养阴清热、活血利水中药组方治疗狼疮性肾炎的疗效观察

Clinical Observation on Lupus Nephritis Treated by TCM Decoction for Nourishing Yin and Clearing Away Heat and Activating Blood and Promoting Diuresis

目的:本研究旨在辨证论治的基础上以养阴清热、活血利水为主要治疗原则,观察自拟养阴清热、活血利水中药组方治疗狼疮性肾炎的临床疗效及不良反应,并为狼疮性肾炎的治疗新方案奠定基础。方法:收集自2008—2009年间上海中医药大学附属市中医医院风湿科病房及门诊狼疮性肾炎病例共98例,分为中医组、西医组和中西医结合组,其中中医组33例,西医组32例,中西医结合组33例。中医组服中药组方(生地、丹参、接骨木、积雪草、猫爪草等)每日1剂,分2次口服;西医组静滴环磷酰胺1.0/月;中西医结合组在口服中药组方的基础上静滴环磷酰胺0.6/月。各组病例均治疗5～6个月为1个疗程,观察3组治疗前后临床症状、实验室指标的变化,并做出统计分析。结果:治疗后3组24h尿蛋白定量比较结果为与治疗前相比中医组和西医组均能降低24h尿蛋白定量(P<0.05),而中西医组能显著降低24h尿蛋白定量(P<0.01),且优于中医组和西医组(P<0.05)。3组血沉比较显示与各自治疗前相比中医组和西医组均能改善血沉(P<0.05),中西医组改善更明显(P<0.01);3组疾病疗效判定中医组总有效率为83.87%,西医组总有效率为80.65%,中西医组总有效率为90.90%,3组疾病疗效比较差异无显著性(P>0.05)。3组不良反应发生率比较,中医组不良反应发生率为9.68%,西医组为35.48%,中西医结合组为12.12%,中医组和中西医结合组不良反应发生率低于西医组(P<0.05)。结论:养阴清热、活血利水中药组方具有一定的抑制免疫作用,可以部分替代免疫抑制剂。中药联合环磷酰胺治疗狼疮性肾炎可以强化免疫抑制的作用,更有效控制病情,并能减少环磷酰胺引起的毒副作用。

Objective ： In this study, on the basis of syndrome differentiation and nourishing Yin and clearing away heat, activating blood and promoting diuresis as the main treatment principle, the clinical effect and adverse reaction on lupus nephritis treated with TCM decoction followed by the above principles were observed,which could contribute to the basis of new lupus nephritis treatment scheme. Methods ：98 lupus nephritis cases were collected from rheumatology department and outpatient of Shanghai Hospital of TCM Affliated to Shanghai University of TCM during 2008 and 2009. They were divided into Chinese medicine group（33 cases）, western medicine group（32 cases）and integrative medicine group （33 cases）. Chinese medicine group used traditionnal Chinese medicine decoction （ Shengdi, Danshen, Jiegumu, Jixuecao, Maozhuacao, etc） twice a day ; western medicine group used intravenous cyclophosphamide 1.0/month;integrative medicine group used Chinese medicine decoction plus intravenous cyclophosphamide 0.6/month. All the patients were treated 5 - 6 months as a course. The clinical symptoms and laboratory indicators before and after treatment in the three groups were observed, and then statistic analysises were made. Results：After treatment, Chinese medicine group and western medicine group could reduce the 24h urinary protein（ P 〈 0. 05 ）, while the integrative medicine group could significantly reduce the 24h urinary protein （ P 〈 0. 01 ） better than the other two groups （ P 〈 0. 05 ）. ESR values were re- duced in western medicine group and Chinese medicine group （ P 〈 0. 05 ） , while significantly reduced in integrative medicine group（P 〈 0. 01 ）. In respect of disease effecttiveness assessment, the total effectiveness rate in Chinese medicine group was 83. 87% ,in western medicine group was 80.65% , and in integrative group was 90.90% （P 〉 0. 05 ）. Adverse event rate was 9.68% in Chinese medicine group,35.48% in western medicine group,and 12.12% in integrative group. Adverse events were lower in Chinese medicine group as well as integrative medicine group, compared with that in western medicine group （P 〈 0. 05 ）. Conclusion：TCM decoction made on the principle of nourishing Yin and clearing away heat and activating blood and promoting diuresis has some immunosuppressive effect, and can be alternative of immunosuppressors partly. Traditional Chinese medicine treatment of lupus nephritis combined with cyclophosphamide can strengthen the role of immunosuppression, control the disease more effectively,and reduce side effects causedby cyclophosphamide.