陈以平教授治疗中重症IgA肾病远期疗效的临床研究

Long-term Efficacy of Professor Chen Yiping in the Treatment of Moderate and Severe IgA Nephropathy

目的:探讨陈以平教授采用中医及中西医结合治疗中重度Ig A肾病的远期疗效和安全性。方法:通过回顾性病例对照研究,选取CKD 2~4期接受中药、中药联合激素或中药联合激素骁悉治疗半年以上,随访时间≥18月的患者139例,分为A组(基础治疗+中药) 76例,B组(基础治疗+中药+激素) 32例,C组(基础治疗+中药+激素+骁悉) 31例。比较其在治疗前后肾功能、24 h尿蛋白定量等方面的差异、计算累积肾脏生存率、记录不良反应。结果:三组基线资料比较,C组24 h尿蛋白定量高于A组和B组(P <0. 05),其余各临床病理资料差异均无统计学意义(P> 0. 05)。在治疗结束时,三组血清白蛋白均有所上升,A组显著高于B组、C组(P <0. 05)。血清肌酐、e GFR、尿酸治疗后组间比较差异无统计学意义(P> 0. 05),但B组e GFR有所上升,且B组e GFR斜率高于A组、C组(P <0. 05)。至随访结束,三组间24 h尿蛋白定量差异不明显(P> 0. 05)。A组、B组、C组累积肾脏生存率分别为72. 37%、81. 25%、77. 42%,其组间差异无统计学意义(P>0. 05)。在治疗过程中,C组发生不良事件8例,A组2例、B组1例。结论:在陈以平教授中医及中西医合治疗中重症Ig A肾病的比较中发现,中药联合激素对肾功能的保护优于单纯中药、中药联合激素骁悉,而中药联合激素骁悉能更好的降低尿蛋白,但骁悉的不良反应发生率较高,在治疗时应密切随访。

Objective:To explore the long-term efficacy and safety of Professor Chen Yiping in the treatment of moderate and severe Ig A nephropathy with traditional Chinese medicine and the combination of traditional Chinese and Western medicine.Methods:Through a retrospective case-control study,139 patients with Ig A nephropathy were treated with Chinese herbs,Chinese herbs combined with glucocorticoids or Chinese herbs combined with glucocorticoids and mycophenolate mofetil(MMF)for more than half a year in stage 2~4 of CKD.The follow-up time was longer than 18 months.There were 76 cases in group A(basic treatment+Chinese herbs),32 cases in group B(basic treatment+Chinese herbs+glucocorticoid),and 31 cases in group C(basic treatment+Chinese herbs+glucocorticoid+MMF).The differences in renal function,24-hour urinary protein quantification,cumulative renal survival rate,adverse reactions and other indicators were compared before and after treatment.Results:Compared with the baseline data of the three groups,24-hour urinary protein quantification in group C was higher than that in group A and group B(P<0.05),and there was no significant difference in other clinicopathological data(P>0.05).At the end of treatment,serum albumin increased in three groups,and group A was significantly higher than group B and group C(P<0.05).There was no significant difference in serum creatinine,e GFR and uric acid between the three groups after treatment(P>0.05),but e GFR increased in group B.By calculating the slope of e GFR,it was found that group B was better than group A and group C(P<0.05).Up to the end of follow-up,there was no significant difference in 24-hour urinary protein between the three groups(P>0.05).The cumulative renal survival rates of group A,group B and group C were 72.37%,81.25%and 77.42%,and there was no significant difference among the groups(P>0.05).In the course of treatment,there were 8 adverse events in group C,2 in group A and 1 in group B.Conclusion:By comparing Professor Chen Yiping in the treatment of moderate and severe Ig A nephropathy with traditional Chinese medicine and the combination of traditional Chinese and Western medicine,it was found that the protection of kidney function by Chinese herbs combined with glucocorticoid was better than that by Chinese herbs alone and Chinese herbs combined with glucocorticoid and MMF,the Chinese herbs combined with glucocorticoid and MMF can better reduce urinary protein.However,the incidence of adverse reactions with MMF is high and should be closely followed up in the treatment.