加味当归补血汤对肾虚血瘀型IgA肾病的疗效与对免疫功能的影响

Effects of Jiaweidangguibuxue Decoction on Kidney Deficiency and Blood Stasis Type IgA Nephropathy and its Effects on Immune System

目的:观察加味当归补血汤治疗肾虚血瘀性IgA肾病的临床疗效及对患者免疫系统的影响,分析其预后并探讨其相关机制。方法:选取2010年1月至2012年1月陕西中医肝肾病医院肾内科门诊及住院的肾虚血瘀型IgA肾病患者126例。按照随机数表法将患者分别纳入对照组和观察组,各63例,对照组在基础治疗上使用科素亚50 mg/d,观察组在对照组基础上加以口服汤剂加味当归补血汤。分别检测治疗前后患者24 h尿蛋白量、尿红细胞计数及血肌酐、血清IgA及T淋巴细胞亚群CD4^+/CD8^+值,同时进行肾穿刺活检,评估肾小球病变病理评分,比较2组临床疗效及预后。结果:经治疗后,2组24 h尿蛋白定量、尿红细胞计数、血肌酐较治疗前明显降低(P<0.05),2组CD4^+/CD8^+、血清IgA值均降低(P<0.05),且观察组优于对照组(P<0.05),2组临床疗效进行比较,观察组总有效率(93.44%)优于对照组(83.33%)(P<0.05)。随访后,2组预后分析中1年肾存活率差异无统计学意义(P>0.05),3年、5年肾存活率观察组明显优于对照组(P<0.05)。结论:加味当归补血汤可以增加治疗肾虚血瘀型IgA肾病患者的临床效果,提高IgA肾病患者的免疫功能,提高生存率,改善预后。

Objective： To observe the clinical effect of Jiaweidangguibuxue Decoction for treating kidney deficiency and blood stasis of Ig A nephropathy and its influence on the immune system of patients,and to analyze the prognosis and discuss the related mechanism. Methods： A total of 126 patients with kidney deficiency and blood stasis type Ig A nephropathy in our hospital from January 2010 to January 2012 were randomly selected. The patients were divided into the control group and the treatment group according to random number table method. The control group was treated with losartan 50 mg qd on the basis of basic treatment. The treatment group was treated with Jiaweidangguibuxue Decoction on the basis of the control group. 24 hours urine protein,urine red blood cell,serum Ig A and T lymphocyte subgroup CD4~＋/CD8~＋ value were detected before and after treatment respectively. And renal biopsy was performed. The glomerular pathological scores were evaluated. The numerical statistical difference was compared,and the clinical curative effect and prognosis of two groups was analyzed. Results： After treatment,24 hours urine protein,urine red blood cell count,serum creatinine of two groups after treatment were significantly lower than that before treatment（ P〈0. 05）.CD4~＋/CD8~＋ and serum Ig A value of two groups were decreased（ P〈0. 05）,and the treatment group was better than the control group（ P〈0. 05）. The clinical efficacy of the two groups was compared. The total effective rate（ 93. 44%） of treatment group was better than the control group（ 83. 33%）,and in the follow-up analysis of the prognosis of the two groups in 1 year,kidney survival rate in one year had no statistically significant differences（ P〈0. 05）,and 3,5 years survival rate of the patients in treatment group was significantly better than the control group（ P〈0. 05）. Conclusion： Jiaweidangguibuxue Decoction can increase the clinical effect of treating kidney deficiency and blood stasis type Ig A nephropathy,improve the immune function of patients with Ig A nephropathy,improve the survival rate and improve the prognosis.