金芪茯膜汤治疗特发性膜性肾病肾虚湿瘀证32例

Jinqi Fumo decoction in the treatment of kidney deficiency and dampness stasis syndrome in 32 cases of idiopathic membranous nephropathy

目的 观察金芪茯膜汤对特发性膜性肾病(IMN)中肾虚湿瘀证患者临床疗效。方法 收集2015年1月至2020年1月膜性肾病肾虚湿瘀证患者64例,根据随机数字表法分为对照组32例和观察组32例,两组均予以降压调脂及半量激素联合环磷酰胺等基础治疗,观察组在对照组基础上加服金芪茯膜汤,连续用药12周。记录两组患者治疗前后血清肌酐(SCr)、尿素氮(BUN)、24 h尿蛋白定量(24hUTP)、血浆白蛋白(ALB)、凝血酶原时间(PT)、CD4/CD8及估算肾小球滤过率(eGFR)的水平并进行比较。结果 观察组总有效率为84.38%,对照组为56.25%,观察组总有效率明显高于对照组,差异有统计学意义(P<0.05)。治疗后,对照组患者SCr、24hUTP水平均较治疗前降低,观察组SCr、eGFR、24hUTP水平均较治疗前降低(P<0.05),且观察组SCr、24hUTP水平低于对照组(P<0.05)。治疗后,观察组患者血清PT、ALB、CD4/CD8高于治疗前(P<0.05),且观察组PT、ALB、CD4/CD8高于对照组(P<0.05)。两组患者均未见严重不良反应。结论 金芪茯膜汤治疗IMN肾虚湿瘀证,可有效改善患者肾功能,降低尿蛋白排泄,延长凝血酶原时间及调整免疫反应程度,安全性较好。

Objective To observe the clinical effect of Jinqi Fumo Decoction on kidney deficiency and dampness stasis syndrome in the patients with idiopathic membranous nephropathy(IMN).Methods Sixty-four IMN patients with kidney deficiency and dampness stasis syndrome were selected from January 2015 to January 2020 and randomly divided into control group and observation group(n=32,each).The basic treatment such as antihypertensive,lipid regulating and half-dose hormone combined with cyclophosphamide were given in both groups,and Jinqi Fumo decoction was added in observation group based on the basic treatment regimen for 12 weeks.Before and after treatment,the levels of serum creatinine(Scr),urea nitrogen(BUN),24-hour urinary albumin(24 hUTP),plasma albumin(ALB),prothrombin time(PT),CD4/CD8 and estimated glomerular filtration rate(eGFR) were recorded and compared between two groups.Results The total effective rate in observation group was significantly higher than that in control group(84.38% vs 56.25%,P<0.05).After treatment,the levels of serum Scr,24 hUTP in control group and SCr,eGFR and 24 hUTP in observation group decreased significantly compared with those before treatment,and the levels of Scr and 24 hUTP in observation group were significantly lower than those in control group(all P<0.05).In observation group,the levels of serum PT,ALB and CD4/CD8 were significantly higher than those before treatment(P<0.05) and those in control group after treatment(P<0.05).No serious adverse reactions were found in both groups.Conclusion Jinqi Fumo decoction could effectively improve renal function,reduce urinary protein excretion,prolong prothrombin time and adjust the degree of immune response in IMN patients with kidney deficiency and dampness stasis syndrome.It has good safety.