世界中医药

目的:观察雷公藤多苷治疗特发性膜性肾病并探讨其对抗磷脂酶A2受体抗体（Anti-PLA2R）的影响。方法：选取2014年6月至2016年6月前来肾内科门诊及住院部就诊的特发性膜性肾病患者，共68例。所有入选者均通过随机数字表法分为观察组和对照组，2组均进行基础对症治疗，对照组加泼尼松联合环磷酰胺(CTX)治疗，观察组加口服雷公藤多苷片治疗，共治疗12周。所有患者均在于治疗前、治疗后第12周进行24 h尿蛋白定量、血清白蛋白（ALB）、血尿素氮（BUN）、血清肌酐（SCr）、血清PLA2R表达进行评价。结果:经过12周的治疗后，通过检测在治疗前后患者的24 h尿蛋白定量、BUN、CREA均明显有下降(P<0.05)，但2组比较，差异无统计学意义（P>0.05）；在治疗后2组ALB均明显升高，与治疗前相比，差异有统计学意义(P<0.05)，但2组比较，差异无统计学意义（P>0.05）；2组血清Anti-PLA2R的表达在治疗后均得到明显降低，且观察组明显优于对照组(P<0.05)。结论:雷公藤多苷片与泼尼松联合环磷酰胺疗效相当，可有效改善特发性膜性肾病患者的肾功能，减轻患者临床症状及体征；且雷公藤多苷片不良反应较少。

English Summary:

To observe the effects of multi-glycosides of tripterygium wilfordii in the treatment of idiopathic membranous nephropathy, and to explore the effects on anti-phospholipase A2 receptors (Anti-PLA2R). Methods:A total of 68 patients with idiopathic membranous nephropathy in our hospital from November 2013 to December 2015 were selected and randomly divided into observation group and control group by random number table. Two groups of patients were given primary symptomatic treatment. The control group was given prednisone and cyclophosphamide, and the treatment group was treated with oral administration of multi-glycosides of tripterygium wilfordii. The treatment last for 12 weeks. 24h urinary protein, serum albumin (ALB), blood urea nitrogen (BUN), serum creatinine (SCr), serum PLA2R expression of all patients before treatment, and 12 weeks after treatment were evaluated. Results:After 12 weeks of treatment, 24h urine protein, BUN, CREA of patients were significantly decreased after treatment (P<0.05), but there was no significant difference between treatment group and control group (P<0.05). After treatment, ALB of both groups was significantly increased. Compared with before treatment, there was statistically significant difference (P<0.05), but there was no significant difference between two groups (P<0.05). The expression of serum Anti-PLA2R of two groups was significantly decreased after treatment, and the treatment groups was significantly better than the control group (P<0.05). Conclusion:Multi-glycosides of tripterygium wilfordii has similar efficacy with prednisone combined with cyclophosphamide, which can effectively improve renal function of patients with idiopathic membranous nephropathy, relieve clinical symptoms and signs. Multi-glycosides of tripterygium wilfordii has less side effects, and is worthy of clinical research.

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