双倍剂量雷公藤多苷治疗糖尿病肾病大量蛋白尿的临床观察

Clinical observation of double dose of.tripterygium wilfordii in the treatment of massive proteinu-ria in diabetic nephropathy patients

目的观察双倍剂量雷公藤多苷治疗糖尿病肾病大量蛋白尿的临床疗效和安全性。方法选取临床明确诊断为糖尿病肾病、24h尿蛋白定量≥3．5g、血浆白蛋白I〉25g／L、血肌酐≤176．8μmol／L的患者60例，随机分为治疗组和对照组，每组30例，治疗组在对照组常规治疗的基础阜加用雷公藤多苷，剂量为2mg／（kg·d），观察两组治疗前及治疗3、6、12个月后24h尿蛋白定量和血白蛋白（ALB）、血肌酐（Scr）水平。结果对照组经过积极的血糖、血压控制达标，蛋白尿、血浆白蛋白、血肌酐与治疗前相比，在随访的3、6个月时实验室检查差异无统计学意义（P〉0．05）；观察终点蛋白尿减少、血浆白蛋白升高，差异有统计学意义（P〈0．05）；血肌酐升高，且与治疗前比较差异有统计学意义（P〈0．05）。治疗组蛋白尿在随访3个月时即较治疗前下降，差异有统计学意义（P〈0．05），至6、12个月时差异有统计学意义（P〈0．01）；血浆白蛋白于随访6个月时升高明显，差异有统计学意义（P〈0．05）；血肌酐在整个观察阶段虽然较治疗前有所升高，但差异无统计学意义（P〉0．05）。治疗组3例患者因肝功能异常退出治疗，未见其他不良反应，提示绝大多数患者对于双倍剂量雷公藤多苷耐受性好。结论双倍剂量雷公藤多苷治疗糖尿病肾病大量蛋白尿安全有效，能够明显减少尿蛋白，延缓肾功能恶化。

Objective To observe the clinical efficacy and safety of double dose of tripterygium wilfordii （TW） in the treatment of massive proteinuria in diabetic nephropathy patients. MethOds Sixty patients were diagnosed as diabetic nephropathy, with a 24-hours urine protein ≥3.5 g, serum albumin ≥ 25 g/L, serum creatinine ≤ 176.8 μmol/L, which were randomly divided into treatment group and con- trol group, with 30 cases in each group. Patients in control group Were given conventional therapy, and patients in treatment group were given TW [ 2 mg/（ kg · d） ] based on the conventional therapy. Then the levels of 24-hours urine protein and serum albumin （ Alb）, serum creatinine （Scr） before treatmentand 3 months, 6 months, 12 months after treatment were observed. Results In the control group, blood glucose, blood pressurewas controlled to the normal standards, compared with those before treatment, the levels of proteinuria, serum albumin, serum creatinine after 3 months, 6 months followed-up showed no significant difference （ P 〉 0. 05 ） , but the urine protein and serum albumin increased at the end, the difference was significant （ P 〈 0. 05 ）. Compared with that before treatment, the level of serum creatinine was elevated there was significant difference （P 〈 0. 05 ）. In treatment group, compared with before treatment, proteinuria de- creased after 3 months followed-up （ P 〈 O. 05 ）, and the difference was statistically significant after 6 months, 12 months followed-up （ P 〈 0. 01 ）, serum albumin increased significantly after 6 months fol- lowed-up, with significant difference （P 〈 0. 05 ）. Throughout the observation phases the level of serum creatinine was increased than that before treatment, but there was no significant difference （P 〉 0. 05 ）. Three patients in the treatment group exited due to abnortnsl liver function, without adverse reactions, which suggested that the majority of patients seemed to have good tolerance to driable dose of TW. Con- clusions Double dose of TW is safe and effective for the treatment of diabetic nephropathy proteinuria, and it can significantly reduce urinary protein and retard the deteriorate of renal function.