激素序贯疗法配合辨证治疗难治性肾病综合征70例疗效观察

Observation of combination of sequential hormone therapy and traditional Chinese medicine syndrome-differentiation therapy on refractory nephrotic syndrome

目的观察激素序贯疗法配合辨证治疗难治性肾病综合征的临床疗效。方法 将140例难治性肾病综合征患者随机分为2组,对照组70例采用醋酸泼尼松口服配合环磷酰胺冲击治疗;治疗组70例采用地塞米松及环磷酰胺双冲击后配合中等量的醋酸泼尼松维持治疗,依据激素用药的不同阶段进行辨证论治。观察2组疗效及有关指标的变化。结果 2组完全缓解率比较差异有统计学意义(P<0.01)。治疗组水肿消退时间、尿蛋白转阴时间和平均住院天数均较对照组短(P<0.01)。2组治疗8周24 h尿蛋白定量、血清白蛋白、甘油三酯(TG)、血清总胆固醇(TC)均较本组治疗前明显改善(P<0.01,P<0.05);治疗组治疗8周24 h尿蛋白定量、血清白蛋白、TG、TC均较对照组同时期改善明显(P<0.01)。治疗组不良反应发生率较对照组低(P<0.05)。治疗组治疗后3、6、12个月复发率均低于对照组(P<0.05),治疗组远期疗效优于对照组。结论激素序贯疗法配合辨证治疗难治性肾病综合征,不仅提高了临床疗效,而且减少了激素和细胞毒药物的不良反应,减少了复发。

Objective To observe the effect of combination of sequential hormone therapy and traditional Chinese medicine syndrome-differentiation therapy on refractory nephrotic syndrome.Methods 140 cases of refractory nephrotic syndrome were randomly divided into two groups.Patients in control group（n=70） were treated by combination of oral use of prednisone acetate and cyclophosphamide pulse therapy.Patients in treatment group were treated by combination of cyclophosphamide pulse therapy and traditional Chinese medicine syndrome-differentiation therapy.Results The total remission rate had significant difference in two groups（P〈0.01）.Regression time of oedema,urine protein clearance time and hospital day in treatment group were shorter than those in control group（P〈0.01）.The improvement of 24h urine protein,serum-albumin,TG and TC in treatment group were superior to those in control group after treatment（P〈0.01）.The incidence rate of adverse effect and recurrence rate in treatment group was lower than that in control group（P〈0.05）.Conclusion Ccombination of sequential hormone therapy and traditional Chinese medicine syndrome-differentiation therapy can not only enhance the clinical effect,but also decrease adverse effect of hormone and cytotoxic drug,and recurrence.