黄芪联合低分子肝素对老年原发性肾病综合征患者免疫功能的影响

Effect of the combination of astragalus and low molecular weight heparin on immune function in elderly patients with primary nephrotic syndrome

目的探讨黄芪联合低分子肝素对老年原发性肾病综合征患者免疫功能的影响。方法选取遵义市第一人民医院2015年3月~2016年4月收治的老年原发性肾病综合征患者96例,根据治疗方法不同分为治疗组(n=48)和对照组(n=48)。对照组给予常规激素对症治疗,治疗组在常规治疗的基础上给予黄芪联合低分子肝素治疗。观察两组患者的临床疗效及治疗前后肾功能指标及血白蛋白变化情况,并比较两组患者治疗前后免疫功能指标水平变化及不良反应发生情况。结果治疗组治疗有效率为87.50%(42/48),明显高于对照组的64.58%(31/48),差异有统计学意义(P<0.05)。治疗后,两组肾功能指标尿素氮(BUN)、肌酐(Scr)水平较治疗前均显著下降,并且治疗组的BUN水平显著低于对照组,而Scr水平显著高于对照组(P<0.05);两组血白蛋白较治疗前均显著升高,且观察组血白蛋白水平高于对照组(P<0.05);两组患者的TGF-β、IFN-γ、IL-8水平较治疗前均显著下降,且治疗组显著低于对照组,并且IL-13水平明显升高且高于对照组,差异均有统计学意义(P<0.05)。两组患者不良反应发生率相比差异无统计学意义(P>0.05)。结论黄芪联合低分子肝素治疗老年原发性肾病综合征患者能有效降低BUN及Scr水平,改善患者肾功能,还能改善患者的免疫功能,提高临床疗效,且不良反应少,是一种安全有效的治疗方法 。

Objective To investigate the effect of the combination of astragalus and low molecular weight heparin on immune function in elderly patients with primary nephrotic syndrome. Methods A total of 96 cases of primary nephrotic syndrome were selected from our hospital between March 2015 and April 2016. According to the different treatment methods,patients were divided into the treatment group（n=48）and the control group（n=48）. Patients in the control group were treated with routine hormone therapy,and the treatment group was treated with astragalus combined with low molecular weight heparin on the basis of the conventional treatment. The clinical curative effect of the two groups were observed,and changes in the renal function indexes and serum albumin before and after treatment were compared between the two groups. Changes in the levels of immune function indicators and adverse reactions before and after the treatment were compared between the two groups. Results The effective rate of treatment group was 87.50%（42/48）,which was significantly higher than the 64.58%（31/48）in the control treatment group,and the difference was statistically significant（P〈0.05）. After treatment,the levels of BUN and Scr in the two groups were significantly lower than that in the two groups before treatment. The levels of the two indexes in the treatment group were significantly lower than those in the control group（P〈0.05）. After treatment,serum albumin in patients of the two groups were significantly higher than in before treatment,and the level of serum albumin in the observation group was higher than those in the control group（P〈0.05）. The level of TGF-β,IFN-γ and IL-8 in the treatment group was significantly lower than that of the control group. However,the level of IL-13 was the opposite,which was significantly higher than in control group（P〈0.05）. There were no significant differences in the incidence of adverse reactions between the two groups（P〈0.05）. Conclusion The combined astragalus and low molecular weight heparin treatment in elderly patients with primary nephrotic syndrome can effectively decrease BUN and Scr levels and improve renal function.Moreover,this combination treatment can also improve patient immune function and increase clinical efficacy and results in less adverse reactions. Therefore,combined astragalus and low molecular weight heparin therapy is a safe and effective treatment method.