中医中药对狼疮性肾炎并股骨头坏死临床疗效的影响

Influence of Chinese Herbal Medicine on Effect of Immunosuppressant for the Treatment of Lupus Nephritis Complicated with Femoral Head Necrosis

【目的】观察中医中药对狼疮性肾炎(LN)并激素性股骨头坏死的治疗效果及对狼疮活动情况的影响,并观察其不良反应情况。【方法】将45例狼疮性肾炎并激素性股骨头坏死患者随机分为2组,对狼疮性肾炎的治疗对照组18例采用非激素免疫抑制剂方案治疗,试验组27例采用非激素免疫抑制剂+中医中药方案治疗。追踪3年观察治疗效果、狼疮活动及不良反应的情况。【结果】(1)治疗后两组临床症状总积分均较治疗前显著下降(P<0.05或P<0.01);两组间比较,试验组在改善临床症状方面优于对照组(P<0.05)。(2)治疗后两组的系统性红斑狼疮疾病活动指标评估(SLEDAI)积分均较治疗前降低(P<0.05);两组间比较,试验组降低幅度大于对照组,但差异无显著性意义(P>0.05)。(3)治疗后两组的尿蛋白定量、尿红细胞计数均下降(与治疗前比较,P<0.05);两组间比较,试验组的下降作用更显著(P<0.05)。(4)试验组的不良反应发生率和并发症均较低,与对照组比较差异有显著性意义(P<0.05或P<0.01)。(5)停药情况:对照组6例、试验组21例可完全停用免疫抑制剂,两组比较差异有显著性意义(P<0.05)。【结论】非激素免疫抑制剂+中医中药治疗方案可改善轻中度活动的LN患者的临床情况,减少药物不良反应和狼疮的复发,部分患者可完全停用免疫抑制剂,说明该方案优于单纯免疫抑制剂治疗。

Objective To investigate the influence of Chinese herbal medicine on effect of immunosuppressant for the treatment of lupus nephritis complicated with femoral head necrosis （ FHN ） , and to observe the adverse reaction. Methods Forty-five lupus nephritis patients complicated with FHN were randomized into 2 groups： the control group （N = 18 ） received immunosuppressant regimen without medication of hormone, and the treatment group （ N = 27 ） received Chinese herbal medicine based on immunosuppressant regimen. The activity of systemic lupus erythematosus （SLE） , and the incidences of lupus nephritis and adverse reaction were monitored during the 3-year follow-up. Results （ 1 ） After treatment, the total score of symptoms was decreased in the two groups （P 〈0. 05 or P 〈0.01 compared with that before treatment）, and the relief of the symptoms was obvious in the treatment group （P 〈 0. 05 compared with that in the control group）. （2） The score of daily activity index of SLE （SLEDAI） was decreased in the two groups （P 〈0. 05 compared with that before treatment）, and the decrease was obvious in the treatment group, but the difference was insignificant between the two groups （P 〉 0. 05 ）. （3） The urine protein volume and urine red blood cell （RBC） count were decreased in the two groups after treatment （ P 〈 0. 05 compared with thoset before treatment） , and the decrease was obvious in the treatment group （ P 〈 0. 05 compared with that in the control group）. （4） The incidences of adverse reaction and complications were reduced in the treatment group （ P 〈 0.05 or P 〈 0. 01 compared with those in the control group ）. （ 5 ） Suspending medication of immunosuppressant can be carried out in 6 patients of the control group and 21 of the treatment group （P 〈0. 05 ）. Conclusion Chinese herbal medicine combined with immunosuppressant regimen can relieve the symptoms and signs of mild and moderate LN, reduce the side reaction of immunosuppressant and the recurrence of SLE, and ensure some of the patients suspending medication of immunosuppressant, indicating that the therapy is superior to immunosuppressant regimen alone.