肾纤康汤联合吗替麦考酚酯治疗增生硬化型IgA肾病的临床观察

Effect of Shen Xian Kang Decoction Combined Mycophenolate Mofetil in Patients with Proliferative Sclerosing IgA Nephropathy

目的：观察肾纤康汤联合吗替麦考酚酯（mycophenolate mofetil，MMF）治疗增生硬化型IgA肾病（IgA nephropathy，IgAN）的疗效。方法：选择肾活检诊断为IgAN-增生硬化型，且符合血肌酐（Scr）〈265 mmol／L及尿蛋白≥1．0g／d的患者36例，随机分成肾纤康组（19例）与对照组（17例）。对照组口服MMF 1～1，5g／d3个月，有效逐渐减量至0．75～1g／d，继续3个月；肾纤康组口服肾纤康汤联合MMF。结果：肾纤康组治疗后3个月和6个月24h尿蛋白降低显著优于对照组（P〈0．01）；12个月随访结束后，肾纤康组Scr及肌酐清除率（Ccr）水平稳定；对照组Scr水平显著升高及Ccr水平显著降低，两组疗程及随访结束时Ccr比较均有统计学差异（P〈0．05）。肾纤康组与对照组发生血肌酐倍增分别为1例与3例，对照组2例进入终末期肾病。结论：与单用MMF治疗比较，肾纤康汤联合MMF治疗IgAN-增生硬化型患者能更有效减少尿蛋白排泄，短期随访发现其似乎有更好的肾功能保护作用。

Objective：To observe the effects of Chinese decoction Shen Xian Kang （SXK） combined mycophenolate mofetil （MMF） in treating patients with proliferative sclerosing IgA nephropathy （IgAN）. Methods： A randomized and controlled trim was conducted in 36 patients with proliferative sclerosing IgAN and daily proteinuria of at least 1.0g and serum creatinine （Scr） lower than 265 mmol/L, who were randomly assigned into two groups （19 in SXK group, 17 in control group） treated with SXK decoction combined MMF and MMF respectively. Results：There was significant differences between the 2 groups in median decrease in daily proteinuria at the end of 3rd month （P〈 0.01 ） and 6th month of therapy （P〈 0.01 ）. In SXK group, Scr and Ccr levels were stable at the end of the 12th month of follow- up. In control group,Scr level increased and Ccr level decreased at the end of the 12th months of follow- up. The differences of Ccr level between the 2 groups at the end of therapy and follow - up were significant. Doubling of baseline serum creatinine was seen in 1 case in SXK group and 3 cases in control group. Two patients in control group devel- oped into ESRD. Conclusion： Therapy with SXK decoction combined MMF seems to be effective by reducing excretion of urinary protein in patients with proliferative sclerosing IgAN, and more favorable renal function preserved in comparison with MMF therapy based on short - term follow- up.