雷公藤多苷联合激素对成人NS糖皮质激素抵抗及HSP90的影响

Effect of Tripterygium Glycosides Combined with Hormones on Adult NS Glucocorticoid Resistance and HSP90

为探讨雷公藤多苷联合激素治疗成人肾病综合征(NS)的临床效果及对患者糖皮质激素抵抗、热休克蛋白90(HSP90)表达的影响,本研究将82例肾病综合征患者按随机数字表法分为对照组与观察组两组,每组41例,两组均予以基础对症处理,对照组采用糖皮质激素泼尼松治疗,1 mg/kg,8周或尿蛋白阴转2周后逐渐减量,维持20 mg/d,观察组加用雷公藤多苷片治疗,20 mg/次,3次/d,共治疗24周。并将观察组与对照组比较,结果发现,观察组治疗总有效率高于对照组(p<0.05),且治疗后,两组尿蛋白定量降低,总蛋白(TP)、血清白蛋白(ALB)均上升,与同组治疗前对比差异有统计学意义(p<0.05),观察组尿蛋白定量降低幅度、TP及ALB上升幅度高于对照组(p<0.05);且观察组血肌酐(Cr)、尿素氮(BUN)、糖皮质激素受体β(GRβ)、HSP90均降低,与同组治疗前及对照组治疗后对比差异有统计学意义(p<0.05);同时观察组不良反应发生率略低于对照组,但未见统计学差异。对成人NS患者采用雷公藤多苷联合糖皮质激素治疗较单纯激素治疗总有效率高,且可明显改善患者肾功能及糖皮质激素抵抗,下调HSP90表达。

To explore the clinical effects of Tripterygium Glycosides combined with hormones in the treatment of adult nepbrotic syndrome （NS）, the effect on glucocorticoid resistance and expression of heat shock protein 90 （HSP90）. In this study, 82 patients with NS were divided into control group and observation group by the random number table method with 41 cases in each group. Both groups were given basic symptomatic treatment. The control group was treated with glucocorticoid prednisone, I mg/kg, 8 weeks later or 2 weeks after negative conversion of urine protein, it was gradually reduced and maintained at 20 mg/d. The observation group was additionally treated with Tripterygium Glycosides, 20 mg/times, 3 times/d, for 24 weeks. Comparison between two groups found that the total effective rate in observation group was higher than that in control group （p 〈0.05）. After treatment, urine protein quantitation in both groups were decreased while total protein （TP） and serum albumin （ALB） were in- creased （t9 〈0.05）, and the decreasing and increasing ranges in observation group were greater than control group （p 〈0.05）; The serum creatinine （Cr）, blood urea nitrogen （BUN）, glucocorticoid receptor β （GR β） and HSP90 in observation group were decreased. Compared with those in the same group before treatment and those in control group after treatment, there were significant differences （p〈0.05）. The incidence of adverse reactions in the observa- tion group was slightly lower than that in the control group, without statistical difference. Tripterygium Glycosides combined with glucocorticoid is significantly effective in the treatment of adult NS and it can significantly improve the renal function and glucocorticoid resistance of patients and down regulate the expression of liSP90.