摘要
目的:观察中药益肾活血联合西药治疗增生硬化性IgAN的远期疗效和安全性,并评估其与临床、病理等的相关性。方法:回顾性分析2001年~2016年我院增生硬化性IgAN随访队列中采用益肾活血组方联合西药治疗的患者,根据治疗方案进一步分为激素组(中药+基础治疗+激素)及激素加免疫抑制剂组(中药+基础治疗+激素+免疫抑制剂)。以肾活检日期为起点,随访至2018年5月31日,随访时间≥12个月,终点事件定义为进入ESRD或eGFR下降50%以上,或血肌酐翻倍,观察其临床表现、实验室指标等方面的变化,及相关的并发症。用Kaplan-Meier法评估患者的累积肾脏生存率,并进一步分析随访结局与临床、病理等的关系。结果:共纳入病例163例,其中激素组44例,激素加免疫抑制剂组119例,中位随访4.42(2.96,7.55)年,末次随访总有效率65.0%,激素组总有效率59.1%(26/44),其中20.5%(9/44)患者进入ESRD,4.5%(2/44)患者Scr翻倍或eGFR下降>50%;激素加免疫抑制剂组总有效率67.2%(80/119),其中19.3%(23/119)患者进入ESRD,4.2%(5/119)患者Scr翻倍或eGFR下降>50%;激素组副反应发生率5例(11.4%),激素加免疫抑制剂组副发生率10例(8.4%),两组间总有效率及进入终点、副反应的差异无统计学意义。利用Kaplan-Meier法计算1、3、5、7、10年肾脏累积生存率分别为100%、93.3%、82.4%、74.4%、53.5%。多因素COX回归分析提示高血压、尿蛋白定量、初始eGFR及LeeⅣ~Ⅴ级是疾病进展的独立危险因素,血红蛋白是患者到达终点事件的独立保护因素。结论:中药益肾活血联合激素能够改善和稳定增生硬化性IgA肾病患者肾功能,有效减少其蛋白尿,且具有较好的安全性,对增生硬化性IgAN加用免疫抑制剂并没有达到更好的疗效。
Objective:To observe the long-term effect and safety of Tonifying Shen,Activating Blood Stasis Combined with Western Medicine for proliferative sclerosing IgA nephropathy,and to evaluate the correlation between efficacy and clinical,pathological.Methods:Patients who were treated with Tonifying Shen,Activating Blood Stasis Combined with Western Medicine in the follow-up cohort of proliferative sclerosing IgAN in our hospital from 2001 to 2016 were retrospectively analyzed and further divided into hormone group(Chinese medicine+basic treatment+hormone)and hormone plus immunosuppressive Group(Chinese medicine+basic treatment+hormone+immunosuppressive agent).A follow-up visit started from the confirmation of renal biopsy to May 31,2018,for at least 12 months.The end point event was defined as entering End Stage Renal Disease(ESRD),estimated glomerular filtration rate(eGFR)decreased by more than 50%,or serum creatinine was doubled.The differences in clinical manifestations,lab indicators and etc.were compared between before treatment and till the end offollow-up.The accumulative kidney survival rate was calculated using Kaplan-Meier method,and to analyze relationship between outcome and clinical.Results:Among the 163 patients,there were 44 cases in the hormone group and 119 cases in the hormone plus immunosuppressive group,the middle follow-up was 4.42(2.96,7.55)years.At the end of follow-up,the total effective rate was 65.0%,the hormone group was 59.1%(26/44),of which 20.5%(9/44)into ESRD,4.5%(2/44)eGFR rate decreased by more than 50%,or serum creatinine was doubled;And the immunosuppressant group was 67.2%(80/119),of which 19.3%(23/119)into ESRD,4.2%(5/119)eGFR rate decreased by more than 50%,or serum creatinine was doubled.The events of hormone and immunosuppressant group was 11.4%vs 8.4%.There were no significant differences in the total effective rate and the incidence of endpoints,event between the two groups(P>0.05).The Kaplan-Meier method was used to calculate the cumulative survival rates of kidneys at 1,3,5,7,and 10 years at 100%,93.3%,82.4%,74.4%,and 53.5%,respectively.Multivariate COX regression analysis suggested that hypertension,urinary protein quantification,initial eGFR,and LeeⅣ-Ⅴ,Rheumatism were independent risk factors for disease progression.Conclusion:Chinese medicine combined hormone can improve and stabilize renal function of patients with proliferative sclerosing IgA nephropathy,effectively reduce proteinuria,and has good safety,immunosuppressive have not achieved better efficacy.
作者
唐洁
俞东容
TANG Jie;YU Dongrong(Department of Nephrology,Guangxing Hospital,Zhejiang University of Troditional Chinese Medicine,Hangzhou,310007)
出处
《中国中西医结合肾病杂志》
2020年第6期488-492,共5页
Chinese Journal of Integrated Traditional and Western Nephrology
基金
杭州市科技局基金资助项目(No.20170533B84)
浙江省科技厅基金资助项目(No.LGF19H270007)。
关键词
IGAN
临床
病理学
中西医结合
益肾活血
远期疗效
IgA nephropathy
Clinical pathology
Integrative medicine
Tonifying shen activating blood stasis
Long-term effect
