deficiency, TCM syndrome-differentiation treatment was more effective than routine western treatment （ P 〈 0.01 ）, but for yang deficiency and deficiency of both yin and yang, the former is similar to the latter （ P 〉 0.05）. The improvement on TCM syndrome scoring in group A was superior to that in group B （ P 〈 0.01 ）. No toxic effect was found in the two groups during the treatment. [ Conclusion ] TCM syndrome differentiation and treatment is effective for IgA nephropathy, especially for IgA nephropathy with yin deficiency, and is safe with less toxic and side effects.