世界中医药

目的：分析中医及中西医结合方案治疗IgA肾病5年的临床疗效及安全性。方法：选取2002年1月至2012年12月上海中医药大学附属龙华医院肾病科收治的疗程满5年并具有完整随访资料的IgA肾病患者131例作为研究对象。按照实际用药情况分为中医组（n=63）和中西医结合组（n=68），观察治疗前后肾功能、24 h尿蛋白定量以及安全性指标的变化。结果：基线数据显示中西医结合组较中医组病情更重，对于轻-中度病理类型（40例，占30.53%），2组治疗前后血肌酐(SCr)、24 h尿蛋白定量比较差异无统计学意义（P>0.05）；对于中-重度病理类型（91例，占69.47%），与治疗前比较，中西医结合组UPRO显著下降（n=53，P<0.05），SCr与肾小球滤过率（eGFR)比较，差异无统计学意义（P>0.05）；中医组在各项指标上比较差异无统计学意义（n=38，P>0.05）。5年患者累计生存率，中西医结合为97.1%，中医组为95.2%，2组生存率比较差异无统计学意义（P>0.05）。中医组较中西医结合组不良事件更少。结论：中医及中西医结合治疗对IgA肾病均有一定的疗效。对于病理类型较重的IgA肾病，临床更倾向于中西医结合治疗，2组治疗均对远期肾功能具有保护作用，并且中医组治疗具有更少的不良反应，安全性更高。

English Summary:

To analyze the five-year clinical efficacy and safety of Integrated traditional Chinese and western medicine in the treatment of IgA nephropathy.Methods:A total of 131patients with IgA nephropathy who had been treated for 5 years from January 2002 to December 2012 with complete follow-up data were divided into a TCM treatment group and an integrated traditional Chinese and western medicine treatment group according to the actual medication status.The changes of renal function,24-hour urinary protein and safety indexes were observed before and after treatment.Results:From the baseline,the condition of the integrated traditional Chinese and western medicine group was more serious than that of the traditional Chinese medicine group.For the mild to moderate pathological type(40 cases,accounting for 30.53%),there was no significant change in SCr and URPO inthe two groups before and after treatment.For the moderate to severe type(91 cases,69.47%),UPRO in the integrated traditional Chinese and western medicine group(53 cases) decreased significantly comparing with before(P<0.05).SCr and eGFR did not change significantly(P>0.05).In the traditional Chinese medicine group(38 cases),there was no significant change in all indexes(P>0.05).The 5-year cumulative kidney survival rate of integrated traditional Chinese and western medicine was 97.1%,and that of the traditional Chinese medicine group was 95.2%.There was no significant difference in the survival rate between the two groups(P>0.05).The adverse events in the traditional Chinese medicine group were less than those in the integrated traditional Chinese and western medicine group.Conclusion:Both traditional Chinese medicine and integrated traditional Chinese and western medicine are effective in the treatment of IgA nephropathy.For the severe type of IgA nephropathy,integrated traditional Chinese and western medicine treatment is preferred clinically.Both of the two treatments have a protective effect on long-term renal function,and the traditional Chinese medicine group has fewer side effects and higher safety.

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