加味固冲汤对IgA肾病患者肾小管间质损伤的保护作用及对尿蛋白、尿渗透压的影响

目的:观察加味固冲汤对IgA肾病患者肾小管间质损伤的保护作用及对尿蛋白、尿渗透压的影响。方法:94例IgA肾病患者随机分为观察组和对照组。对照组给予缬沙坦治疗,观察组在对照组治疗基础上给予加味固冲汤治疗。比较两组治疗前后24小时尿蛋白定量(24-hour proteinuria,24h Upro)、尿渗透压值,血清胱抑素C(cystatin C,Cys C)、β2-微球蛋白(β2-microglobulin,β2-MG)及尿中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)水平,临床疗效及不良反应。结果:与治疗前比较,两组治疗8周后24h Upro均显著降低(t=11.901、8.971,P0.01),尿渗透压均显著升高(t=11.619、5.843,P0.01),且观察组改善效果更显著(t=5.723、5.255,P0.01)。治疗8周后,观察组有效率为91.5%,对照组有效率为72.3%,两组比较,差异有统计学意义(χ2=5.817,P=0.016)。两组治疗8周后血清Cys C、β2-MG及尿NGAL水平均显著低于治疗前(t=5.710、6.496、3.809,P0.01),且观察组下降更显著(t=10.764、16.111、9.278,P0.01)。两组不良反应率比较,差异无统计学意义(χ~2=0.154,P=0.694)。结论:加味固冲汤治疗IgA肾病临床疗效显著,能有效缓解其临床症状体征,降低尿蛋白、提高尿渗透压,保护肾小管间质,延缓IgA肾病病情进展。

The Protective Effect of Jiawei Guchong Decoction on Renal Tubulointerstitial Injury in Patients with IgA Nephropathy and Its Effect on Urinary Protein and Urine Osmotic Pressure

Objective:To investigate the protective effect of Jiawei Guchong Decoction on renal tubulointerstitial injury in patients with IgA nephropathy(IgAN) and its effect on urinary protein and urine osmotic pressure (Uosm).Methods:94 cases of IgAN patients were randomly divided into the observation group and the control group.All patients were treated with the same general treatment strategy,on the basis of which,the control group was treated with valsartan,and the observation group on the basis of the control group adopted Jiawei Guchong Decoction.Then 24-hour proteinuria (24h Upro),Uosm,serum cystatin C (CysC),β2-microglobulin(β2-MG) and urinary neutrophil gelatinase associated lipocalin(NGAL) level 24 h before and after the treatment,comprehensive clinical curative effect and adverse reaction were recorded and compared between the two groups.Results:Compared with those before the treatment,the 24h Upro of the two groups after treatment for 8 hours decreased significantly (P ＜ 0.01),while Uosm increased significantly(P ＜ 0.01).And the improvement effect of the observation group was more significant(P ＜ 0.01).After 8 weeks of the treatment,the total effective rate of the observation group was 91.5％,which increased significantly when compared with that of the control group(X2 =5.817,P ＜ 0.05),and serum CysC,β2-MG and urinary NGAL levels were significantly lower than those before the treatment(P ＜ 0.01),and the observation group decreased more significantly(P ＜ 0.01).There was no significant difference in adverse reactions between the two groups (X2 =0.154,P =0.694,P ＞ 0.05).Conclusion:The treatment with Jiawei Guchong Decoction of IgA nephropathy patients can effectively alleviate the clinical symptoms,reduce urinary protein,improve urine osmolality,protect tubulointerstitial,and delay the progression of IgAN,with more significant comprehensive curative effect and high safety.