益肾通络方干预低中危PLA2R-Ab阳性膜性肾病进程的临床研究

Clinical Studies of Yishen Tongluo Recipe on Intervention of Low and Medium Risk of PLA2R-Ab Positive Membranous Nephropathy

目的:观察益肾通络方干预治疗低中危型PLA2R-Ab阳性膜性肾病的临床疗效。方法:中医辨证为脾肾亏虚兼有血瘀的低、中危PLA2R-Ab阳性膜性肾病患者90例,低危组患者42例,随机分为对照组和治疗组,各21例;中危组患者48例,随机分为对照组和治疗组,各24例。对照组给予基础治疗,治疗组在对照组基础上服用益肾通络方。每月检测24 h UTP、Alb、TC、PLA2R-Ab,每月监测血常规、肝功能、肾功能。观察6个月。结果:有效率比较:低危组第3个月,治疗组80.95%vs对照组65%(P<0.05);第6个月,治疗组90.48%vs对照组75%(P<0.05);中危组第3个月,治疗组78.26%vs对照组63.63%(P<0.05);第6个月,治疗组86.96%vs对照组72.73%(P<0.05)。化验指标比较:治疗第3、6个月两组24 h UTP明显下降(P<0.01),TC、PLA2R-Ab均较治疗前下降(P<0.05),Alb较治疗前升高(P<0.05)。低危组与中危组比较,在第6个月时,低危组治疗组24 h UTP、TC较中危组降低更明显(P<0.05),Alb升高更显著(P<0.05);而低、中危两组中治疗组的PLA2R-Ab在第3个月就较对照组有明显下降(P<0.05);低、中危两组治疗组比较,低危组PLA2R-Ab下降更明显,差异有统计学意义(P<0.05)。低、中危两组BUN、Scr在治疗前后均无明显变化。结论:基础治疗加益肾通络方可更有效、更快速地诱导原发性低中危膜性肾病缓解,且安全性高。

Objective:To observe the clinical efficacy of YishenTongluo Recipe in thetreatment of primary low-and medium-risk membranous nephropathy.Methods:Therewere90 patients with primary low-and medium-risk membranous nephropathy who were diagnosed as spleen-kidney deficiency and blood stasis.42 patients in the risk group were randomly divided into the control group and the treatment group,with 21 cases in each group.48 patients in the middle-risk group were randomly divided into the control group and the treatment group,with 24 cases in each group.The control group was given basic treatment,and the treatment group was supplemented with YishenTongluo Recipe on the basis of the control group.24 hours UTP,Alb,TC,PLA2R-Ab were tested monthly,and blood routine,liver function and renal function were monitored monthly.Observe for 6 months.Results:Efficient comparison,in the third month of treatment in the low-risk group,80.95%in the treatment group and 65%in the control group(P<0.05);in the sixth month of treatment,90.48%in the treatment group and 75%in the control group(P<0.05).In the third month of treatment in the middle-risk group,78.26%in the treatment group and 63.63%in the control group(P<0.05);in the sixth month of treatment,86.96%in the treatment group and 72.73%in the control group(P<0.05).Comparison of laboratory indicators:At the 3rd and 6th month of treatment,the 24 h UTP of the low and middle-risk groups decreased significantly(P<0.01),the TC and PLA2R-Ab decreased compared with the pre-treatment(P<0.05),and the Alb increased compared with the pre-treatment(P<0.05).Compared with the medium-risk group,at the 6th month,the 24 h UTP and TC in the low-risk group were significantly lower than those in the medium-risk group(P<0.05),and the Alb increase was more significant(P<0.05).In the low-and medium-risk groups,the PLA2R-Ab in the treatment group was significantly lower than the control group in the third month(P<0.05).Compared with the treatment group of the low-and medium-risk groups,the decrease of PLA2R-Ab in the low-risk group was more significant(P<0.05).There were no significant changes in BUN and Scr between the low and medium-risk groups before and after treatment.Conclusion:On the basis of western medicine treatment,the addition of YishenTongluoRecipecan induce the relief of primary low-and medium-risk membranous nephropathy more effectively and rapidly,and which is safe.