雷公藤多苷联合RAS阻断剂治疗CKD 2~3期IgA肾病

Treatment of Tripterygium wilfordii Hook F combined with RAS blockers in CKD stages 2-3 of IgA nephropathy

目的：观察雷公藤多苷联合肾素-血管紧张素系统（RAS）阻断剂治疗慢性肾脏病（CKD）2-3期IgA肾病（IgAN）的疗效及安全性。方法：109例患者随机分为观察组（n=55）和对照组（n=54）,在口服RAS阻断剂的基础上,观察组给予雷公藤多苷,对照组给予甲泼尼龙,观察两组尿蛋白与肾功能的变化及不良反应的发生率。结果：治疗后3、6、9、12个月,两组尿蛋白定量均显著低于基线值（P〈0.05）。随访期间,两组估算肾小球滤过率（eGFR）值与基线值相比差异无统计学意义（P〉0.05）。两组间尿蛋白、eGFR、总有效率比较差异无统计学意义。不良反应：观察组不良反应的发生率为9.8%,对照组为27.4%,比较差异有统计学意义（P〈0.05）。结论：雷公藤多苷联合RAS阻断剂能有效降低CKD 2-3期IgAN患者尿蛋白水平,保护肾功能,而且副作用较少,是CKD 2-3期IgAN有效的治疗模式之一。

Objective To investigate the efficacy and safety of Tripterygium wilfordii Hook F（TwHF）combined with renin-angiotensin system（RAS） blockers in chronic kidney disease（CKD） stages 2-3 of IgA nephropathy.Methods 109 patients were randomized into the observation group and the control group.On the basis of taking RAS blockers,patients in the observation group received TwHF,and patients in the control group received methylprednisolone.The proteinuria,renal function and adverse effect were observed during treatment.Results At 3,6,9 and 12 months of treatment,proteinuria in the two groups was lower than the baseline（P〈0.05）.During follow-ups,there was no significant difference of eGFR between the two groups and baseline（P〉0.05）.Besides,there was no significant difference in terms of proteinuria,eGFR and effective rate in the two groups.The occurrence rate of adverse effects was 9.8%vs 27.4%and there was significant difference in the two groups（P〈0.05）.Conclusions TwHF combined with RAS blockers can decrease proteinuria,protect renal function and have less adverse effects,and it is a useful therapeutic options for CKD stages 2-3 of IgAN.