[1]朱德礼,李建平,张元丽,等.参芪地黄汤联合来氟米特治疗气阴两虚型狼疮性肾炎临床研究[J].陕西中医,2023,(8):1069-1073.[doi:DOI:10.3969/j.issn.1000-7369.2023.08.016]
 ZHU Deli,LI Jianping,ZHANG Yuanli,et al.Clinical observation of Shenqi Dihuang decoction combined with leflunomide in treating lupus nephritis with deficiency of Qi and Yin[J].,2023,(8):1069-1073.[doi:DOI:10.3969/j.issn.1000-7369.2023.08.016]
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参芪地黄汤联合来氟米特治疗气阴两虚型狼疮性肾炎临床研究
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《陕西中医》[ISSN:1000-7369/CN:61-1281/TN]

卷:
期数:
2023年8期
页码:
1069-1073
栏目:
临床研究
出版日期:
2023-08-05

文章信息/Info

Title:
Clinical observation of Shenqi Dihuang decoction combined with leflunomide in treating lupus nephritis with deficiency of Qi and Yin
作者:
朱德礼李建平张元丽林子程
(三亚市中医院,海南 三亚 572000)
Author(s):
ZHU DeliLI JianpingZHANG YuanliLIN Zicheng
(Sanya Hospital of Traditional Chinese Medicine,Sanya 572000,China)
关键词:
狼疮性肾炎 参芪地黄汤 来氟米特 Th17/Treg细胞平衡 补体因子H 肾功能
Keywords:
Lupus nephritis Shenqi Dihuang decoction Leflunomide Th17/Treg cell balance Complement factor H Rrenal function
分类号:
R 692.3
DOI:
DOI:10.3969/j.issn.1000-7369.2023.08.016
文献标志码:
A
摘要:
目的:观察参芪地黄汤联合来氟米特治疗气阴两虚型狼疮性肾炎疗效。方法:将93例狼疮性肾炎患者按照随机数字表法分为两组,常规组46例,研究组47例。常规组在常规治疗基础上予来氟米特治疗,研究组在常规组治疗基础上给予参芪地黄汤治疗。比较两组治疗前后中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、可溶性血栓调节蛋白(sTM)、富亮氨酸α-2糖蛋白-1(LRG1)、可溶性肿瘤坏死因子Ⅰ型受体(sTNF-RⅠ)、Rho激酶2(ROCK2)、补体因子H(CFH)、免疫球蛋白结合蛋白1(IGBP1)、24 h尿蛋白定量(24 hUPE)、补体C3、肾损伤分子1抗体(KIM-1)水平及Th17/Treg细胞比例。比较两组治疗前后系统性红斑狼疮疾病活动评分(SLEDAI)、健康调查简表(SF-36)评分,比较两组临床疗效。结果:研究组LRG1、IGBP1、HMGB1、ROCK2、Th17/Treg水平较常规组降低(均P<0.05); 研究组补体C3、CFH、sTNF-RⅠ水平及SF-36评分较常规组升高(均P<0.05); 研究组24 hUPE、KIM-1、NGAL、sTM水平及SLEDAI评分较常规组降低(均P<0.05)。研究组总有效率高于常规组(P<0.05)。结论:参芪地黄汤联合来氟米特治疗气阴两虚型狼疮性肾炎患者,可抑制炎症反应,调节Th17/Treg细胞平衡,改善机体免疫状态、肾功能及狼疮性肾炎活动性,提升临床疗效。
Abstract:
Objective:To observe the efficacy of Shenqi Dihuang decoction combined with leflunomide in the treatment of lupus nephritis with both Qi and Yin deficiency.Methods:A total of 93 patients with lupus nephritis were randomly divided into two groups,46 cases in the conventional group and 47 cases in the study group.The conventional group was treated with leflunomide on the basis of conventional treatment,and the study group was treated with Shenqi Dihuang decoction on the basis of conventional treatment.Neutrophil gelatinase-associated lipid carrier protein(NGAL),soluble thromboregulatory protein(sTM),leucine-richα-2 glycoprotein-1(LRG1),soluble tumor necrosis factor typeⅠreceptor(sTNF-RⅠ),and Rho kinase 2(ROCK2),complement factor H(CFH),immunoglobulin binding protein 1(IGBP1),24 h urinary protein quantification(24 hUPE),complement C3,kidney injury molecule-1 antibody(KIM-1)and Th17/Treg cell ratio were detected in both groups before and after treatment.Systemic lupus erythematosus disease activity score(SLEDAI),health survey brief form(SF-36)and clinical effect were compared between the two groups.Results:The study group contents of LRG1,IGBP1,HMGB1,ROCK2 and Th17/Treg were lower than those in conventional group(all P<0.05),while the contents of C3,CFH,sTNF-RⅠ and SF-36 scores in the study group were higher than those in the conventional group,the difference was statistically significant(all P<0.05).The contents of 24 hUPE,KIM-1,NGAL,sTM and SLEDAI score in the study group were lower than those in the conventional group,the difference was statistically significant(all P<0.05).The study group total effective rate was higher than that in conventional group,the difference was statistically significant(P<0.05).Conclusion:Shenqi Dihuang decoction combined with leflunomide can inhibits inflammation,regulate Th17/Treg cell balance,improve immune status,renal function and lupus nephritis activity,and improve clinical efficacy in the treatment of patients with both Qi and Yin deficiency lupus nephritis.

参考文献/References:

[1] 龙 洁,王 涛,朱长亮.西药联合免疫吸附法治疗系统性红斑狼疮肾炎的效果及对炎性细胞因子和免疫功能的影响[J].中国医药导报,2018,15(24):63-66.
[2] Soliman WM,Sherif NM,Ghanima IM,et al.Neutrophil to lym-phocyte and platelet to lymphocyteratios in systemiclupus ery-thematosus relation with disease activity and lupus nephritis[J].Reumatol Clin,2020,16(4):255-261.
[3] 余家静,李兴锐,谭 悦,等.来氟米特联合阿托伐他汀钙治疗系统性红斑狼疮肾炎对尿液指标及血脂的影响[J].临床误诊误治,2022,35(3):32-35.
[4] 肖 敏,雷 晴,严晓萍,等.温肾培土方治疗系统性红斑狼疮肾炎临床及血清抗C1q抗体表达水平影响研究[J].中国中西医结合皮肤性病学杂志,2019,18(6):599-601.
[5] 张 昊,刘兴林,施威振,等.来氟米特挽救性治疗难治性狼疮肾炎的临床疗效[J].实用临床医药杂志,2022,26(18):93-97.
[6] 赵亚峰,边 静,李娜梅,等.狼疮性肾炎患者中医证型与临床病理分析[J].陕西中医,2019,40(11):1555-1558.
[7] Bertsias GK,Tektonidou M,Amoura Z,et al.Joint european league against rheumatism and european renal association-european dialysis and transplant association(EULAR/ERA-EDTA)recommendations for the management of adult and paedi-atric lupus nephritis[J].Ann Rheum Dis,2012,71(11):1771-1782.
[8] 中华中医药学会肾病分会.狼疮性肾炎的诊断、辨证分型及疗效评定(试行方案)[J].上海中医药杂志,2008,42(2):9-10.
[9] 王 建,孙静静,李振军,等.狼疮性肾炎的临床病理特点及影响肾脏病理损害的危险因素分析[J].国际泌尿系统杂志,2020,40(4):672-675.
[10] Bai L,Li H,Li J,et al.Immunosuppressive effect of artemisinin and hydroxychloroquine combination therapy on IgA nephropathy via regulating the differentiation of CD4+ T cell subsets in rats[J].International Immunopharmacology,2019,70:313-323.
[11] Phatak S,Chaurasia S,Mishra SK,et al.Urinary B cell activating factor(BAFF)and a proliferation-inducing ligand(APRIL):Potential biomarkers of active lupus nephritis[J].Clin Exp Immunol,2017,187(3):376-382.
[12] 朱安琪,刘春莹.刘春莹主任医师治疗狼疮性肾炎经验摭拾[J].陕西中医,2020,41(7):951-953.
[13] Naranjo-Escobar J,Manzi E,Posada JG,et al.Kidney transplantation for end-stage renal disease in lupus nephritis,a very safe procedure:A single Latin American transplant center experience[J].Lupus,2017,26(11):1157-1165.
[14] 王海峰,东 淳,李春梦.血清β2-微球蛋白、尿微量白蛋白、尿N-乙酰-β-氨基葡萄糖苷酶联合检测在高血压早期肾损伤诊断中的临床价值[J].陕西医学杂志,2020,49(7):897-899.
[15] Deng DQ,Zhang PL,Guo Y,et al.A randomised double-blind,placebo-controlled trial of allogeneic umbilical cord-derived mesenchymal stem cell for lupus nephritis[J].Ann Rheum Dis,2017,76(8):1436-1439.
[16] 赵伟杰,王苗苗.连续性静脉-静脉血液滤过与泼尼松联合吗替麦考酚酯对重症狼疮性肾炎Alb、BUN、WBC的影响[J].中国现代医药杂志,2017,19(9):42-44.
[17] Li QY,Yu F,Zhou FD,et al.Plasmapheresis is associated with better renal outcomes in lupus nephritis patients with thrombotic microangiopathy a case series study[J].Medicine,2016,95(18):e3595.
[18] 马风英,张如峰,包淑贞.来氟米特联合激素治疗系统性红斑狼疮60例疗效及预后分析[J].陕西医学杂志,2017,46(8):1124-1126.
[19] 邓晓蔚,熊有明,覃应媛,等.参芪地黄汤加减联合泼尼松片治疗气阴两虚证活动期狼疮性肾炎疗效观察[J].现代中西医结合杂志,2016,25(33):3698-3700.
[20] 李清清,刘志斋,张 洁,等.中药药用活性成分的生物合成研究进展[J].中成药,2022,44(11):3603-3608.
[21] 徐东川,杨宗统,苏 敏.何首乌的现代药理作用及机制研究进展[J].西安文理学院学报:自然科学版,2022,25(2):79-83.
[22] 夏成云,周京国,张国元.重症狼疮肾炎患者血清TNF-α与sTNF-R水平及甲泼尼龙与环磷酰胺双冲击治疗对其的影响[J].中华风湿病学杂志,2006,10(2):91-94.
[23] 焦书丽,赵荣香,陈 竹,等.血清sTNF-R1、IGFBP-2、CFH对狼疮性肾炎患儿疾病活动度及预后的评估价值[J].国际检验医学杂志,2022,43(8):945-949.
[24] 边彩月,范文强,高 晓,等.益肾祛瘀化湿汤对狼疮性肾炎患者肾功能和NGAL、HMGB1、sTM、IGBP1水平的影响[J].中医药信息,2022,39(5):60-64.
[25] 罗亚丹.狼疮性肾炎肾小球系膜细胞增殖中HMGB1的作用机制研究[J].贵州医药,2022,46(5):675-676,679.
[26] 李华锋,莫怡浩,曾 敏,等.狼疮性肾炎患者血清LRG1、ROCK2表达与自身免疫抗体及疾病活动的相关性分析[J].中国中西医结合肾病杂志,2021,22(12):1067-1069.
[27] 刘 涛.补体C3及其相关信号通路在狼疮性肾炎中的机制研究[D].长春:吉林大学,2022.
[28] 李 莉,张老追,李玲玲,等.狼疮性肾炎患者血清和尿液中IL-32和KIM-1的表达水平及临床意义[J].河北医药,2019,41(3):361-364,369.
[29] 马 珍,杨朝美.血清α1-MG和NGAL在狼疮肾炎早期诊断中的临床价值[J].国际检验医学杂志,2022,43(23):2933-2936.
[30] 曾 睿,薛健楠.霉酚酸酯与厄贝沙坦联合治疗狼疮性肾炎对患者活动指数、肾脏病理指标、血清TGF-β1及sTM的影响[J].中国医学创新,2022,19(9):42-46.

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备注/Memo

备注/Memo:
基金项目:海南省卫生健康行业科研项目(19A200155,20A200199)
更新日期/Last Update: 2023-08-10