滋阴益肾汤对原发性IgA肾病的疗效观察及机制研究

目的:分析滋阴益肾汤辨治原发性IgA肾病的疗效及相关机制。方法:选取2015年2月至2017年1月日照市中医医院收治的原发性IgA肾病患者112例作为研究对象,按照随机数字表法分为对照组和观察组,每组56例。对照组予常规西药治疗,观察组在此基础上加用滋阴益肾汤加减辨证治疗。2组患者均连续治疗3个月。比较2组患者γ-干扰素(IFN-γ)、白细胞介素-2(IL-2)、肿瘤坏死因子-β(TNF-β)和Th2分子[白细胞介素-4(IL-4)、IL-5、IL-6、IL-10]漂移情况,24 h尿蛋白定量、血肌酐(Scr)、血尿素氮(BUN)、血清IgA水平变化、临床疗效以及不良反应情况。结果:与对照组比较,滋阴益肾汤可明显提高原发性IgA肾病临床有效率,升高外周血IFN-γ、TNF-β、IL-2水平,降低IL-4、IL-5、IL-6、IL-10表达及24 h尿蛋白定量、Scr、BUN、血清IgA水平,且2组患者不良反应率比较差异无统计学意义(P>0.05)。结论:滋阴益肾汤辅助西药治疗IgA肾病,可促进漂移外周血Th1/Th2系统归于平衡,从而平衡机体促炎抗炎系统,提高临床疗效,不增加患者不良反应,具有较高的临床价值。

Therapeutic Effects and Mechanism of Ziyin Yishen Decoction on Primary IgA Nephropathy

Objective:To analyze the therapeutic effects of Ziyin Yishen Decoction on primary IgA nephropathy and its related mechanism.Methods:A total of 112 patients with primary IgA nephropathy were randomly divided into a control group(n=56)and a study group(n=56)according random number table.The control group was treated with routine Western medicine,and the study group was treated with the syndrome treatment of modified Ziyin Yishen Decoction.Patients in both groups were treated continuously for 3 months.The drift of interferon-gamma(IFN-γ),interleukin-2(IL-2),tumor necrosis factor-β(TNF-β)and Th2(interleukin-4(IL-4),IL-5,IL-6,IL-10),24-hour urinary protein,serum creatinine(Scr),blood urea nitrogen(BUN),serum IgA level changes,clinical efficacy and adverse reactions were compared between the 2 groups.Results:Compared with the control group,Ziyin Yishen Decoction could significantly increase the clinical effective rate of primary IgA nephropathy,increase the levels of IFN-γ,TNF-β and IL-2 in peripheral blood,and decrease the expression of IL-4,IL-5,IL-6,IL-10 and the levels of 24-hour urinary protein,Scr,BUN and serum IgA level.There was no significant difference in adverse reaction rate between the 2 groups.Conclusion:Ziyin Yishen Decoction combined with Western medicine in the treatment of IgA nephropathy can promote the balance of drifting peripheral blood Th1/Th2 system,thus balance the body′s pro-inflammatory and anti-inflammatory system,improve the clinical effects,and does not increase the adverse reactions of patients,so it has high clinical value.