温阳通络方联合非免疫抑制治疗特发性膜性肾病脾肾阳虚、风湿瘀痹证的临床研究

Clinical efficacy of Wenyang Tongluo Decoction combined with non-immunosuppressive therapies for patients with idiopathic membranous nephropathy of spleen-kidney yang deficiency and rheumatic syndrome and stasis

目的观察温阳通络方联合非免疫抑制治疗特发性膜性肾病(IMN)脾肾阳虚、风湿瘀痹证的临床疗效。方法将60例IMN脾肾阳虚、风湿瘀痹证患者按照随机数字表法分为2组,对照组30例(实际完成26例)予西医非免疫抑制治疗,治疗组30例(实际完成27例)在对照组基础上联合中药温阳通络方治疗。2组均治疗24周后统计疗效,比较2组治疗前后肾功能相关指标血肌酐(SCr)、24 h尿蛋白定量(24 h-UTP)、血清白蛋白(ALB)及免疫指标血清抗磷脂酶A2受体(PLA2R)水平变化情况。结果治疗组总有效率66.7%(18/27),对照组总有效率34.6%(9/26),治疗组总有效率高于对照组(P<0.05)。与本组治疗前比较,2组治疗后24 h-UTP均降低(P<0.05),ALB水平均升高(P<0.05),且治疗组治疗后24 h-UTP及ALB水平改善优于对照组(P<0.05)。2组治疗前后SCr水平均无明显变化(P>0.05)。与本组治疗前比较,2组治疗后血清抗PLA2R抗体水平均降低(P<0.05),且治疗组治疗后血清抗PLA2R抗体水平低于对照组(P<0.05)。结论温阳通络方联合非免疫抑制治疗IMN脾肾阳虚、风湿瘀痹证临床疗效确切,可有效改善患者肾功能,具有良好的有效性和安全性,其作用机制可能与降低血清抗PLA2R抗体水平,改善免疫功能有关。

Objective To observe the clinical efficacy of Wenyang Tongluo Decoction combined with non-immunosuppressive therapies for patients with idiopathic membranous nephropathy(IMN)of spleen-kidney yang deficiency and rheumatic syndrome and stasis.Methods A total of 60 IMN patients(spleen-kidney yang deficiency and rheumatic syndrome and stasis)were randomly assigned into the treatment group(n=30,3 cases of shedding)and the control group(n=30,4 cases of shedding).All patients were managed by non-immunosuppressive therapies,and those in the treatment group were additionally treated with Wenyang Tongluo Decoction.A 24-week treatment was performed to compare renal function indexes(serum creatinine[SCr],24-h urinary total protein[24 h-UTP],serum albumin[ALB]),immune index(anti-phospholipase A2 receptor[PLA2R]).The curative effect was assessed.Results The overall effective rate in the treatment group was better than that in the control group(66.7%[18/27]vs 34.6%[9/26],[P<0.05],respectively).After treatment,decreased 24h-UTP and increased ALB were detected in both groups(all P<0.05),improvement of which in the treatment group were significantly better(P<0.05).There was no significant difference in SCr levels between groups before and after treatment(P>0.05).The anti-PLA2R levels in groups were decreased(P<0.05),which were decreased in the treatment group compared with the control group(P<0.05).Conclusion For IMN patients(spleen-kidney yang deficiency and rheumatic syndrome and stasis),Wenyang Tongluo Decoction combined with non-immunosuppressive therapies has definite clinical efficacy,which can effectively improve renal function by reducing serum anti-PLA2R levels and improving immune function,and with good efficacy and safety.