雷公藤多甙治疗慢性肾小球肾炎临床疗效观察

目的观察雷公藤多甙片治疗慢性肾小球肾炎的临床疗效。方法 142例肾小球肾炎患者按照入院先后顺序随机分为对照组(70例)和联合给药组(72例),在休息和低盐、低蛋白饮食及常规治疗的基础上,联合给药组加服雷公藤多甙。并测定血浆白蛋白(ALB)、24 h尿蛋白定量、血肌酐(Scr)、尿素氮(BUN)、尿常规等指标。结果联合用药组治疗总有效率84.72%,对照组治疗总有效率68.57%,2组比较具有显著性差异(P<0.05)。结论雷公藤多甙片治疗肾小球肾炎具有较好的临床疗效。     

雷公藤多苷联合激素治疗紫癜性肾炎

目的观察雷公藤多苷片联合激素治疗紫癜性肾炎的临床疗效。方法回顾性观察36例紫癜性肾炎患者在休息和低盐及常规治疗的基础上,采用雷公藤多苷片联合激素治疗后的疗效,以及与病理损害程度及肾组织荧光检测的关系。结果联合治疗总有效率94.4%,临床表现有血肌酐升高、高血压、病理类型在Ⅲ级以上、肾间质损害明显者预后差,免疫荧光有IgG\IGM\C3沉积的疗效差,联合治疗仍有效。结论雷公藤多苷片联合激素治疗紫癜性肾炎是安全有效的。     

盐酸左西替利嗪胶囊联合雷公藤多甙片治疗慢性荨麻疹疗效观察

目的 观察左西替利嗪胶囊联合雷公藤多甙片治疗慢性荨麻疹的疗效.方法 188例慢性荨麻疹患者分为治疗组98例,口服左西替利嗪胶囊5 mg/d、雷公藤多甙片30 mg/d;对照组90例,口服左西替利嗪胶囊5 mg/d.4周后观察疗效.结果 治疗组疗效明显优于对照组,差异有统计学意义(P<0.005).结论 左西替利嗪胶囊联合雷公藤多甙片治疗慢性荨麻疹疗效较好、无明显不良反应.     

中西医联合治疗口腔扁平苔藓临床疗效研究

目的:探讨中西医结合方法治疗口腔扁平苔藓的临床疗效。方法:选取我院收治的口腔扁平苔藓患者60例,随机分为对照组和观察组。对照组单纯采用西医药物治疗,观察组在对照组治疗基础上加用中药雷公藤多甙片进行治疗。观察两组患者症状评分和疗效情况。结果:观察组治疗后糜烂面得分(0.9±0.2)分,疼痛得分(1.3±0.5)分,观察组明显低于对照组(P<0.05);观察组显效16例,有效11例,总有效率90%,明显高于对照组(P<0.05);观察组随访1年复发3例(10%),明显优于对照组(P<0.05)。结论:口服雷公藤多甙片联合局部注射醋酸泼尼松治疗口腔扁平苔藓临床疗效满意。     

地氯雷他定联合雷公藤多甙片治疗慢性特发性荨麻疹疗效研究

目的探究地氯雷他定联合雷公藤多甙片治疗慢性特发性荨麻疹的临床疗效。方法选择深圳市第七人民医院2013年4月至2014年12月接诊的120例慢性特发性荨麻疹患者,随机分为观察组和对照组,每组60例。对照组给予单用地氯雷他定治疗,观察组给予地氯雷他定联合雷公藤多甙片治疗,观察两组的临床疗效。结果观察组治疗有效率为83.33%,高于对照组53.33%,差异有统计学意义(P<0.05);观察组生活质量改善率为90.00%,高于对照组(71.67%),差异有统计学意义(P<0.05);两组不良反应发生率比较差异未见统计学意义(P>0.05)。结论地氯雷他定联合雷公藤多甙片治疗慢性特发性荨麻疹具有良好的疗效,能明显改善患者生活质量,且不增加不良反应,值得临床推广。     

他克莫司联合雷公藤多甙治疗难治性肾病综合征的有效性及安全性

目的分析联用他克莫司、雷公藤多甙治疗难治性肾病综合征(RNS)患者的临床价值。方法选取2014年1月至2019年3月许昌市中心医院收治的60例RNS患者的临床资料,按照随机数字表法分为两组,每组30例。研究组行他克莫司联合雷公藤多甙治疗,对照组行他克莫司治疗,记录两组疗效及药物所致不良反应发生情况。结果研究组临床总有效率为86.67%(26/30),对照组为70.00%(21/30),差异有统计学意义(P<0.05)。两组药物所致不良反应发生率比较,差异未见统计学意义(P>0.05)。结论联合应用他克莫司、雷公藤多甙治疗RNS患者临床有效性、安全性均较优。     

雷公藤多甙联合依那普利治疗38例慢性肾小球肾炎患者的疗效观察

目的研究雷公藤多甙联合依那普利治疗慢性肾小球肾炎患者的疗效。方法选取某院76例慢性肾小球肾炎患者,按治疗方案不同分组,各38例。对照组给予依那普利治疗,观察组给予雷公藤多甙+依那普利治疗,比较两组治疗效果、治疗前后血肌酐(SCr)、尿素氮(BUN)、24 h尿蛋白定量(Upro)及不良反应。结果观察组总有效率92.11%较对照组73.68%高,差异有统计学意义(P0.05);治疗前,两组SCr、BUN、Upro差异无统计学意义(P0.05);治疗1个月后,观察组SCr、BUN、Upro低于对照组,差异有统计学意义(P0.05);观察组与对照组不良反应发生率比较差异无统计学意义(P0.05)。结论雷公藤多甙联合依那普利治疗慢性肾小球肾炎患者,疗效显著,可改善肾功能,减少尿蛋白,且不增加药物不良反应。     

雷公藤多甙片治疗糖尿病蛋白尿的短期疗效

目的:观察雷公藤多甙片联合低分子肝素治疗糖尿病肾病的疗效。方法:糖尿病肾病患者16例,随机分为雷公藤组及对照组各8例,均给予低分子肝素5000U/d腹壁皮下注射,雷公藤组加服雷公藤多甙片,每次2片,每天3次。结果:治疗30d后,2组血肌酐治疗前后无明显变化。雷公藤组24h尿蛋白及纤维蛋白原与治疗前及对照组比较明显下降(P<0.01)。结论:雷公藤多甙片联合低分子肝素治疗可有效降低糖尿病肾病患者蛋白尿,改善临床症状。     

甲氨蝶呤联合雷公藤多甙片治疗类风湿性关节炎的疗效及安全性评价

目的研究甲氨蝶呤(MTX)联合雷公藤多甙片治疗类风湿性关节炎(RA)的疗效。方法回顾性分析2014-06—2015-06沈阳医学院附属中心医院治疗的74例RA患者的临床资料,将74例患者按照治疗方式的不同分为观察组和对照组,观察组37例,给予甲氨蝶呤10 mg/周、雷公藤多甙片60 mg/d,对照组37例,仅给予甲氨蝶呤10 mg/周,对比分析两组患者病情改善情况及药物不良反应。结果治疗后,观察组临床缓解率、总有效率分别为40.54%,91.89%;对照组临床缓解率、总有效率分别为29.73%,78.38%;观察组在临床缓解率、总有效率方面均明显优于对照组,表明观察组疗效显著,组间差异有统计学意义(P0.05);两组患者的关节压痛指数、关节肿胀指数、ESR、CRP均较治疗前明显下降(P0.05),但观察组患者的关节压痛指数、关节肿胀指数明显低于对照组患者(P0.05)。不良反应发生率分别为观察组13.51%,对照组10.81%,两组差异无统计学意义(P0.05)。结论甲氨蝶呤联合雷公藤多甙片治疗RA疗效明显,且安全性高。     

雷公藤多甙联合福辛普利治疗儿童肾病综合征型紫癜性肾炎疗效分析

目的观察雷公藤多甙联合福辛普利治疗儿童肾病综合征型紫癜性肾炎的治疗效果。方法2006年12月至2009年12月在我院儿科就诊的38例诊断为肾病综合征型紫癜性肾炎的患儿,分别将患儿随机分为治疗组20例（口服雷公藤多甙联合福辛普利）和对照组18例（口服雷公藤多甙）,观察药物对两组患儿水肿、高血压、血尿、蛋白尿的疗效,采用SPSS10．0软件进行统计学分析。结果治疗组完全缓解18例（90％）,部分缓解2例（10％）。对照组完全缓解11例（61％）,部分缓解6例（39％）,无效1例（6％）两组缓解率比较,差异无显著性（P〉0．05）,但治疗组水肿消退、血压恢复正常、血尿消失、尿蛋白转阴的平均时间均明显短于对照组,差异有显著性（P〈0．01）。结论雷公藤多甙联合福辛普利治疗儿童肾病综合征型紫癜性肾炎疗效优于单用雷公藤多甙,值得临床应用。     

The use of ultrahigh doses of corticosteroids in treating the most severe variants of lupus nephritis

The authors analyze the 10-year experience gained with the use of steroid pulse-therapy for the gravest forms of lupus nephritis--rapid-progressing lupus nephritis and active lupus nephritis associated with the nephrotic syndrome. Ultrahigh doses of prednisolone and methylprednisolone (1000 mg i. v. for 3 days) was monotherapy or as a constituent part of multimodality treatment were given to 30 patients including 27 women and 3 men aged 18 to 48 years. Of these, 12 patients had rapid-progressing lupus nephritis and 18 active lupus nephritis. The short-term treatment results were estimated after 1 to 3 months, whereas the long-term ones after 12 months to 9 years. Analysis of the treatment results allows the following conclusions to be drawn: the use of steroid pulse-therapy was monotherapy is only justified in patients suffering from active lupus nephritis with the nephrotic syndrome without renal failure and only at the disease debut. In rapid-progressing lupus nephritis and long active lupus nephritis with the phenomena of renal failure, the positive effect can only be attained after combination of steroid pulse therapy and high doses of prednisolone per os or long intake of cytostatics per os or in the form of cytostatic pulses.     

Study of lupus nephritis: its classification and the significance of subendothelial deposits

This study describes the clinical and pathological characteristics of 74 patients with lupus nephritis classified according to renal biopsy findings using light, electron and immunofluorescent microscopy, and further, assesses the significance of subendothelial deposits in evaluating disease activity. In membranous lupus nephritis (14 cases), many cases showed normal renal function even with the nephrotic syndrome, although five cases had little or no urinary abnormalities. Glomerular cellular proliferation was very mild and subepithelial deposits with a few mesangial deposits were the main pathological alterations. Mesangial proliferative lupus nephritis (17 cases) clinically had very mild renal disease. Renal biopsies in this group revealed mesangial deposits with slight cellular proliferation. Although clinical features of mild diffuse proliferative lupus nephritis (16 cases) were similar to those of mesangial lupus nephritis, glomerular loop deposits were seen in addition to mesangial deposits. In moderate diffuse proliferative lupus nephritis (17 cases), renal function was slightly decreased, moderate proteinuria with haematuria were found, and C3 level was low. Renal biopsies showed active proliferative changes, and subendothelial deposits were frequently seen. In severe diffuse proliferative lupus nephritis (10 cases), the duration from onset of SLE to renal biopsy was short. Impairment of renal function, and nephrotic syndrome with haematuria and hypocomplementemia were frequent. Only three patients survived in this group. Renal biopsies demonstrated highly active proliferative and necrotizing changes, and electron microscopy showed massive subendothelial and mesangial deposits accompanied by subepithelial and intramembranous deposits. The amount of subendothelial deposits correlated with those of mesangial deposits and subepithelial deposits in the cases with diffuse proliferative lupus nephritis. Urinary protein loss and histologic activity showed statistically significant correlations with the amount of subendothelial deposits, but C3 levels and creatinine clearance revealed negative correlations with those deposits.     

Secondary nephrotic syndrome due to collagen disease and vasculitis

The most frequent and representative nephrotic syndrome associated with collagen disease is encountered in patients suffering from lupus nephritis. Lupus nephritis is a glomerulonephritis, which discloses various localizations of immune complexes in the endothelium, mesangium and subepithelium. In addition, vasculitides complicated by nephrotic syndrome also show the deposition of immune complexes in their glomeruli, such as Henoch-Sch?nlein nephritis and cryoglobulinemic nephritis. The pathogenetic mechanisms of these nephrotic syndromes are explained as follows. The depositions of immune complexes in glomeruli causes proteinuria through a variety of mechanisms. Namely, subendothelial and mesangial immune deposits give capillary and mesangial injuries as well as inflammation that are mediated through activation of complements and cytokines, and subsequently leads to nephrotic-range proteinuria and impairment of renal function. On the other hand, subepithelial and intramembranous deposits disrupt the regulated arrangement of epithelial cells and slit diaphragms, and then disturb the slit diaphragms. The eventual dysfunction of slit diaphragms accordingly progresses to massive proteinuria even without capillary injury. Therefore, nephrotic syndrome associated with collagen disease or vasculitis is usually observed in lupus nephritis or vasculitis related to immune complex depositions, but is not observed in non-immune complex glomerulopathy or vasculopathy.     

尿微量蛋白分类定量分析对系统性红斑狼疮早期肾损害诊断的意义及免疫调节治疗对其影响

目的　本研究旨在探讨系统性红斑狼疮 (SLE)患者尿中不同种微量蛋白的改变对早期诊断肾脏损害的意义及免疫调节治疗对其影响。方法　应用酶联免疫法定量分析 2 0例健康志愿者及 5 2例SLE患者 (尿常规检查尿蛋白阴性组和阳性组 )免疫调节治疗前后尿中视黄醇结合蛋白 (RBP)、白蛋白 (ALB)、转铁蛋白 (TRF)及免疫球蛋白G(IgG)的变化。结果　SLE尿蛋白阴性组患者尿中RBP、ALB、TRF、IgG含量分别升高到健康对照组的 19 8、30 9、19 5、5 5倍 ,尿蛋白阳性组患者尿中RBP、ALB、TRF、IgG分别升高到正常组的 10 5 7、2 10 8、135 5、31 5倍。两组间差异显著(P <0 0 0 1)。治疗后两组患者尿微量蛋白量均较治疗前明显下降 ,SLE尿蛋白阴性组下降的幅度较大 ,RBP、ALB、TRF、lgG分别下降了 4 0 1%、4 9 8%、6 8 8%、80 6 %。而尿蛋白阳性组下降的幅度比前者略小 ,四种蛋白分别下降了31 5 %、4 9 5 %、4 0 4 %、4 2 2 %。结论　SLE患者在临床诊断为狼疮肾炎之前 ,尿蛋白量已明显增加 ,尿RBP、ALB、TRF及IgG升高 ,提示肾小管及肾小球功能均受损 ,其中以ALB升高最明显。因此 ,ALB、RBP可作为早期诊断LN较为敏感的指标。早期治疗SLE肾损害疗效较为明显 ,尿TRF及ALB可作为较为敏感的疗效观察指标。     

霉酚酸酯治疗IV型狼疮性肾炎的疗效观察与护理研究

目的 观察新型免疫抑制剂酶酚酸酯（ＭＭＦ）治疗Ⅳ型狼疮性肾炎（ＬＮ）的疗效，找出其治疗期间的有效护理方法。方法 ２３例经肾活栓主宰的Ⅳ型ＮＬ患者， 接受传统免疫抑制剂或其它治疗无效或复发，必用ＭＭＦ治疗，其中，２１例联合使用小剂量激素，ＭＭＦ剂量：０．２５￣２．０ｇ／ｄ。结果 经ＭＭＦ治疗１２个月后，８例肾功能不全者５例肾功能恢复正常，３例需透析者摆脱了透析；尿蛋白下降超过基础值５０％者占１００％     

西藏地区儿童常见肾脏疾病发病情况调查

目的了解西藏地区儿童常见肾脏疾病的发病情况。 方法回顾2015年1月1日至2018年12月31日西藏自治区人民医院儿科收治的肾脏疾病患儿,分析其发病情况,并与同期北京大学第一医院儿科肾脏专业病房相同病种进行对比。 结果西藏自治区人民医院儿科共收治患儿8300例,其中肾脏疾病398例（4.80%）,包括过敏性紫癜204例（其中紫癜性肾炎88例）、泌尿系感染44例、原发性肾病综合征41例、血尿和蛋白尿26例、泌尿系结石25例、急性链球菌感染后肾小球肾炎23例、系统性红斑狼疮18例（其中狼疮性肾炎16例）、IgA肾病12例、孤立性蛋白尿3例、孤立性血尿2例。西藏自治区人民医院儿童以过敏性紫癜（紫癜性肾炎）、泌尿系结石发病率较高,但病种相对较少。 结论西藏地区儿童肾脏疾病,以过敏性紫癜、紫癜性肾炎最为常见,整体儿科肾脏疾病诊治水平相对较为落后,对于一些疑难、罕见和重症儿童肾脏疾病尚不能进行诊治。     

Mizoribine pulse therapy for a pediatric patient with steroid-resistant nephrotic syndrome

A 12-year-old Japanese boy was referred to our hospital with a 2-month history of persistent proteinuria. Despite urinary protein excretion in the nephrotic range, associated with hypoproteinemia, the patient did not complain of any disability. A percutaneous renal biopsy revealed minor glomerular abnormalities, without any evidence of immune complex deposition. Therapy with prednisolone (60 mg/day) was initiated, and while the proteinuria decreased after 4-week therapy, elevated urinary protein excretion persisted thereafter, at 1-2 g/day. Because of the steroid-resistant proteinuria, mizoribine (MZR), was started at 150 mg/day (3 mg/kg), administered as a single daily dose an immunosuppressive agent, in combination with prednisolone. Although there was some fluctuation in the urinary protein excretion, heavy proteinuria persisted for the next 4 weeks. The peak blood level of MZR was 0.9 microg/ml. Since we have previously reported the efficacy and safety of oral MZR pulse therapy, which is associated with higher peak serum MZR levels than conventional MZR therapy in selected patients with lupus nephritis, we adopted MZR pulse therapy for this patient, after obtaining informed consent. MZR was started at the daily dose of 300 mg (6 mg/kg), administered as a single dose before breakfast, twice a week (on Monday and Thursday). The peak blood level of MZR then increased to 1.29 microg/ml. Thereafter, despite a gradual reduction of the concomitantly administered prednisolone dose, the urinary protein excretion decreased rapidly to around 0.3 g/day and remained at this level thereafter. No adverse effects of MZR were observed. Based on these clinical observations, we suggest that oral MZR pulse therapy may be the treatment of choice in selected patients of steroid-resistant nephrotic syndrome, in addition to those of lupus nephritis.     

Plasmapheresis in lupus nephritis with nephrotic syndrome: A long-term followup

Lupus nephritis with nephrotic syndrome is one of the most serious complications of systemic lupus erythematosus. Six female patients with systemic lupus and nephrotic syndrome, refractory to immunosuppressive drug therapy, received 15–20 exchange plasmaphereses. One patient, treated concurrently with high-dose steroids, showed temporary improvement, and five patients, treated concurrently with steroids and either cyclophosphamide or azathioprine, had long-term remissions. Plasmapheresis is a promising therapeutic modality in cases of refractory lupus nephritis with nephrotic syndrome.     

Long-term treatment of lupus nephritis with cyclosporin A

We evaluated the efficacy and safety of long-term treatment with cyclosporin A (CSA) in type IV lupus nephritis. Seventeen patients with biopsy-proven WHO type IV lupus nephritis were enrolled in a prospective, open study. Twelve of the 17 completed 48 months of treatment with CSA and prednisolone. Three patients required the addition of azathioprine, at 12, 38 and 47 months, respectively, for cutaneous disease flare with refractory rashes. One patient was lost to follow-up at 40 months. The mean +/- SD duration of treatment was 43.2 +/- 10.1 months (range 15.7-48 months). A significant reduction of proteinuria and a significant rise in serum albumin were noted 1 month after initiation of treatment. Improvement was maintained throughout the study except for three patients who relapsed with recurrence of nephrotic syndrome. There were no significant changes in serum creatinine level or creatinine clearances throughout the study. Repeat renal biopsy at 12 months following treatment with CSA showed histological improvement, with WHO type II changes in all 17 patients accompanying significant reduction in activity indices. Patients with baseline haemoglobin (Hgb) levels < 12 g/dl showed significant improvement. Serum C3 and C4 levels were not changed significantly. Corticosteroid-sparing effects were noted. Side-effects included hypertension, gum hypertrophy and mild hirsuitism, but were not serious. Combination therapy using CSA and prednisone is effective and safe for long-term treatment in lupus patients with WHO type IV nephritis.