雷公藤多苷片联合缬沙坦治疗慢性肾小球肾炎合并高血压患者的效果

Effect of tripterygium wilfordii polyglycoside tablets combined with valsartan in patients with chronic glomerulonephritis and hypertension

目的探讨雷公藤多苷片联合缬沙坦在慢性肾小球肾炎合并高血压患者的治疗效果。方法收集慢性肾小球肾炎合并高血压患者150例,依据随机数表法分为试验组(n=75)与对照组(n=75)。2组患者均给予相同的基础对症治疗,对照组给予缬沙坦80 mg·d^(-1),试验组在对照组的基础上给予雷公藤多苷片,每次20 mg,每天3次,2组均治疗24周。比较2组治疗前后的肾功能指标血尿素氮(BUN)、血肌酸酐(Scr)、24 h尿蛋白定量(24 h Upro)及肾小球滤过率(GFR)、CD4^(+)T及CD8^(+)T淋巴细胞亚群及炎症指标白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)及肿瘤坏死因子-α(TNF-α),比较2组的临床疗效及药物不良反应发生情况。结果治疗后,试验组临床总有效率(89.33%)显著高于对照组(77.33%),差异有统计学意义(P<0.05)。治疗后,对照组与试验组的BUN分别为(7.70±1.16),(6.78±1.15)mmol·L^(-1),Scr分别为(181.10±20.76),(154.44±27.11)μmol·L^(-1),24 h Upro分别为(1.64±0.25),(1.19±0.23)g,CD8^(+)T分别为(25.25±4.37)%,(22.35±3.63)%,IL-6分别为(14.58±2.15),(11.88±2.40)pg·mL^(-1),hs-CRP分别为(9.41±2.21),(7.57±2.29)pg·mL^(-1),TNF-α分别为(47.86±4.61),(42.85±5.66)pg·mL^(-1),试验组均显著低于对照组(P<0.05);治疗后,对照组与试验组的GFR分别为(68.35±7.39),(71.19±8.32)mL·min^(-1),CD4^(+)T分别为(39.10±5.55)%,(43.40±6.50)%,CD4^(+)T/CD8^(+)T比值分别为1.58±0.28,1.98±0.35,差异均有统计学意义(均P<0.05)。2组药物不良反应发生率差异无统计学意义(P>0.05)。结论雷公藤多苷片联合缬沙坦可显著改善慢性肾炎患者的肾功能、免疫功能及炎症反应,效果优于缬沙坦单独治疗。

Objective To investigate the therapeutic effect of Tripterygium wilfordii polyglycoside tablets combined with valsartan in patients with chronic glomerulonephritis complicated with hypertension.Methods A total of 150 patients with chronic glomerulonephritis complicated with hypertension were collected and divided into treatment group(n=75)and control group(n=75)according to random number table method.The two groups were given the same basic symptomatic treatment,control group was given valsartan 80 mg·d^(-1),treatment group was given tripterygium wilfordii polyglycoside tablets,20 mg each time,3 times a day,based on the control group,for 24 weeks.The renal function indexes blood urea nitrogen(BUN),serum creatinine(Scr)and 24 h urinary protein(24 h Upro),glomerular filtration rate(GFR),CD4^(+)T and CD8^(+)T lymphocyte subsets and inflammatory indicators interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α)were compared between the two groups before and after treatment.The clinical efficacy and incidence of adverse drug reactions of the two groups were compared.Results After treatment,the total clinical effective rate of treatment group(89.33%)was significantly higher than that of control group(77.33%),the difference was statistically significant(P<0.05).After treatment,BUN in control group and treatment group were(7.70±1.16),(6.78±1.15)mmol·L^(-1),Scr were(181.10±20.76),(154.44±27.11)μmol·L^(-1),24 h Upro were(1.64±0.25),(1.19±0.23)g,CD8^(+)T were(25.25±4.37)%,(22.35±3.63)%,IL-6 were(14.58±2.15),(11.88±2.40)pg·mL^(-1),hs-CRP were(9.41±2.21),(7.57±2.29)pg·mL^(-1),TNF-α were(47.86±4.61),(42.85±5.66)pg·mL^(-1),respectively,and the treatment group were significantly lower than control group(P<0.05).After treatment,GFR of control group and treatment group were(68.35±7.39),(71.19±8.32)mL·min^(-1),CD4^(+)T were(39.10±5.55)%,(43.40±6.50)%,CD4^(+)T/CD8^(+)T ratio were 1.58±0.28,1.98±0.35,the differences were statistically significant(allP<0.05).There was no significant difference in the incidence of adverse drug reactions between the two groups(P>0.05).Conclusion Tripterygium glycosides tablets combined with valsartan can significantly improve renal function,immune function and inflammatory response in patients with chronic nephritis,and the effect is better than valsartan alone.