黄芪、生地黄配合糖皮质激素治疗系统性红斑狼疮的临床研究

Clinical study of Radix Astragali, Radix Rehmanniae combined with glucocorticoid intreating systemic lupus erythematosus

目的观察黄芪、生地黄配合糖皮质激素（激素）治疗系统性红斑狼疮（systemic lupuserythematosus，SLE）的疗效及对相关实验室指标的影响。方法按随机数字表法将72例SLE患者随机分为两组各36例，治疗组在常规治疗的基础上加用药对黄芪、生地黄治疗；对照组应用强的松、环磷酰胺为主治疗，均治疗6个月，比较两组患者相关临床、实验室指标的变化。结果治疗组完成治疗27例、脱失9例，对照组完成治疗34例、脱失2例。至观察终点，治疗组强的松用量（15．41±7．65）mg／d低于对照组（17．25±8．83）mg／d，但差异无统计学意义（t=0．85，P〉0．05）。治疗组激素撤减量总量为（50.12±12．53）mg，略高于对照组（48．96±13．71）mg，两组激素撤减量比较，差异无统计学意义（t=O．34，P〉0．05）：治疗过程中，治疗组因病情反复需加量使用激素者（15．92％）明显低于对照组（38．24％），差异有统计学意义（x2=3．24，P〈0．05）。两组不良反应柯兴氏征、感染、胃肠道出血、心血管异常的发生率比较，差异无统计学意义（矿分别为0．42，0．98，0．01，0．03，P均〉0．05），但失眠、潮热及虚汗等，治疗组明显低于对照组（x2=4．24，5．93，P〈0．05）。两组患者治疗后SLEDAI积分、血沉、C-反应蛋白、血补体3、血免疫球蛋白G比较，差异无统计学意义（t值分别为2．16，1．04，1．18，0．26，1．61，P均〉0．05），治疗组24h尿蛋白定量（1．06±0．12）g／L低于对照组（1．42±0．54）g/L（t=3．78，P〈0．05）。结论药对黄芪、生地黄配合糖皮质激素治疗SLE，疗效增益不明显，但可减少激素的部分副作用，有利于激素的平稳撤减。

Objective To observe the therapeutic effect of Radix Astragali, Radix Rehmanniae combined with glucocorticoid（GC） in treating patients with systemic lupus erythematosus（SLE） and its influence on some experimental indexes. Methods 72 cases of SLE were randomly recruited into the integrated traditional Chinese and western medicine treated group （treated group） and the western medicine treated group （control group）. The control group was treated with prednisone and cyclophosphamide, while the treated group was treated with Radix Astragali and Radix Rehmanniae on the basis of the control group. Both groups had been treated for 6 months as a therapy course. The use of prednisone dosage were recorded and its influence on indexes of clinical and laboratory value were observed. Results 27 SLE patients in the treated group and 34 in the control group were completely observed. The dosages of prednisone in both groups were decreased gradually after the state of disease had been relieved. The prednisone dosage in the treated group was lower than that in the control group in the therapy course （15.41 ±7.65）mg vs （17.25±8.83）mg, but without significant difference （t=0.85, P〉0.05）. The total decreased prednisone dosage in the treated group （50.12±12.53 mg） was slightly higher than that in control group（48.96± 13.71） mg （t=0.34, P〉0.05）. The ratio of cases who had to add prednisone for aggravating disease in treated group （15.92%） was less than that in the control group （38.24%）, the difference was significant （X2=3.24, P〈0.05）. The incidence rate of cushing syndrome, infection, diseases of digestive, cardiovascular anomalies in the treated group was slightly less than the control group（x2=0.42, 0.98, 0.01, 0.03respectivly, P〉0.05）, but the number of insomnia and hot flush were significantly larger in the control group than the treatment group （x2=4.24, 5.93, P〈0.05）. No difference about the SLEDAI, ESR, CRP, Blood Complement3, Blood imune globinG was found between the two groups （t=2.16, 1.04, 1.18, 0.26, 1.61 respectively, P〉0.05）, and 24 hours urinary protein count decreased significantly in the treated group （1.06 -4± 0.12） g/L, compared with control group （1.42 ± 0.54） g/L, （t = 3.78, P 〈 0.05 ） . Conclusion Radix Astragal, Radix Rehmanniae combined with conventional treatment of western medicine could withdraw corticosteroid smoothly, relieve symptoms and alleviate some sideeffects of western medicine.