火把花根片联合免疫抑制方案治疗慢性移植肾肾病临床观察

作者	单位
李夏玉	浙江大学医学院附属第一医院肾脏病中心
范永升	浙江中医药大学
贺学林	浙江大学医学院附属第一医院肾脏病中心
何强	浙江大学医学院附属第一医院肾脏病中心
瞿立辉	浙江大学医学院附属第一医院肾脏病中心
王苏娅	浙江大学医学院附属第一医院肾脏病中心
黄洪锋	浙江大学医学院附属第一医院肾脏病中心
陈江华	浙江大学医学院附属第一医院肾脏病中心

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中文摘要:

目的观察火把花根片联合免疫抑制方案治疗慢性移植肾肾病(chronic allograft nephropathy,CAN)患者的疗效。方法选择符合尿蛋白≥1.0 g/24 h及血肌酐(SCr)≥150(μmol/L)的CAN患者33例,分成治疗组(15例)与对照组(18例),对照组接受免疫抑制改良方案,治疗组接受火把花根片联合免疫抑制改良方案,疗程均为6个月。观察两组临床疗效,检测24 h尿蛋白、SCr及肌酐清除率(CCr)。结果治疗组有效率为60%(9/15例),显著高于对照组的22%(4/18例,P<0.05);治疗3个月、6个月24 h尿蛋白亦显著低于对照组(P<0.05);12个月随访结束时,治疗组SCr及CCr水平保持稳定,对照组SCr水平显著升高及CCr水平显著降低(P<0.05);两组治疗6个月及随访结束时SCr及CCr比较差异均有统计学意义(P<0.05)。治疗组与对照组发生血清肌酐翻倍患者分别为2例、7例,进入终末期肾病患者分别为1例、4例。结论与单用免疫抑制改良方案治疗比较,火把花根片联合免疫抑制改良方案治疗CAN患者能更有效减少尿蛋白排泄,短期随访结果显示其有更好的移植肾功能保护作用。

英文摘要:

Objective To observe the effects of Colquhounia root tablet (CRT) combined with immunosup- pressive protocal in treating patients with chronic allograft nephropathy (CAN).Methods Thirty-three patients of CAN,with urinary protein≥1.0 g/24 h and serum creatinine (SCr)≥150 (μmol/L),were assigned to two groups,the 15 in the treated group treated with CRT combining modified immunosuppressive protocol (IIP) therapy and the 18 in the control group treated with IIP alone,all for 6 months.The clinical efficiency,24 h urinary pro- tein and clearance of creatinine (CCr) were observed.Results The effective rate in the treated group [60% (9/ 15 cases)]was significantly higher than that in the control group [22.0% (4/18 cases),P<0.05],and the low- ering of 24 h urinary protein in the former was more significant than in the latter at the end of the 3rd and the 6th month of treatment (P<0.05).At the end of 12-month follow-up,SCr and CCr level were stable in the treated group,while in the control group,SCr level increased and CCr level decreased significantly (P<0.05),compari- sons of the two indexes between the two groups at the end of the therapeutic course and follow-up study all showed significant differences (P<0.05).Serum creatinine doubling to baseline were seen in 2 patients of the treated group and 7 of the control group.One patient in the treated group and 4 in the control group entered the end stage of renal disease.Conclusion Therapy with CRT combined IIP seems to be more effective in reducing urinary pro- tein excretion in patients with CAN than that with IIP alone,and a more favorable renal function preserving effect of the former is shown by a short-term follow-up.

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