健脾益气活血解毒法治疗膜性肾病长期预后研究

Long-term prognosis study on membranous nephropathy treated by the method of invigorating spleen,benefiting qi,activating blood and removing toxicity

目的:比较单纯使用健脾益气活血解毒方案以及联合激素或(和)免疫抑制剂治疗膜性肾病的长期预后情况及影响其预后的危险因素。方法:对接受健脾益气活血解毒法治疗并随访1年以上的膜性肾病患者,根据是否使用过激素或(和)免疫抑制剂,采用倾向得分匹配方法按照1:1分为中药组及中西医结合组,各147例。观察两组患者完全缓解(CR)、部分缓解(PR)、未缓解、复发以及终点事件的发生情况,分析影响肾脏预后的危险因素,并比较两种治疗方案的肾脏累计存活率。结果:中药组的CR显著高于中西医结合组(P<0.05),复发率显著低于中西医结合组(P<0.05),复合终点事件的发生显著低于中西医结合组(P<0.01)。单因素COX回归显示是否缓解、治疗前的白蛋白、血红蛋白、肌酐、尿素氮、eGFR以及是否使用激素或(和)免疫抑制治疗是影响复合终点的危险因素,多因素COX回归结果显示是否缓解、尿素氮是影响复合终点的独立危险因素。将复合终点作为结局事件,中药组的肾脏累计存活率显著高于中西医结合组(P<0.05)。结论:单纯使用健脾益气活血解毒法治疗膜性肾病比联合激素或(和)免疫抑制剂在提高临床缓解率,减少复发率、终点事件发生率以及肾脏长期预后方面都更具优势。

Objective: To compare the long-term prognosis and the risk factors of membranous nephropathy(MN) treated with invigorating spleen, benefiting qi, activating blood and detoxifying alone and combined with hormone or immunosuppressive agents. Methods: Patients with membranous nephropathy treated by TCM methods of invigorating spleen, benefiting qi, activating blood and detoxifying and followed up for more than one year in the department of Nephrology of Longhua Hospital were admitted. According to whether use of hormones or(and) immunosuppressants, patients were divided into traditional Chinese medicine group and integrated traditional Chinese and Western medicine group. The propensity score matching method is adopted according to the ratio of 1∶1, 147 cases in each group. The occurrence of complete remission(CR), partial remission(PR), nonremission, recurrence, and end-point events were observed in both groups. The risk factors of renal prognosis were analyzed,and the cumulative renal survival rates the two treatment regimens were compared. Results: The CR rate of the TCM group was significantly higher than that of the integrated traditional Chinese and western medicine group(P=0.011), and the recurrence rate was significantly lower than that of the integrated traditional Chinese and western medicine group(P=0.033). The occurrence of the composite endpoint events in TCM group was significantly lower than that of the integrated traditional Chinese and western medicine group, and the difference was statistically significant(P=0.005). Univariate COX regression showed whether remission,baseline albumin, hemoglobin, creatinine, urea nitrogen, eGFR, and the use of hormones or(and) immunosuppressive therapy were risk factors of composite endpoint. Multivariate COX regression results showed that remission and urea nitrogen were independent risk factors affecting the composite end point. Taking the composite endpoint as the outcome event, the cumulative renal survival rate of the TCM group was higher than that of the integrated traditional Chinese and Western medicine group with statistically significant difference(P<0.05). Conclusion: The treatment of membranous nephropathy by invigorating spleen, benefiting qi,activating blood and detoxifying alone is more advantageous than the integrated traditional Chinese and Western medicine group in improving clinical remission rate, reducing recurrence rate, endpoint events and improving long-term renal prognosis.