益气养阴利咽方联合咽部啄治法治疗IgA肾病伴咽部炎症临床研究
|
摘要
目的评价益气养阴利咽方联合咽部啄治法治疗伴有咽部炎症的IgA肾病的有效性和安全性。方法将90例中医辨证为气阴两虚证合并咽炎及扁桃体炎的IgA肾病患者采用随机数字表法,分为益气养阴利咽方联合咽部啄治法治疗组(45例)和厄贝沙坦对照组(45例),试验疗程12周,随访24周。疗效性观察指标包括尿红细胞计数(RBC)、24 h尿蛋白定量、咽部症状、中医证候积分,安全性观察指标包括一般体格检查及血常规、血肌酐、尿素氮、总胆固醇、甘油三酯、谷丙转氨酶、谷草转氨酶。结果完成试验85例,脱落5例。与本组治疗前比较,治疗组治疗20、24周尿RBC下降(P<0.05)。与对照组比较,治疗组治疗20、24周24 h尿蛋白定量、尿RBC计数下降(P<0.05)。24周随访结束后,治疗组24 h尿蛋白定量总有效率(72.1%)、RBC下降率(67.9%)及咽部症状缓解率(93%)均优于对照组(分别为45.2%,56.9%及21.4%;P<0.01,P<0.05)。两组治疗后血常规、血肌酐、尿素氮、总胆固醇、甘油三酯、谷丙转氨酶、谷草转氨酶差异均无统计学意义(P>0.05)。结论益气养阴利咽方联合咽部啄治法可以减少IgA肾病伴有咽部炎症患者的蛋白尿和血尿,改善咽部症状,疗效优于厄贝沙坦。
Objective To evaluate the efficacy and safety of Yiqi Yangyin Liyan Prescription combined with the tonsil-pecking method for the treatment of IgA nephropathy with pharyngeal inflammation. Methods Ninety patients with IgA nephropathy associated with qi and yin deficiency, pharyngitis and tonsillitis were assigned to the test group(45 cases) and the control group(45 cases) according to the random digit table. The test group received Yiqi Yangyin Liyan Prescription combined with the tonsil-pecking method and the control group took Irbesartan.The treatment cycle consist of 12 weeks with 24-week follow-ups.The curative effect observation indicators included urine RBC count,24 h urine protein, pharyngeal symptom score and Chinese medical symptom score.The safety observation indicators included physical examination, routine blood test, SCR,BUN,TG,TC,ALT,AST. Results Totally 85 cases completed the study,5 cases dropped out. Compared with before treatment in the same group,the urine RBC count decreased in the test group at the 20 and 24 weeks(P<0.05). Compared with the control group, 24 h urine protein and urine RBC count decreased in the test group at the 20 and 24 weeks(P<0.05). After 24 weeks of follow-up, the effective rate of the treatment group in the 24 h urine protein(72.1%), the rate of the decreased in urine RBC count(67.9%) and the effective rate in pharyngeal symptom score(93%) were better than the control group(45.2%,56.9% and 21.4%; P<0.01, P<0.05).Compared with before treatment,the blood routine test,SCR,BUN,TG,TC,ALT,AST showed no statistical difference after treatment(P>0.05). Conclusion Yiqi Yangyin Liyan Prescription combined with tonsil-pecking method could reduce 24 h urine protein,urine RBC count and improve the symptoms of pharyngeal inflammation, with the therapeutic effect significantly superior over Irbesartan.
Objective To evaluate the efficacy and safety of Yiqi Yangyin Liyan Prescription combined with the tonsil-pecking method for the treatment of IgA nephropathy with pharyngeal inflammation. Methods Ninety patients with IgA nephropathy associated with qi and yin deficiency, pharyngitis and tonsillitis were assigned to the test group(45 cases) and the control group(45 cases) according to the random digit table. The test group received Yiqi Yangyin Liyan Prescription combined with the tonsil-pecking method and the control group took Irbesartan.The treatment cycle consist of 12 weeks with 24-week follow-ups.The curative effect observation indicators included urine RBC count,24 h urine protein, pharyngeal symptom score and Chinese medical symptom score.The safety observation indicators included physical examination, routine blood test, SCR,BUN,TG,TC,ALT,AST. Results Totally 85 cases completed the study,5 cases dropped out. Compared with before treatment in the same group,the urine RBC count decreased in the test group at the 20 and 24 weeks(P<0.05). Compared with the control group, 24 h urine protein and urine RBC count decreased in the test group at the 20 and 24 weeks(P<0.05). After 24 weeks of follow-up, the effective rate of the treatment group in the 24 h urine protein(72.1%), the rate of the decreased in urine RBC count(67.9%) and the effective rate in pharyngeal symptom score(93%) were better than the control group(45.2%,56.9% and 21.4%; P<0.01, P<0.05).Compared with before treatment,the blood routine test,SCR,BUN,TG,TC,ALT,AST showed no statistical difference after treatment(P>0.05). Conclusion Yiqi Yangyin Liyan Prescription combined with tonsil-pecking method could reduce 24 h urine protein,urine RBC count and improve the symptoms of pharyngeal inflammation, with the therapeutic effect significantly superior over Irbesartan.
引文
[1] Zhang YM, Zhou XJ, Zhang H. What genetics tells us about the pathogenesis of IgA nephropathy: The role of immune factors and infection[J]. Kidney Int Rep, 2017, 2(3): 318-331.
[2] Kidney Disease Improving Global Outcomes. KDIGO clinical practice guidelines for glomerulonephritis[J]. Kidney Int, 2012, 2: 139-172.
[3] Min L, Wang Q, Cao L, et al. Comparison of combined leflunomide and low-dose corticosteroid therapy with full-dose corticosteroid monotherapy for progressive IgA nephropathy[J]. Oncotarget, 2017, 8(29): 44838-48375.
[4] Shu D, Xu F, Zhen S, et al. Risk factors of progressive IgA nephropathy which progress to end stage renal disease within ten years: a case–control study[J]. BMC Nephrol, 2017, 18(1): 11.
[5] Coppo R. Treatment of IgA nephropathy: recent advances and prospects[J]. Nephro Ther, 2018, 14(S1): S13-S21.
[6] Xie JY, Lv JC, Wang WM, et al. Kidney failure risk prediction equations in IgA nephropathy: a multicenter risk assessment study in Chinese patients[J]. Am J Kidney Dis, 2018, 72(3): 371-380.
[7] 何岩, 余仁欢, 汪涛, 等. 108例IgA肾病患者黏膜受累情况调查[J]. 中国中西医结合肾病杂志, 2013, 14
(12): 1095-1096.
[8] Yang D, He L, Peng X, et al. The efficacy of tonsillectomy on clinical remission and relapse in patients with IgA nephropathy: a randomized controlled trial[J]. Ren Fail, 2016, 38(2): 242-248.
[9] Feehally J, Coppo R, Troyanov S, et al. Tonsillectomy in a European cohort of 1 147 patients with IgA nephropathy[J]. Nephron, 2016, 132(1): 15-24.
[10] Kawamura T, Yoshimura M, Miyazaki Y. A multicenter randomized controlled trial of tonsillectomy combined with steroid pulse therapy in patients with immunoglobulin A nephropathy[J]. Nephrol Dial Transplant, 2014, 29(8): 1546-1553.
[11] Yuzawa Y, Yamamoto R, Takahashi K, et al. Evidence-based clinical practice guidelines for IgA nephropathy 2014[J]. Clin Exp Nephrol, 2016, 20(4): 511-535.
[12] 聂莉芳, 于大君, 许勇钢, 等. 益气滋肾颗粒对IgA肾病辅助性T淋巴细胞亚群的影响[J]. 中国中西医结合杂志, 2006, 26(9): 836-838.
[13] 曲汝鹏, 孙海波, 冷辉, 等. 中医烙治、啄治法治疗慢性扁桃体炎240例[J]. 环球中医药, 2016, 9(1): 97-99.
[14] Churg J, Bernstein J, Classock RJ. Renal disease classification and atlas of glomerular disease[M] .2nd ed. New York: Ikagushoin Medical Publishers Inc, 1995: 4.
[15] 邹万忠主编. 肾活检病理学[M]. 北京: 北京大学医学出版社, 2009: 121.
[16] 国家中医药管理局. 中医病证诊断疗效标准[M]. 南京: 南京大学出版社, 1994: 110.
[17] 中华中医药学会肾病分会. IgA肾病的诊断、辨证分型和疗效评定[J]. 上海中医药杂志, 2007, 41(5): 9-10.
[18] 于兴娟, 汪冰. 扁桃体啄治法治疗慢性扁桃体炎51例[J]. 中医外治杂志, 2008, 17(5): 34-35.
[19] 国家中医药管理局医政司. 24个专业105个病种中医诊疗方案[M]. 北京: 中国中医药出版社, 2011: 506-508.
[20] Knoppova B, Reily C, Maillard N, et al. The origin and activities of IgA1-containing immune complexes in IgA nephropathy[J]. Front Immunol, 2016, 7: 117.
[21] Inoue T, Sugiyama H, Kitagawa M, et al. Suppression of adiponectin by aberrantly glycosylated IgA1 in glomerular mesangial cells in vitro and in vivo[J]. PLoS One, 2012, 7(3): e33965.
[22] Liu H, Peng Y, Liu F, et al. Expression of IgA class switching gene in tonsillar mononuclear cells in patients with IgA nephropathy[J]. Inflamm Res, 2011, 60(9): 869-878.
[23] 黄帝内经·灵枢[M]. 成都: 四川科学技术出版社, 2008: 110.
[2] Kidney Disease Improving Global Outcomes. KDIGO clinical practice guidelines for glomerulonephritis[J]. Kidney Int, 2012, 2: 139-172.
[3] Min L, Wang Q, Cao L, et al. Comparison of combined leflunomide and low-dose corticosteroid therapy with full-dose corticosteroid monotherapy for progressive IgA nephropathy[J]. Oncotarget, 2017, 8(29): 44838-48375.
[4] Shu D, Xu F, Zhen S, et al. Risk factors of progressive IgA nephropathy which progress to end stage renal disease within ten years: a case–control study[J]. BMC Nephrol, 2017, 18(1): 11.
[5] Coppo R. Treatment of IgA nephropathy: recent advances and prospects[J]. Nephro Ther, 2018, 14(S1): S13-S21.
[6] Xie JY, Lv JC, Wang WM, et al. Kidney failure risk prediction equations in IgA nephropathy: a multicenter risk assessment study in Chinese patients[J]. Am J Kidney Dis, 2018, 72(3): 371-380.
[7] 何岩, 余仁欢, 汪涛, 等. 108例IgA肾病患者黏膜受累情况调查[J]. 中国中西医结合肾病杂志, 2013, 14
(12): 1095-1096.
[8] Yang D, He L, Peng X, et al. The efficacy of tonsillectomy on clinical remission and relapse in patients with IgA nephropathy: a randomized controlled trial[J]. Ren Fail, 2016, 38(2): 242-248.
[9] Feehally J, Coppo R, Troyanov S, et al. Tonsillectomy in a European cohort of 1 147 patients with IgA nephropathy[J]. Nephron, 2016, 132(1): 15-24.
[10] Kawamura T, Yoshimura M, Miyazaki Y. A multicenter randomized controlled trial of tonsillectomy combined with steroid pulse therapy in patients with immunoglobulin A nephropathy[J]. Nephrol Dial Transplant, 2014, 29(8): 1546-1553.
[11] Yuzawa Y, Yamamoto R, Takahashi K, et al. Evidence-based clinical practice guidelines for IgA nephropathy 2014[J]. Clin Exp Nephrol, 2016, 20(4): 511-535.
[12] 聂莉芳, 于大君, 许勇钢, 等. 益气滋肾颗粒对IgA肾病辅助性T淋巴细胞亚群的影响[J]. 中国中西医结合杂志, 2006, 26(9): 836-838.
[13] 曲汝鹏, 孙海波, 冷辉, 等. 中医烙治、啄治法治疗慢性扁桃体炎240例[J]. 环球中医药, 2016, 9(1): 97-99.
[14] Churg J, Bernstein J, Classock RJ. Renal disease classification and atlas of glomerular disease[M] .2nd ed. New York: Ikagushoin Medical Publishers Inc, 1995: 4.
[15] 邹万忠主编. 肾活检病理学[M]. 北京: 北京大学医学出版社, 2009: 121.
[16] 国家中医药管理局. 中医病证诊断疗效标准[M]. 南京: 南京大学出版社, 1994: 110.
[17] 中华中医药学会肾病分会. IgA肾病的诊断、辨证分型和疗效评定[J]. 上海中医药杂志, 2007, 41(5): 9-10.
[18] 于兴娟, 汪冰. 扁桃体啄治法治疗慢性扁桃体炎51例[J]. 中医外治杂志, 2008, 17(5): 34-35.
[19] 国家中医药管理局医政司. 24个专业105个病种中医诊疗方案[M]. 北京: 中国中医药出版社, 2011: 506-508.
[20] Knoppova B, Reily C, Maillard N, et al. The origin and activities of IgA1-containing immune complexes in IgA nephropathy[J]. Front Immunol, 2016, 7: 117.
[21] Inoue T, Sugiyama H, Kitagawa M, et al. Suppression of adiponectin by aberrantly glycosylated IgA1 in glomerular mesangial cells in vitro and in vivo[J]. PLoS One, 2012, 7(3): e33965.
[22] Liu H, Peng Y, Liu F, et al. Expression of IgA class switching gene in tonsillar mononuclear cells in patients with IgA nephropathy[J]. Inflamm Res, 2011, 60(9): 869-878.
[23] 黄帝内经·灵枢[M]. 成都: 四川科学技术出版社, 2008: 110.