苏蝉益肾汤结合西医常规疗法治疗慢性肾小球肾炎蛋白尿临床研究

Clinical research of Suchan-Yishen Decoction combined with conventional western medicine in treating proteinuria due to chronic glomerulonephritis

目的评价苏蝉益肾汤结合西医常规疗法治疗慢性肾小球肾炎蛋白尿的疗效。方法选择2017年1月-2018年12月本院符合入选标准的慢性肾小球肾炎蛋白尿患者86例,按随机数字表法分为2组,每组43例。对照组在西医常规治疗基础上口服缬沙坦胶囊,观察组在对照组基础上加服苏蝉益肾汤。2组均连续治疗2个月。采用生化分析仪检测患者24 h尿蛋白定量、BUN、SCr水平,采用流式细胞仪检测CD3^+、CD4^+、CD8^+,采用ELISA法检测血清IL-6、IL-17、TNF-α水平,评价临床疗效。结果观察组总有效率为88.4%(38/43)、对照组为67.4%(29/43),2组比较差异有统计学意义(χ^2=4.324,P=0.038)。治疗后,观察组24 h尿蛋白定量[(0.82±0.13)g比(1.04±0.17)g,t=6.009]、BUN[(6.12±0.71)mmol/L比(6.60±0.75)mmol/L,t=6.411]、SCr[(82.87±10.43)μmol/L比(94.11±11.17)μmol/L,t=17.433]水平均低于对照组(P<0.01);CD3+、CD4+水平高于对照组(t值分别为7.981、8.904,P<0.01),CD8+水平低于对照组(t=8.933,P<0.01);血清IL-6、IL-17、TNF-α水平均低于对照组(t值分别为10.983、49.005、13.994,P值均<0.01)。结论苏蝉益肾汤结合西医常规疗法可降低慢性肾小球肾炎患者24 h尿蛋白定量及血清炎性细胞因子水平,纠正T细胞亚群失衡状态,提高临床疗效。

Objective To investigate the efficacy of Suchan-Yishen Decoction combined with western routine medicine on proteinuria due to chronic glomerulonephritis.Methods A total of 86 patients with urinary protein,who met the inclusion criteria in Zhongshan people’s hospital from January of 2017 to December of 2018,were selected and divided into two groups according to the random number table method with 43 patients in each group.The control group took valsartan capsule orally on the basis of conventional western medicine,and the observation group took Suchan-Yishen Decoctionon the basis of the control group.Both groups were treated continuously for two months.The CD3^+,CD4^+,CD8^+were determined by flow cytometry;the serum levels of interleukin(IL)-6,IL-17 and tumor necrosis factor(TNF)-αwere determined by ELISA method.Results The total effective rate was 88.4%(38/43)in the observation group and 67.4%(29/43)in the control group.The difference between the two groups was statistically significant(χ^2=4.324,P=0.038).After the treatment,levels of urinary protein(0.82±0.13 g vs.1.04±0.17 g,t=6.009),BUN(6.12±0.71 mmol/L vs.6.60±0.75 mmol/L,t=6.411)and SCr(82.87±10.43μmol/L vs.94.11±11.17μmol/L,t=17.433)in the observation group at 24 h were all significantly lower than those of the control group(P<0.01).After the treatment,levels of CD3+and CD4+in the observation group were significantly higher than those of the control group(t values were 7.981,8.904,respectively,all Ps<0.01),and level of CD8+was significantly lower than that of the control group(t=8.933,P<0.01).Serum levels of IL-6,IL-17,TNF-a in the observation group were significantly lower than those of the control group(t values were 10.983,49.005,13.994,respectively,all Ps<0.01).Conclusions The Suchan-Yishen Decoction combined with conventional western medicine can relieve the clinical symptoms of chronic glomerulonephritis patients,increase the therapeutic effect of proteinuria,correct the imbalance of T cell subgroup,and down-regulate serum levels of IL-6,IL-17,TNF-α.