加减地龙活血汤联合激素治疗原发性肾病综合征

Earthworm and promoting blood flow decoction soup combined with hormone therapy for primary nephrotic syndrome

目的探讨加减地龙活血汤治疗原发性肾病综合征的临床疗效。方法将病理表现为系膜增生性肾小球肾炎（MsPNS）的原发性肾病综合征患者96例随机分为A、B、C组，各32例。A组用泼尼松和（或）环磷酰胺（CTX）联合地龙活血汤和相应时间的辨证中药；B组除不用地龙活血汤，其余治疗方法同A组；C组仅用泼尼松和（或）CTX治疗。比较3组治疗前以及治疗后第6、12个月24h尿蛋白定量、总胆固醇（TC）、三酰甘油（TG）、血浆白蛋白（Alb）、血红蛋白（Hb）、D二聚体及尿纤维蛋白降解产物（UFDP）等，并比较各组转归与疗效、复发情况和不良反应。结果A组总有效率高于B、C组（P〈0．05或P〈0．01）。3组治疗6个月后复发率无差异（P〉0．05）；治疗12个月后，A、B、C组复发率依次升高（P〈0．05）。A、B组阴虚火旺症、Cushing综合征与感染发生率较C组低；B、C组血栓形成发生率较A组高（Pd0．05）。结论泼尼松和（或）CTX联合地龙活血汤可增强肾病综合征患者疗效，而且可减低复发和不良反应的发生。

Objective To investigate the clinical effect of earthworm and promoting blood flow decoction soup （EPBFDS） for primary nephrotic syndrome. Methods Ninety-six patients with primary mesangial proliferative nephrotic syndrome （MsPNS） were randomly divided into groups A, B and C （n= 32 each）. The patients in group A were treated with prednisone and （or） cyclophosphamide （CTX） combined with EPBFDS and the traditional Chinese medicine on differentiation of symptoms and signs, those in group B were treated with prednisone and （or） CTX with the traditional Chinese medicine on differentiation of symptoms and signs, and non-EPBFDS, and those in group C were trea- ted with prednisone and （or） CTX. Before and 6 and 12 months after treatment, the levels of 24-h u- rine protein, total cholesterol （TC）, triglyceride （TG）, serum albumin （Alb）, hemoglobin （Hb）, D- dimer and urine fibrin degradation products （UFDP） were determined and compared among groups. The outcomes of each group and the efficacy, recurrence and the side effects were analyzed. Results The total effective rate in group A was significantly higher than in groups B and C （P〈0.05 or P〈 0. 01）. Six months after treatment, there was no significant difference in recurrent rate among three groups （P〈0. 05）. At 12th month after treatment, there was significant difference in the recurrent rate among three groups （P^0. 05）. The Yin-Xu Huo-Wang syndrome, Cushing syndrome and the incidence of infection in groups A and B were significantly reduced as compared with group C; the thrombosis rate in groups B and C was significantly higher than in group A （P〈0. 05）. Conclusions Prednisone and （or） CTX combined with EPBFDS not only can strengthen curative effects, but also can significantly reduce recurrence and the side effects.