针刺穴位配合甲泼尼龙、环磷酰胺治疗重度膜性肾病35例疗效观察
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摘要
目的观察针刺配合糖皮质激素和细胞毒药物治疗重度膜性肾病的效果。方法选择2016年3月至2017年1月住院治疗的重度膜性肾病患者70例,按照随机数表法分为对照组和治疗组,每组35例患者,对照组在给予对症支持治疗的基础上使用甲泼尼龙口服与环磷酰胺进行静脉冲击量治疗:甲泼尼龙,口服,前8周以日量40 mg顿服,以后每4周减少10 mg,稳定在每日顿服10 mg,静脉输注环磷酰胺0.8克/次每周一次,在总剂量到达8 g时停止。治疗组在对照组基础上,再加用每天针刺肾腧、气海等穴位。对治疗的效果进行对比。结果治疗之后,两组患者的抗磷脂酶A2受体抗体、24 h尿蛋白、血清白蛋白、三酰甘油、胆固醇、肾小球滤过率均出现了改善,治疗组患者改善的程度大于对照组患者,均差异有统计学意义(F不同时间点=20.356,13.684,21.139,9.682,12.253,18.647,P<0.05,F两组比较=18.457,17.775,16.563,15.531,22.225,15.952,P<0.05,F交互作用=11.159,12.645,14.368,10.329,19.952,12.265,P<0.05),其中,治疗之后,对照组PLA2R抗体从(25.21±6.38)RU·m L-1下降为(12.75±6.09)RU·m L-1,24 h尿蛋白从(7.16±0.41)g下降为(3.98±0.46)g,肾小球滤过率从(68.12±8.35)m L·min-1升高为(90.33±11.89)m L·min-1,治疗组PLA2R抗体从(24.99±6.44)RU·m L-1下降为(8.92±4.16)RU·m L-1,24 h尿蛋白从(7.23±0.49)g下降为(3.05±0.52)g,肾小球滤过率从(69.69±8.94)m L·min-1升高为(98.36±8.54)m L·min-1,对照组治疗有效率(37.14%)低于治疗组(62.86%)(χ2=4.629,P<0.05),治疗组治疗效果显著优于对照组,差异有统计学意义(Z=3.639,P<0.05),两组消化道症状、糖耐量异常、肝损害等不良反应发生率差异无统计学意义(χ2=0.159,0.000,0.094,0.357,0.000,0.402,P>0.05)。结论针刺穴位配合甲泼尼龙、环磷酰胺治疗重度膜性肾病的患者,可以显著改善患者的各项生理指标,提高治疗的效果,并且不良反应的概率未增加,是值得推广的一种治疗方法。
Objective To observe the effect of acupuncture combined with Glucocorticoid and Cytotoxic drugs in the treatment of severe membranous nephropathy. Methods Seventy patients with severe membranous nephropathy who were hospitalized from March 2016 to January 2017 were selected and randomly assigned into control group and treatment group,35 patients in each group,On the basis of symptomatic support treatment,the patients in the control group were given oral methylprednisolone,with a daily dose of 40 mg meals for the first 8 weeks,and a decrease of 10 mg per week,and the daily dose of 10 mg was stable. Intravenous infusion of cyclophosphamide0. 8 g/times once a week,when the total dose reached 8 g,stopped. On the basis of the therapy of the control group was given acupuncture plus daily Shenshu,Qihai acupuncture. The treatment effects were compared between the two groups. Results After treatment,the data of PLA2 R antibody,24 h urine protein,serum albumin,triglyceride,cholesterol and glomerular filtration rate in the two groups were improved. The improvement of the patients in the treatment group was greater than that in the control group. The differences of data were statistically significant(F = 20. 356,13. 684,21. 139,9. 682,12. 253,18. 647 for different time points,P < 0. 05;F = 18. 457,17. 775,16. 563,15. 531,22. 225,15. 952 for comparison between the two groups,P < 0. 05;F = 11. 159,12. 645,14. 368,10. 329,19. 952,12. 265 for interaction,P < 0. 05). After treatment,the PLA2 R antibody in the control group decreased from(25. 21 ± 6. 38)RU·m L-11 to(12. 75 ± 6. 09) RU·m L-1,and the 24-hour urinary protein decreased from(7. 16 ± 0. 41) g to(3. 98 ± 0. 46) g,and the glomerular filtration rate was(68. 12 ± 8. 35) m L·min-1 increased to(90. 33 ± 11. 89) m L·min-1. The PLA2 R antibody in the treatment group decreased from(24. 99 ± 6. 44) RU·m L-1 to(8. 92 ± 4. 16) RU·m L-1,and the 24-hour urinary protein decreased from(7. 23 ± 0. 49) g to(3. 05 ± 0. 52) g,and glomerular filtration rate increased from(69. 69 ± 8. 94) m L·min-1(98. 36± 8. 54) m L·min-1. The effective rate of treatment in the control group(37. 14%) was lower than the treatment group(62. 86%);there was significant difference between the two groups(χ2= 4. 629,P < 0. 05). The therapeutic effect of the treatment group was significantly better than that of the control group,and the difference between the two groups was statistically significant(Z = 3. 639,P <0. 05). There was no statistically significant difference in the incidence of adverse reactions such as digestive tract symptoms,abnormality of glucose tolerance,and liver damage in the two groups(χ2= 0. 159,0. 000,0. 094,0. 357,0. 000,0. 402,P > 0. 05). Conclusions Acupuncture combined with Methylprednisolone and Cyclophosphamide in treating patients with severe membranous nephropathy can significantly improve the physiological indicators of the patients,improve the efficacy of treatment,and the probability of adverse reactions does not increase,which is worthy of promotion.
Objective To observe the effect of acupuncture combined with Glucocorticoid and Cytotoxic drugs in the treatment of severe membranous nephropathy. Methods Seventy patients with severe membranous nephropathy who were hospitalized from March 2016 to January 2017 were selected and randomly assigned into control group and treatment group,35 patients in each group,On the basis of symptomatic support treatment,the patients in the control group were given oral methylprednisolone,with a daily dose of 40 mg meals for the first 8 weeks,and a decrease of 10 mg per week,and the daily dose of 10 mg was stable. Intravenous infusion of cyclophosphamide0. 8 g/times once a week,when the total dose reached 8 g,stopped. On the basis of the therapy of the control group was given acupuncture plus daily Shenshu,Qihai acupuncture. The treatment effects were compared between the two groups. Results After treatment,the data of PLA2 R antibody,24 h urine protein,serum albumin,triglyceride,cholesterol and glomerular filtration rate in the two groups were improved. The improvement of the patients in the treatment group was greater than that in the control group. The differences of data were statistically significant(F = 20. 356,13. 684,21. 139,9. 682,12. 253,18. 647 for different time points,P < 0. 05;F = 18. 457,17. 775,16. 563,15. 531,22. 225,15. 952 for comparison between the two groups,P < 0. 05;F = 11. 159,12. 645,14. 368,10. 329,19. 952,12. 265 for interaction,P < 0. 05). After treatment,the PLA2 R antibody in the control group decreased from(25. 21 ± 6. 38)RU·m L-11 to(12. 75 ± 6. 09) RU·m L-1,and the 24-hour urinary protein decreased from(7. 16 ± 0. 41) g to(3. 98 ± 0. 46) g,and the glomerular filtration rate was(68. 12 ± 8. 35) m L·min-1 increased to(90. 33 ± 11. 89) m L·min-1. The PLA2 R antibody in the treatment group decreased from(24. 99 ± 6. 44) RU·m L-1 to(8. 92 ± 4. 16) RU·m L-1,and the 24-hour urinary protein decreased from(7. 23 ± 0. 49) g to(3. 05 ± 0. 52) g,and glomerular filtration rate increased from(69. 69 ± 8. 94) m L·min-1(98. 36± 8. 54) m L·min-1. The effective rate of treatment in the control group(37. 14%) was lower than the treatment group(62. 86%);there was significant difference between the two groups(χ2= 4. 629,P < 0. 05). The therapeutic effect of the treatment group was significantly better than that of the control group,and the difference between the two groups was statistically significant(Z = 3. 639,P <0. 05). There was no statistically significant difference in the incidence of adverse reactions such as digestive tract symptoms,abnormality of glucose tolerance,and liver damage in the two groups(χ2= 0. 159,0. 000,0. 094,0. 357,0. 000,0. 402,P > 0. 05). Conclusions Acupuncture combined with Methylprednisolone and Cyclophosphamide in treating patients with severe membranous nephropathy can significantly improve the physiological indicators of the patients,improve the efficacy of treatment,and the probability of adverse reactions does not increase,which is worthy of promotion.
引文
[1]段玉静,柴华旗,沙文刚,等.75例特发性膜性肾病临床病理分析[J].安徽医药,2014,18(8):1530-1532.
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[4]王述莲,孙钧,郑继伟,等.抗磷脂酶A2受体抗体表达在特发性膜性肾病人肾组织及血液中的检测价值[J].实用医学杂志,2016,32(3):434-436.
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[6]方玲,顾向明,周泽红,等.ELISA检测血清抗磷脂酶A2受体抗体在膜性肾病中的应用探讨[J].国际检验医学杂志,2017,38(4):450-451,454.
[7]TRAN TH,J HUGHES G,GREENFELD C,et al.Overview of current and alternative therapies for idiopathic membranous nephropathy[J].Pharmacotherapy,2015,35(4):396-411.
[8]朱楠,刘东伟,郭佳,等.血清抗PLA2R抗体在特发性膜性肾病中的临床应用价值[J].实用医学杂志,2017,33(4):619-622.
[9]郭玉,徐丹,陆晨,等.特发性膜性肾病关联基因多态性研究进展[J].临床肾脏病杂志,2016,16(4):249-253.
[10]郭红霞,史均宝,陆敏,等.环磷酰胺联合糖皮质激素治疗以肾病综合征为临床表现的特发性膜性肾病疗效[J].临床荟萃,2015,30(1):104-106.
[11]杨雪芬,潘阳彬,丁国华,等.成人特发性膜性肾病与分泌型磷脂酶A2-ⅠB及抗磷脂酶A2受体抗体的相关性研究[J].中国全科医学,2015,18(9):1018-1022,1028.
[12]高世平,王莉,姚恬.特发性膜性肾病患者免疫抑制剂治疗效果的影响因素[J].海南医学,2017,28(8):1230-1232.
[13]周密,祝胜郎.特发性膜性肾病研究进展[J].临床军医杂志,2017,45(4):434-437.
[14]杨书光,窦艳娜,王春燕,等.M型磷脂酶A2受体相关检测在成人特发性膜性肾病诊断中的应用[J].中国现代医学杂志,2017,27(5):42-46.
[15]张霖,程德根,邝剑彬,等.补腰健肾汤口服联合肾腧穴贴敷治疗腰椎间盘突出症[J].长春中医药大学学报,2017,33(4):611-613.
[16]刘丽红,刘慧军,陈丽娜,等.足三里穴位注射改善脾肾气虚、阳虚型维持性透析患者营养不良的临床观察[J].中国医药导报,2015,12(22):109-112,120.
[2]刘立刚.来氟米特联合小剂量泼尼松治疗特发性膜性肾病的疗效[J].安徽医学,2014,35(1):94-96.
[3]姚霞娟,胡宏,张英姿.不同分期特发性膜性肾病的临床病理特点和治疗体会[J].中国临床研究,2016,29(6):760-763.
[4]王述莲,孙钧,郑继伟,等.抗磷脂酶A2受体抗体表达在特发性膜性肾病人肾组织及血液中的检测价值[J].实用医学杂志,2016,32(3):434-436.
[5]林伟锋,李航,李雪梅,等.抗磷脂酶A2受体抗体与特发性膜性肾病的关系[J].中华内科杂志,2015,54(9):783-788.
[6]方玲,顾向明,周泽红,等.ELISA检测血清抗磷脂酶A2受体抗体在膜性肾病中的应用探讨[J].国际检验医学杂志,2017,38(4):450-451,454.
[7]TRAN TH,J HUGHES G,GREENFELD C,et al.Overview of current and alternative therapies for idiopathic membranous nephropathy[J].Pharmacotherapy,2015,35(4):396-411.
[8]朱楠,刘东伟,郭佳,等.血清抗PLA2R抗体在特发性膜性肾病中的临床应用价值[J].实用医学杂志,2017,33(4):619-622.
[9]郭玉,徐丹,陆晨,等.特发性膜性肾病关联基因多态性研究进展[J].临床肾脏病杂志,2016,16(4):249-253.
[10]郭红霞,史均宝,陆敏,等.环磷酰胺联合糖皮质激素治疗以肾病综合征为临床表现的特发性膜性肾病疗效[J].临床荟萃,2015,30(1):104-106.
[11]杨雪芬,潘阳彬,丁国华,等.成人特发性膜性肾病与分泌型磷脂酶A2-ⅠB及抗磷脂酶A2受体抗体的相关性研究[J].中国全科医学,2015,18(9):1018-1022,1028.
[12]高世平,王莉,姚恬.特发性膜性肾病患者免疫抑制剂治疗效果的影响因素[J].海南医学,2017,28(8):1230-1232.
[13]周密,祝胜郎.特发性膜性肾病研究进展[J].临床军医杂志,2017,45(4):434-437.
[14]杨书光,窦艳娜,王春燕,等.M型磷脂酶A2受体相关检测在成人特发性膜性肾病诊断中的应用[J].中国现代医学杂志,2017,27(5):42-46.
[15]张霖,程德根,邝剑彬,等.补腰健肾汤口服联合肾腧穴贴敷治疗腰椎间盘突出症[J].长春中医药大学学报,2017,33(4):611-613.
[16]刘丽红,刘慧军,陈丽娜,等.足三里穴位注射改善脾肾气虚、阳虚型维持性透析患者营养不良的临床观察[J].中国医药导报,2015,12(22):109-112,120.