白芍总苷治疗低度危险特发性膜性肾病的疗效及血清抗磷脂酶A2受体抗体在治疗中的意义

Efficacy of total glucosides of Radix paeoniae alba in the treatment of low risk idiopathic membranous nephropathy and the value of serum anti-phospholipase A_2 receptor antibodies

目的:观察白芍总苷(total glucosides of Radix paeoniae alba,TGP)治疗低度危险特发性膜性肾病(idiopathic membranous nephropathy,IMN)病人的疗效,并探讨血清抗磷脂酶A2受体(phospholipase A2receptor,PLA2R)抗体在治疗中的意义。方法:65例经肾活检确诊为低度危险IMN的病人(24h尿蛋白定量<4g且肾功能正常),根据血清抗PLA2R抗体检测结果分成4组,分别为抗PLA2R抗体阳性治疗组(A组,n=22)、抗PLA2R抗体阳性对照组(B组,n=22)、抗PLA2R抗体阴性治疗组(C组,n=10),以及抗PLA2R抗体阴性对照组(D组,n=11)。两组对照组采用保守治疗,两组治疗组在保守治疗基础上加用TGP 600mg/次,tid,治疗12个月。检测基线,治疗6、12个月后的24h尿蛋白、尿白蛋白与肌酐比值(ACR)、血白蛋白(SAlb)、血肌酐(SCr)、血清抗PLA2R抗体,并进行疗效及安全性评价。结果:65例病人中血清抗PLA2R抗体阳性病人44例,阳性率为67.7%。与同组基线和两个同期对照组比较,C组治疗6个月、12个月后,A组治疗12个月后,24h尿蛋白、ACR显著降低(P<0.05),SAlb显著升高(P<0.05)。治疗12个月后C组24h尿蛋白、ACR下降和SAlb升高比A组更显著(P<0.05)。治疗12个月后,两个治疗组(A组和C组)与两个对照组(B组和D组)比较有效率有统计学差异(66.7%vs 31%,P<0.01)。结论:TGF能有效减少低度危险IMN病人蛋白尿,提高临床疗效。与血清抗PLA2R抗体阳性组比较,血清抗PLA2R抗体阴性组治疗后蛋白尿和SAlb改善更显著。检测血清抗PLA2R抗体对低度危险IMN病人的治疗有参考价值。

Objective:To observe the efficacy of total glucosides of Radix paeoniae alba(TGP)in the treatment of patients with low risk idiopathic membranous nephropathy(IMN),and to evaluate the value of serum anti-phospholipase A2receptor(PLA2R)antibodies in the treatment.Methods:Sixty-five low risk IMN patients with24h urinary protein excretion<4g and normal renal function were divided into four groups according to the detection results of serum anti-PLA2R antibodies:the anti-PLA2R antibodies positive group(the treatment group A,n=22),the anti-PLA2R antibodies positive control group(the control group B,n=22),the anti-PLA2R antibodies negative group(the treatment group C,n=10),and the anti-PLA2R antibodies negative group(the control group D,n=11).The patients in the two control groups received conservative treatment and the patients in the two treatment groups were supplemented with600mg TGP three times a day for a succession of12months on the basis of conservative treatment.24h urinary protein,the ratio of urinary albumin to creatinine(ACR),serum albumin(SAlb)and serum creatinine(SCr)and serum anti-PLA2R antibodies were detected6and12months after treatment.Then,efficacy and safety were evaluated.Results:Of the65patients,there were44patients with positive serum anti-PLA2R antibodies,with a positive rate of67.7%.Compared with the baseline of the same group and those of the2control groups detected within the same time span,the24h urinary protein and ACR of the patients in group C after6-month and12-month treatment,and the same data of the patients in group A after12-month treatment,all decreased significantly(P<0.05),while the level of SAlb elevated significantly(P<0.05).The decreased rate of24-h urinary protein and ACR of the patients in group C after12-month treatment and the increased rate of SAlb were more significant,as compared with those of group A(P<0.05).After12months of treatment,statistical differences could be noted in effective rate,when comparisons were made between the2treatment groups(group A and group C)and2control groups(group B and group D)(66.7%vs31.0%,P<0.01).Conclusion:TGP could effectively reduce proteinuria level in patients with low risk IMN and improve clinical efficacy.Compared with the anti-PLA2R antibodies positive group,the levels of proteinuria and SAlb in the patients of the antibodies negative group improved more significantly.The detection of serum anti-PLA2R antibodies is helpful for the treatment of patients with low risk IMN.