| 引用本文:王 丽 伟.泼尼松联合霉酚酸酯结合中药治疗重症IgA肾病[J].世界中医药,2013,8(09):. |
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| 泼尼松联合霉酚酸酯结合中药治疗重症IgA肾病 |
| Prednisone and Mycophenolate Mofetil Combined with Traditional Chinese Medicine for Treatment of Severe IgA Nephropathy |
| 投稿时间：2013-04-08 |
| DOI：10.3969/j.issn.1673-7202.2013.09.023 |
| 中文关键词: 重症IgA肾病 霉酚酸酯 环磷酰胺 中西医结合 |
| English Keywords:Severe IgA nephropathy Mycophenolic acid ester Effects of glutamine Integrated Western and Chinese Medicine |
| 基金项目: |
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| 中文摘要: |
| 目的:比较泼尼松联合霉酚酸酯(MMF)结合中药汤剂与泼尼松联合环磷酰胺(CYC)治疗重症IgA肾病的临床疗效。方法:84例重症IgA肾病患者根据入院先后顺序按随机原则分别给予泼尼松联合MMF结合中药汤剂治疗(MMF组,n=42),或采用泼尼松联合CYC治疗(CYC组n=42),持续12个月。两组患者基础病情无差异,随访时间18个月,观察两组患者临床缓解率以及相应实验室指标如24 h尿蛋白定量、血肌酐、血浆白蛋白、总蛋白、血脂变化,并比较两组治疗的不良反应。结果:1)临床缓解率:治疗18个月时MMF组临床总有效率高于CYC组,分别为85.7% VS 61.8%(P<0.05);2)观察期末,MMF组患者24 h尿蛋白定量(0.6±0.3)明显低于CYC组(1.4±0.5)(P<0.05),血浆白蛋白和总蛋白(43.2±4.3和70.2±8.1)均显著高于CYC组患者(36.9±3.6和60.3±7.6)(P<0.05);3)血脂变化:MMF组血脂较治疗前明显降低,而CYC组无变化(P<0.05);4)不良反应发生率:MMF组不良反应发生率(4.76%)明显低于CYC组(19.0%)。结论:泼尼松联合MMF治结合中药汤剂疗重症IgA肾病,临床缓解率高于泼尼松联合CYC静脉滴注疗法,能更有效降低患者24 h尿蛋白定量,改善患者血脂和血浆白蛋白水平,维持患者肾功能稳定,并且MMF不良反应发生率显著低于CYC疗法。 |
| English Summary: |
| To compare efficacy of 1) Prednisone and mycophenolate mofetil (MMF) and herbal decoctions with 2) prednisone and cyclophosphamide (CYC) for treating severe IgA nephropathy. Methods:Eighty-four patients with severe IgA nephropathy were randomly given prednisone and MMF and herbal decoction (MMF group, n=42), or treated with prednisone and CYC (CYC group n=42), for 12 months. Patients were of no difference in terms of basic illness severity. In 18-month followups, observe clinical effective rate and the corresponding laboratory indicators such as 24-hour urine protein quantitative, serum creatinine, serum albumin, total protein, serum lipid levels, and adverse event. Results: 1) Effective rate: Total effective rate of MMF group was higher than that of the CYC group, 85.7% vs. 61.8% (P<0.05); 2) 24 h proteinuria in MMF group (0.6 ± 0.3) was significantly lower than that of the CYC Group (1.4 ± 0.5) (P<0.05), serum albumin and total protein (43.2 ± 4.3 and 70.2 ± 8.1) are substantially higher than those of the CYC Group (36.9 ± and 3.6 ± 7.6) (P<0.05); 3) Lipids: MMF group lipids significantly reduced after treatment, CYC groups showed no significant change (P<0.05);4) Adverse event: AE incidence of MMF Group (4.76%) was significantly lower than that of CYC Group (19%). Conclusion: Compared with prednisone and intravenous infusion of CYC therapy, Prednisone and MMF combined with TCM treatment is more effective to treat severe IgA nephropathy, reduce the 24 h urinary protein, improve serum lipids and serum albumin level, maintain renal function, and have less adverse reaction. |
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