中西医结合治疗狼疮足细胞病案例报道

Case Report of Integrated Chinese and Western Medicine Treatment of Lupus Podocytosis

狼疮足细胞病是系统性红斑狼疮一种特殊亚型的肾小球病变,以肾病综合征或大量蛋白尿为主要临床表现。电镜下可见弥漫性上皮细胞足突消失,无免疫复合物沉积。目前国际肾脏病学会/肾脏病理学会分类标准尚未纳入该型,因此临床易误诊为增殖性/膜性狼疮性肾炎。狼疮足细胞病可在短时间内快速进展,且暂无中西医结合干预案例,因此文章报道1例快速进展型病例。以急则治其标、缓则治其本为治疗原则,运用十枣汤、通脉四逆汤、真武汤等经方联合糖皮质激素、免疫抑制剂等治疗后,达到了临床缓解,为中西医联合治疗狼疮足细胞病提供了具体的治疗方案和临床借鉴。

Lupus podocytosis is a special subtype of systemic lupus erythematosus,with nephrotic syndrome or macroproteinuria as the main clinical manifestations.Under electron microscope,diffuse epithelial cells disappear from the foot process and no immune complex is deposited.At present,this type has not been included in the International Society of Nephrology/Society of Renal Pathology classification,so it is easily misdiagnosed as proliferative/membranous lupus nephritis.Lupus podocytosis can progress rapidly in a short period of time,and there is no intervention case of integrated Chinese and western medicine,so a case of rapidly progressive type is reported in this paper.According to the treatment principle of symptomatic treatment in acute condition,radical treatment in chronic case,Shizao Decoction(十枣汤),Tongmai Sini Decoction(通脉四逆汤)and Zhenwu Decoction(真武汤)combined with glucocorticoids and immunosuppressants have achieved clinical remission,which provides specific treatment plan and clinical reference for the treatment of lupus podocytosis with integrated Chinese and western medicine.