肾9方联合清热膜肾冲剂治疗多药无效特发性膜性肾病临床观察

Clinical Observation of Shen No. 9 Recipe with Qingre Moshen Granule on the Treatment of Idiopathic Membranous Nephropathy after Treated by Multiple Western Drugs with No Efficacy

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DOI：

中文关键词: 特发性膜性肾病肾9方清热膜肾冲剂

英文关键词:idiopathic membranous nephropathy Shen No.9 Recipe Qingre Moshen Granule

基金项目:“十一五”国家科技攻关项目(No.2006BAI04A07-2)

作者	单位
钟逸斐	上海中医药大学附属龙华医院肾内科
张先闻	上海中医药大学附属龙华医院肾内科
刘睿	上海中医药大学附属龙华医院肾内科
韩莉	江苏省连云港市中医院肾内科
邓跃毅	上海中医药大学附属龙华医院肾内科
陈永乐	上海中医药大学附属龙华医院肾内科
陈以平	上海中医药大学附属龙华医院肾内科

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中文摘要:

目的观察肾9方联合清热膜肾冲剂治疗激素及免疫抑制剂无效特发性膜性肾病(idiopathic membranous nephropathy,IMN)的临床疗效,并通过检测患者细胞免疫功能、白细胞介素-2(IL-2),探讨该方案治疗多药无效IMN的可能作用机制。方法观察2007年10月-2009年10月收治的多药无效IMN患者44例,采用肾9方(每天1剂,分2次口服)联合清热膜肾冲剂(1包/次,每天3次)治疗,疗程为24周。检测患者24h尿蛋白定量(24hU)、肾小球滤过率(GFR)、血浆白蛋白(Alb)、血肌酐(SCr)、尿素氮(BUN)、甘油三酯(TG)、血清总胆固醇(TC)、细胞免疫功能(CD4+、CD8+、CD4+/CD8+比值)、IL-2的水平。观察并记录患者中医证候疗效及不良反应等。结果治疗后,完全缓解率、基本缓解率、总有效率分别为4.5%、68.2%、84.1%;患者中医证候疗效总显效率为90.9%;中医症状积分较治疗前显著下降(P<0.01)。24hU明显降低(P<0.01),Alb明显升高(P<0.01);TC、TG水平均明显下降(P<0.01,P<0.05);SCr及BUN水平无明显变化(P>0.05);GFR显著升高(P<0.05)。CD4+、CD4+/CD8+比值明显提高(P<0.01),CD8+明显降低(P<0.01);IL-2显著升高,但仍低于正常值,差异有统计学意义(P<0.01)。结论肾9方联合清热膜肾冲剂治疗多药无效IMN临床疗效确切,可提高患者细胞免疫功能,改善体内异常表达的IL-2水平。

英文摘要:

Objective To observe the clinical efficacy of Shen No. 9 Recipe(SR) combined with Qingre Moshen Granule(QMG) in treatment of idiopathic membranous nephropathy(IMN) patients with no efficacy after treated by hormone or immunosuppressive agent,and further to explore the possible mechanism of this method in treatment of IMN by detecting the cellular immune function and cytokine interleukin-2(IL-2) . Methods Forty-four IMN patients with no efficacy after treated by multiple Western drugs were recruited from October 2007 to October 2009. They took SR(one dosage daily,oral administration in two portions) and QMG(each package each time,thrice daily) for 24 weeks. The 24-h urine protein,glomerular filtration rate(GFR) ,plasma albumin(Alb) ,serum creatinine(SCr) ,urea nitrogen(BUN) ,triglyceride(TG) ,serum total cholesterol(TC) ,levels of cellular immune function(CD4+,CD8+,CD4+/CD8+ ratio) ,and IL-2 were detected before and after treatment. The changes of Chinese medicine syndrome and adverse reactions were observed and recorded. Results After treatment the complete remission rate,the basic remission rate,and the total effective rate was 4.5%,68.2%,84.1%,respectively. The total markedly-effective rate of Chinese medicine syndrome was 90.9%. The Chinese medicine syndrome was significantly lower than before treatment(P<0.01) . The 24-h urine protein obviously decreased(P<0.01) ,Alb obviously increased(P<0.01) ,levels of TC and TG obviously decreased(P<0.01,P<0.05) . There was no obvious change in levels of SCr and BUN(P>0.05) . The GFR significantly increased(P<0.05) . CD4+and the ratio of CD4+/CD8+ were obviously elevated(P<0.01) and the CD8+ obviously decreased(P<0.01) . The expression level of IL-2 obviously increased,but it still was lower than the normal value,showing statistical difference(P<0.01) .Conclusions SR+QMG showed definite efficacy in treatment of IMN patients with no efficacy after treated by multiple Western drugs. It could improve the level of cellular immunity and improve abnormal expression levels of IL-2.

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