雷公藤多苷联合福辛普利治疗过敏性紫癜性肾炎的临床疗效及相关机制研究

Study of the Clinical Curative Effect and Relevant Mechanism of Tripterygium Wilfordii Combined Fosinopril Treating Henoch-Schonlein Purpura Nephritis

目的探讨雷公藤多苷联合福辛普利治疗过敏性紫癜性肾炎的临床疗效及相关机制。方法选取2011年4月至2014年5月在雅安市中医院治疗的紫癜性肾炎患者73例作为研究对象,根据随机数字表分为观察组（37例）和对照组（36例）。对照组给予福辛普利治疗,每晚10 mg,每日1次,连续服用4~8周,观察组采用雷公藤多苷联合福辛普利治疗,福辛普利钠用药量为每晚10 mg,每日1次,雷公藤多苷用药量10~20 mg/次,每日3次。两组患者均在治疗3个月后对其临床疗效进行评价,同时对患者治疗前后免疫球蛋白水平,凝血酶原时间（PT）、纤维蛋白原（FIB）水平,活化部分凝血活酶时间（APPT）,血小板水平（PLT）进行测定。结果观察组患者总有效率为94.6%（35/37）,显著高于对照组的75.0%（27/36）（P〈0.05）。观察组患者腹痛、关节肿痛、水肿、蛋白尿和血尿等临床症状消失时间均显著短于对照组[（4.8±2.1）d比（7.4±2.7）d,（5.3±1.8）d比（6.7±1.4）d,（8±3）d比（10±4）d,（18±6）d比（27±7）d,（34±9）d比（46±9）d],差异有统计学意义（P〈0.05）。治疗后观察组患者PT水平显著高于对照组[（12.8±1.5）s比（11.9±1.3）s],PLT计数、IgA水平显著低于对照组[（242±35）×10~9/L比（268±29）×10~9/L,（2.8±0.5）mg/L比（3.3±0.6）mg/L],差异有统计学意义（P〈0.05）。IgG和IgM水平差异无统计学意义（P〉0.05）。结论雷公藤多苷联合福辛普利对过敏性紫癜性肾炎有较好的临床疗效,其机制可能与其能升高PT、降低PLT和IgA水平有关。

Objective To investigate the clinical curative effect and relevant mechanism of tripterygium wilfordii combined fosinopril to treat Henoch-Schonlein Purpura nephritis. Methods Total of 73 patients with henoch-schonlein purpura nephritis Treated in Ya’an Traditional Chinese Medicine Hospital from Apr.2011 to May 2014 were divided into observation group（ 37 cases） and control group（ 36 cases） according to random number table method. The control group was treated with fosinopril,10 mg / time,once every night,for 4-8 weeks; and the observation group was treated with tripterygium wilfordii（ 10-20 mg / time,three times every day） combined with fosinopril（ 10 mg / time,once every night）. After 3 months of treatment,the clinical efficacy of both groups were evaluated,both before and after treatment by the levels of immune globulin,prothrombin time（ PT）,fibrinogen（ FIB） level,activated partial thrombin time（ APPT）,platelets（ PLT）.Results Total effective rate of the observation’ s 94. 6%（ 35 /37） was significantly higher than the control group’s 75. 0%（ 27 /36） P 〈 0. 05）. The disappearance time of abdominal pain,joint swelling,edema,proteinuria and hematuria in the observation group were significantly shorter than the control group [（ 4. 8 ±2. 1） d vs（ 7. 4 ± 2. 7） d,（ 5. 3 ± 1. 8） d vs（ 6. 7 ± 1. 4） d,（ 8 ± 3） d vs（ 10 ± 4） d,（ 18 ± 6） d vs（ 27 ± 7） d,（ 34 ± 9） d vs（ 46 ± 9） d,P 〈 0. 05]. After treatment,the PT in the observation group was significantly higher than the control group[（ 12. 8 ± 1. 5） s vs（ 11. 9 ± 1. 3） s],and the PLT and IgA levels in the observation group were significantly lower than the control group（ P 〈 0. 05） [（ 242 ± 35） × 10~9/ L vs（ 268 ± 29） × 10~9/ L,（ 2. 8 ± 0. 5） mg / L vs（ 3. 3 ± 0. 6） mg / L],and there was no significant difference of IgG and IgM level（ P 〉 0. 05）. Conclusion Tripterygium wilfordii combined with fosinopril has better clinical curative effect on curing henoch-schonlein purpura nephritis,which may be attributed to its increasing of PT,decreasing of PLT and IgA levels.