参芪地黄汤联合来氟米特治疗气阴两虚型狼疮性肾炎临床研究

Clinical observation of Shenqi Dihuang decoction combined with leflunomide in treating lupus nephritis with deficiency of Qi and Yin

目的:观察参芪地黄汤联合来氟米特治疗气阴两虚型狼疮性肾炎疗效。方法:将93例狼疮性肾炎患者按照随机数字表法分为两组,常规组46例,研究组47例。常规组在常规治疗基础上予来氟米特治疗,研究组在常规组治疗基础上给予参芪地黄汤治疗。比较两组治疗前后中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、可溶性血栓调节蛋白(sTM)、富亮氨酸α-2糖蛋白-1(LRG1)、可溶性肿瘤坏死因子Ⅰ型受体(sTNF-RⅠ)、Rho激酶2(ROCK2)、补体因子H(CFH)、免疫球蛋白结合蛋白1(IGBP1)、24 h尿蛋白定量(24 hUPE)、补体C3、肾损伤分子1抗体(KIM-1)水平及Th17/Treg细胞比例。比较两组治疗前后系统性红斑狼疮疾病活动评分(SLEDAI)、健康调查简表(SF-36)评分,比较两组临床疗效。结果:研究组LRG1、IGBP1、HMGB1、ROCK2、Th17/Treg水平较常规组降低(均P<0.05);研究组补体C3、CFH、sTNF-RⅠ水平及SF-36评分较常规组升高(均P<0.05);研究组24 hUPE、KIM-1、NGAL、sTM水平及SLEDAI评分较常规组降低(均P<0.05)。研究组总有效率高于常规组(P<0.05)。结论:参芪地黄汤联合来氟米特治疗气阴两虚型狼疮性肾炎患者,可抑制炎症反应,调节Th17/Treg细胞平衡,改善机体免疫状态、肾功能及狼疮性肾炎活动性,提升临床疗效。

Objective:To observe the efficacy of Shenqi Dihuang decoction combined with leflunomide in the treatment of lupus nephritis with both Qi and Yin deficiency.Methods:A total of 93 patients with lupus nephritis were randomly divided into two groups,46 cases in the conventional group and 47 cases in the study group.The conventional group was treated with leflunomide on the basis of conventional treatment,and the study group was treated with Shenqi Dihuang decoction on the basis of conventional treatment.Neutrophil gelatinase-associated lipid carrier protein(NGAL),soluble thromboregulatory protein(sTM),leucine-richα-2 glycoprotein-1(LRG1),soluble tumor necrosis factor typeⅠreceptor(sTNF-RⅠ),and Rho kinase 2(ROCK2),complement factor H(CFH),immunoglobulin binding protein 1(IGBP1),24 h urinary protein quantification(24 hUPE),complement C3,kidney injury molecule-1 antibody(KIM-1)and Th17/Treg cell ratio were detected in both groups before and after treatment.Systemic lupus erythematosus disease activity score(SLEDAI),health survey brief form(SF-36)and clinical effect were compared between the two groups.Results:The study group contents of LRG1,IGBP1,HMGB1,ROCK2 and Th17/Treg were lower than those in conventional group(all P<0.05),while the contents of C3,CFH,sTNF-RⅠand SF-36 scores in the study group were higher than those in the conventional group,the difference was statistically significant(all P<0.05).The contents of 24 hUPE,KIM-1,NGAL,sTM and SLEDAI score in the study group were lower than those in the conventional group,the difference was statistically significant(all P<0.05).The study group total effective rate was higher than that in conventional group,the difference was statistically significant(P<0.05).Conclusion:Shenqi Dihuang decoction combined with leflunomide can inhibits inflammation,regulate Th17/Treg cell balance,improve immune status,renal function and lupus nephritis activity,and improve clinical efficacy in the treatment of patients with both Qi and Yin deficiency lupus nephritis.