参芪地黄汤治疗M型磷酯酶A2受体抗体阳性特发性膜性肾病临床研究

Clinical observation of Shenqi Dihuang decoction in the treatment of idiopathic membranous nephropathy with positive antibody of M-type phospholipase A2 receptor

目的观察参芪地黄汤治疗血清M型磷酯酶A2受体(PLA2R)抗体阳性特发性膜性肾病(IMN)的临床疗效。方法将60例血清PLA2R抗体阳性IMN患者按随机数字表法分为2组。对照组30例采用常规西药治疗,治疗组30例在对照组治疗基础上予参芪地黄汤治疗。2组均治疗24周。比较2组治疗前后血清白蛋白、24 h尿蛋白定量、血清PLA2R抗体指标变化及中医证候评分变化,并统计2组临床疗效。结果治疗组总有效率85. 71%(24/28),对照组总有效率73. 08%(19/26),治疗组疗效优于对照组(P <0. 05)。治疗8、16、24周2组血清白蛋白均较本组治疗前升高(P <0. 05),24 h尿蛋白定量均降低(P <0. 05),治疗组PLA2R抗体滴度降低(P <0. 05);治疗24周对照组PLA2R抗体滴度较治疗前降低(P <0. 05)。治疗组治疗16、24周血清白蛋白均高于对照组同期(P <0. 05),治疗8、16、24周24 h尿蛋白定量、PLA2R抗体滴度均低于对照组同期(P <0. 05)。入组时血清PLA2R抗体≤300 U/m L的患者中,治疗8、16、24周2组24 h尿蛋白定量均较本组治疗前降低(P <0. 05),治疗组PLA2R抗体滴度较治疗前降低(P <0. 05);治疗16、24周对照组PLA2R抗体滴度较治疗前降低(P <0. 05)。治疗8、16、24周治疗组24 h尿蛋白定量低于对照组同期(P <0. 05),治疗8周治疗组PLA2R抗体滴度低于对照组同期(P <0. 05)。入组时血清PLA2R抗体> 300 U/m L的患者中,治疗16、24周治疗组24 h尿蛋白定量、PLA2R抗体滴度均较本组治疗前降低(P <0. 05),治疗24周对照组24 h尿蛋白定量、PLA2R抗体滴度较治疗前均降低(P <0. 05)。治疗8、16、24周2组组间24 h尿蛋白定量、PLA2R抗体滴度比较差异无统计学意义(P> 0. 05)。治疗组治疗后疲倦乏力、食少纳呆、少气懒言、水肿、口干、手足心热评分均较本组治疗前降低(P <0. 05),对照组治疗后疲倦乏力、食少纳呆、口干、目睛干涩评分均较本组治疗前降低(P <0. 05),治疗组治疗后各项中医证候评分均低于对照组(P <0. 05)。结论参芪地黄汤治疗血清PLA2R抗体阳性IMN疗效显著。血清PLA2R抗体滴度的变化与中药治疗效果及病情预后一致。

Objective To observe the effect of Shenqi Dihuang decoction in the treatment of idiopathic membranous nephropathy( IMN) with positive antibody of M-type phospholipase A2 receptor( PLA2R). Methods 60 patients with IMN of positive PLA2 R antibody were randomly divided into two groups according to the random number table method. 30 cases in control group were treated by conventional western medicine. 30 cases in treatment group were treated by Shenqi Dihuang decoction on the basis of the control group. Both groups were treated for 24 weeks. The changes of albumin,24 h urinary protein,serum PLA2R antibody index and TCM syndrome score before and after treatment were compared between the two groups,and the clinical efficacy of the two groups was counted. Results The total effective rate of the treatment group was 85. 71%( 24/28),and that of the control group was 73. 08%( 19/26).The curative effect of the treatment group was better than that of the control group( P < 0. 05). After 8,16 and 24 weeks of treatment,albumin in both groups was increased compared with that before treatment( P < 0. 05),24 h urine protein quantitation was decreased( P < 0. 05),PLA2R antibody titer in treatment group was decreased( P <0. 05),and PLA2R antibody titer in control group was decreased after 24 weeks of treatment( P < 0. 05). After 16 and 24 weeks of treatment,the albumin in the treatment group was higher than that in the control group at the same time( P < 0. 05). After 8,16 and 24 weeks of treatment,the 24 h urine protein quantity and PLA2R antibody titer in the treatment group were lower than those in the control group at the same period( P < 0. 05). In the patients with serum PLA2R antibody ≤300 U/m L at the time of admission,the 24 h urine protein quantitation of the two groups after 8,16 and 24 weeks of treatment was lower than that in the group before treatment( P < 0. 05),and the PLA2R antibody titer in the treatment group was decreased( P < 0. 05). After 16 and 24 weeks of treatment,the PLA2 R antibody titer in the control group was decreased( P < 0. 05). After 8,16 and 24 weeks of treatment,the 24 h urinary protein in the treatment group was lower than that in the control group at the same period( P < 0. 05). After 8 weeks of treatment,the antibody titer of PLA2R in the treatment group was lower than that in the control group at the same time( P < 0. 05). In the patients with serum PLA2R antibody > 300 U/m L at the time of admission,the 24 h urinary protein quantity and PLA2R antibody titer in the treatment group were decreased after 16 and 24 weeks of treatment( P <0. 05). After 24 weeks of treatment,24 h urinary protein and PLA2R antibody titer in the control group were decreased( P < 0. 05). After treatment,there was no significant difference in 24 h urine protein quantity and PLA2R antibody titer between the two groups( P > 0. 05). After treatment,the scores of fatigue,food less anorexia,less Qi and lazy speech,edema,dry mouth and hand foot heart heat in the treatment group were lower than those before treatment( P < 0. 05). After treatment,the scores of fatigue,food less anorexia,dry mouth and dry eyes in the control group were lower than those before treatment( P < 0. 05),and the scores of TCM syndromes in the treatment group were lower than those in the control group( P < 0. 05). Conclusion Shenqi Dihuang decoction has significant effect on IMN with positive PLA2 R antibody. The change of serum PLA2 R antibody titer was consistent with the therapeutic effect of traditional Chinese medicine and the prognosis of the disease.