泼尼松联合雷公藤多苷治疗成人紫癜性肾炎的临床观察

Clinical observation of prednisone combined with tripterygium glycosides in treatment of adult purpura nephritis

目的探讨泼尼松联合雷公藤多苷治疗成人紫癜性肾炎的临床疗效及安全性。方法选取2011年1月至2013年1月贵阳中医学院第一附属医院成人紫癜性肾炎患者83例,随机分为治疗组(41例)和对照组(42例)。对照组患者入院后完善辅助检查,患者低盐、低蛋白及低脂肪饮食,采用补充白蛋白、低分子肝素抗凝及保肾等对症支持治疗,同时口服泼尼松,30 mg/次,1次/d,治疗8周后减量,减量速度为2.5 mg/周,最后以10 mg/d剂量维持治疗,治疗6个月。治疗组患者在对照组基础上加用雷公藤多苷,20 mg/次,3次/d,用药8周以上。治疗结束后,比较两组患者的临床疗效及不良反应发生情况,同时比较两组患者平均蛋白尿转阴时间、血尿转阴时间、水肿消失时间及高血压消失时间。结果治疗组患者治疗总有效率为92.68%,显著高于对照组的76.19%(P<0.05)。治疗组患者平均蛋白尿转阴时间、血尿转阴时间、水肿消失时间及高血压消失时间均显著短于对照组(P<0.05)。两组患者不良反应发生率差异无统计学意义。结论在成人紫癜性肾炎的治疗中,泼尼松联合雷公藤多苷可以明显改善患者的临床症状,具有较高的治疗总有效率。

Objective To investigate the clinical efficacy and safety of prednisone combined with tripterygium glycosides in the treatment of adult purpura nephritis. Methods The patients （83 cases） diagnosed with adult purpura nephritis in Guiyang Hospital of Traditional Chinese Medicine from January 2011 to January 2013 were randomly divided into treatment （41 cases）and control （42 cases） groups. The patients in the control group underwent the auxiliary examination after admission, and they were administered with low-salt, low-protein, and low-fat diet. They were given albumin, heparin with low molecular weight, and kidneys supportive treatment, while they were po administered with prednisone （30 mg/d）. The amount of prednisone was reduced eight weeks later, and the reduction rate was 2.5 mg per week, and finally 10 mg/d maintained the therapy. The treatment lasted for six months. The patients in the treatment group were po administered with tripterygium glycosides （20 mg） on the basis of control group, three times daily for eight weeks or more. After the treatment, the clinical efficacy and adverse reactions of the two groups were compared, and the average clearance times of proteinuria and hematuria, edema and hypertension disappearance times were compared. Results After the treatment, the efficacies in the treatment and control groups were 92.68% and 76.19%, respectively, with the significant difference between the two groups （P 〈 0.05）. The average clearance times of proteinuria and hematuria, edema and hypertension disappearance times of the treatment group were significantly shorter than those of the control group （P 〈 0.05）. There was no significant difference on the incidence of the adverse reactions between the two groups. Conclusion Prednisone combined with tripterygium glycosides in the treatment of adult purpura nephritis could significantly improve the clinical symptoms, which has a high total efficiency.