中西医结合治疗狼疮性肾炎47例临床分析

目的:探讨狼疮肾I号方联合激素及免疫抑制剂治疗狼疮性肾炎(LN)的临床疗效及其作用机制。方法:将94例LN患者随机按数字表法分为西药组和中西医结合组各47例。西药组采用甲泼尼龙片和注射用环磷酰胺治疗,中西医结合组加用狼疮肾I号方辨证内服,两组疗程均为6个月。于治疗前、治疗后2,4,6个月进行系统性红斑狼疮疾病活动度评分(SLEDAI),进行治疗前后24 h尿蛋白定量、尿素氮(BUN)和肌酐(SCr)检测;检测治疗前后免疫球蛋白G(Ig G),补体C3,C4水平;检测治疗前后抗双链DNA(ds-DNA),血浆纤维蛋白原(FIB),D-二聚体(D-D)水平。结果:经Ridit分析,中西医结合组蛋白尿临床疗效优于西药组(P0.05);在治疗后4,6个月,中西医结合组SLEDAI评分低于西药组(P0.01);治疗后中西医结合组24 h尿蛋白定量低于西药组(P0.01);中西医结合组6个月内完全缓解例数多于西药组,但差异无统计学意义;中西医结合组平均缓解时间短于西药组(P0.05);中西医结合组治疗后Ig G,ds-DNA,FIB和D-D水平均低于西药组(P0.01);治疗后中西医结合组补体C3,C4水平均高于西药组(P0.05,P0.01)。结论:狼疮肾I号方联合激素及免疫抑制剂的中西医结合治疗方案能控制LN患者病情活动,改善血液高凝状态,保护肾功能,减轻尿蛋白尿,缩短了病程,其疗效优于单纯的西药治疗。

Clinical Research of Traditional Chinese Medicine Combined Western Medicine in Treating 47 Cases with Lupus Nephritis

Objective: To discuss the curative efficacy and the mechanism of Langchuangshen number I decoction combined hormone and immune inhibitor in treating lupus nephritis (LN). Method: Ninety-four patients with LN were randomly divided into the western medicine group (47 cases) and the combination group (47 cases). Patients in the western medicine group received methyl prednisolone tablets and cyclophosphamide injection. Based on the treatment of western medicine group, patients in the combination group added orally Langchuangshen number I decoction. The patients in both two groups received 6-month treatment. The systemic lupus erythematosus disease activity score (SLEDAI) at the second, fourth and sixth months after treatment were recorded. The 24-h urine protein quantitation, blood urea nitrogen (BUN) and serum creatinine (SCr) were tested before and after treatment. Besides, the levels of immunoglobulin G (IgG), complement C3, complement C4, and the levels of resistance of double-stranded DNA (ds-DNA), plasma fibrinogen (FIB), D-dimer (D-D) were detected. Result: The clinical effect of proteinuria in the combination group was superior to that in western medicine group (P<0.05). Score of SLEDAI in the combination group was less than that in western medicine group at the fourth and sixth months after treatment (P<0.01). The amount of 24-h urine protein in the combination group was less than that in western medicine group after treatment (P<0.01). The number of completely relieve cases in the combination group was more than that in western medicine group during six months. But there was no statistically significant difference between two groups. The average alleviate time in the combination group was shorter than that in western medicine group (P<0.05). Levels of IgG, ds-DNA, FIB and D-D in the combination group was inferior to that in western medicine group (P<0.01). Besides, complement C3 and complement C4 levels in the combination group were higher than those in western medicine group (P<0.05, P<0.01). Conclusion: Langchuangshen number I decoction combined hormone and immune inhibitor coud control the disease activity in LN patients, improve blood high condensation state, protect renal function, reduce urinary protein and cut down the disease course. The curative effect of traditional Chiese medicine combined western medicine treatment is superior to western medicine treatment alone in treating LN.