益气滋肾颗粒干预IgA肾病蛋白尿的临床疗效评价

IgA肾病最常见的中医证型为气阴两虚证（占66．81％）,其次是肝肾阴虚证（占17．99％）。1995年聂莉芳教授提出了以益气滋肾法为主治疗IgA肾病的中医方案,并研制了经验方——益气滋肾颗粒,15年来的临床观察和“十五”攻关期间的多中心临床试验,证实了益气滋肾颗粒具有控制IgA肾病血尿,改善患者症状方面具有较好作用,     

血尿康胶囊治疗IgA肾病血尿的临床疗效观察

目的：观察血尿康胶囊治疗IgA肾病血尿的临床疗效。方法：100例IgA肾病随机分为血尿康胶囊组（治疗组）50例,雷公藤多苷片组（对照组）50例,观察患者临床症状,中医症候积分,尿红细胞,24h尿蛋白定量,尿ANG、尿β2微球蛋白,血TGF-β1改善情况及疗效,辨证分型与疗效的关系。结果：血尿康胶囊有减轻IgA肾病血尿、蛋白尿作用,控制血尿疗效优于雷公藤多苷（P〈0.05）。改善中医临床症候积分、改善腰膝酸软等症状方面优于雷公藤多苷（P〈0.05）。降低血TGF-β1、尿NAG方面优于对照组（P〈0.05）。治疗组、对照组均能稳定BUN、Scr、Ccr水平,两组差异无统计学意义（P〉0.05）。治疗组中医症候、西医疗效有效率分别为98%,88%;对照组有效率74%,70%,治疗组优于雷公藤对照组（P〈0.05）。阴虚火旺、瘀血阻络两证型治疗组疗效亦优于对照组P〈0.05）。结论：血尿康胶囊可能通过多种调节机制,具有一定的减轻IgA肾病血尿的作用,值得进一步研究。     

中医“从咽论治”联合西药治疗IgA肾病的临床研究

目的:观察中医"从咽论治"联合西药治疗IgA肾病的临床疗效。方法:53例临床分型为"反复肉眼血尿型"或"尿检异常型"的IgA肾病患者,随机分为治疗组和对照组,对照组24例,给予氯沙坦+雷公藤治疗,治疗组29例,在对照组的基础上配合中医疏风清利,清热解毒治疗。3个月后观察两组疗效,比较血肌酐、尿蛋白、尿红细胞及肉眼血尿发生情况,同时观察肾小管间质损害程度对于疗效的影响。结果:两组患者治疗后尿蛋白、尿红细胞均较治疗前明显改善;治疗组患者尿红细胞、肉眼血尿的改善情况更优于对照组;肾小球、肾小管间质损伤越轻治疗效果越好。结论:中医"从咽论治"联合西药可以明显改善IgA肾病患者的临床症状,尤其对于血尿的防治效果更好,其治疗效果与肾小球、肾小管间质损伤程度密切相关。     

益气养肾汤治疗IgA肾病气阴两虚证临床研究

目的:以血管紧张素转化酶抑制剂洛汀新为阳性对照药,观察益气养肾汤治疗IgA肾病气阴两虚证的疗效及安全性。方法:将90例IgA肾病气阴两虚证患者随机分为治疗组和对照组各45例,治疗组采用益气养肾汤治疗,对照组给予洛汀新(盐酸贝那普利片,北京诺华制药有限公司生产)10 mg,每日1次。两组均治疗12周,比较治疗前后24 h尿蛋白定量,中医证候积分,血肌酐、尿素氮、肌酐清除率及肝功能等安全性指标及不良反应。结果:治疗组总体疗效明显优于对照组(P<0.01)。两组24 h尿蛋白定量较治疗前均明显下降(P<0.05),治疗组更显著,两组差异有统计学意义(P<0.05),有统计学意义。两组中医主症积分均较基线明显下降(P<0.05),两组下降幅度差异有统计学意义(P<0.05)。两组中医兼症积分较治疗前均明显下降(P<0.05),但组间差异无统计学意义(P>0.05)。两组的血肌酐、尿素氮等生化指标无明显变化(P>0.05)。两组不良事件发生率差异无统计学意义,且均未发生严重不良事件。结论:益气养肾汤可以显著降低IgA肾病气阴两虚证患者蛋白尿,明显改善患者中医证候疗效,作用优于洛汀新,且无严重不良反应,安全性好。     

中医益气固摄法治疗原发性肾病综合征的系统评价

目的:系统评价中医益气固摄法治疗原发性肾病综合征的疗效与安全性。方法:检索Cochrane图书馆临床对照试验数据库、Medline、CBM、CNKI、万方数据库、维普中文科技期刊数据库中关于益气固摄法治疗原发性肾病综合征的随机对照临床试验,评价纳入研究方法学质量,采用Rev Man 5.2软件Meta分析。结果:纳入12项临床研究,共936名患者,Meta分析显示:与对照组比较,益气固摄法可减少原发性肾病综合征患者24 h尿蛋白定量,升高血清白蛋白,提高总缓解率,降低胆固醇及三酰甘油。结论:中医益气固摄法在减少原发性肾病综合征蛋白尿、升高血清白蛋白、提高缓解率、降脂等方面上优于常规治疗组。     

通络保肾复方治疗早期糖尿病肾病的疗效观察

目的:观察通络保肾复方治疗早期糖尿病肾病的临床疗效。方法:选取符合诊断标准的早期糖尿病肾病56例,随机分为治疗组与对照组,两组给予西药厄贝沙坦基础治疗,治疗组在此基础上予以通络保肾复方治疗12周。观察治疗前后中医证候积分、尿微量白蛋白/尿肌酐、糖化血红蛋白、肝肾功能、血脂等指标的变化。结果:12周后,治疗组总有效率为71. 4%,优于对照组(P 0. 05)。与对照组比较,治疗组的尿微量白蛋白/尿肌酐明显下降;与治疗前比较,治疗组治疗后中医证候积分相比有所下降,差异有统计学意义(P 0. 05)。结论:通络保肾复方治疗早期糖尿病肾病疗效显著,能明显改善临床症状,降低蛋白尿。     

肾络宁治疗IgA肾病的临床疗效及安全性评价

目的：观察疏利少阳标本兼治法之肾络宁治疗IgA肾病气阴两虚兼有湿热证的临床疗效及安全性。方法：将90例IgA肾病气阴两虚兼有湿热证患者随机分为治疗组和对照组,治疗组在基础治疗的同时,加服肾络宁;对照组在基础治疗的同时,加服肾炎康复片。治疗6个月后,观察两组患者治疗前后中医证候积分变化,以及尿常规,24 h尿蛋白定量,尿NAG、GAL,肝肾功能等实验室指标的变化。结果：（1）临床疗效比较：肾络宁组总有效率为86.67%,对照组为80%;中医证候疗效比较：肾络宁组总有效率为93.33%,对照组为86.67%。（2）对尿红细胞及尿蛋白的影响：肾络宁可明显降低患者尿中红细胞数量及减少尿蛋白,且在改善血尿方面疗效优于肾炎康复片组。（3）肾功能的影响：本研究选择的IgA肾病患者,其肾脏病理分级多在三级以下,肾功能基本正常,故未能反映出肾络宁在此方面的疗效。（4）观察期间,两组患者均未发生不良反应。结论：肾络宁治疗IgA肾病气阴两虚兼有湿热证的临床疗效肯定,安全性良好;能较好地改善患者症状,有效地减少患者血尿、尿蛋白,保护肾小管功能,且在减少血尿方面优于对照组。     

槐杞黄颗粒对儿童孤立性血尿的疗效观察

目的 通过观察槐杞黄颗粒对孤立性血尿患儿的治疗效果,为临床治疗儿童孤立性血尿可能提供新的方法及思路.方法 将2007年至2014年收治入院的326例儿童孤立性血尿患者根据口服的药物不同随机分为槐杞黄治疗组、VitE治疗组及空白组,观察其血尿阴转时间及阴转率,分析槐杞黄颗粒治疗孤立性血尿阴转的肾脏病理.结果 随访6个月,空白组有10/104例患儿血尿转阴,槐杞黄治疗组有46/116例患儿血尿转阴,VitE治疗组有10/106例患儿血尿转阴.经槐杞黄治疗发生阴转的肾脏病理改变类型及病例数分别为MsPGN.28例,IgM肾病12例,IgA肾病4例,C3肾病2例.6例IgG肾病的孤立性血尿患儿口服槐杞黄未见血尿阴转病例,槐杞黄治疗组中28例阴转的MsPGN中表现为肾小球系膜IgG沉积10例中未见阴转病例.结论 槐杞黄颗粒对儿童孤立性血尿阴转有一定的疗效,可能对于免疫机制介导的血尿疗效更好.槐杞黄颗粒对于IgM肾病效果较好,对于IgA肾病可能有效.     

IgA肾病治疗的思考

IgA肾病是我国最常见的原发性肾小球疾病。主要以IgA免疫球蛋白沉积于肾小球为病理特征;以血尿、蛋白尿、高血压和肾功能损害为主要临床表现。每次血尿和(或)蛋白尿发作是肾小球损伤的标志,如不有效进行干预,可逐渐出现肾功能损害。控制血尿和(或)蛋白尿,降低尿检异常发生的频率,是治疗原发性IgA肾病及防止肾脏慢性化损伤的关键。ACEI/ARB在减少IgA肾病患者的蛋白尿、保护残存肾功能、延缓其进展为终末期肾病等方面优于其他降压药。IgA肾病如有较多新月体形成、明显血尿和蛋白尿,可考虑使用糖皮质激素和(或)与免疫抑制剂。由于IgA肾病是一个慢性化过程,长期随访对改善该病的预后显得尤为重要。     

固本通络冲剂治疗IgA肾病的疗效特点分析

目的：研究中药复方固本通络冲剂治疗IgA肾病的疗效特点。方法：对肾活检证实的IgA肾病息随机分为固本通络冲剂治疗组(50例)及潘生丁对照组(30例)进行疗效特点分析，疗程3个月。结果：其疗效特点为对病理损害轻，临床表现为持续镜下血尿伴少量蛋白尿，中医辨证为气阴两虚的病人疗效最好；而对病理损害重，临床表现为肾病综合征，中医辨证为脾肾气虚疗效差。结论：固本通络冲剂对临床表现为持续镜下血尿伴少量蛋白尿，中医辨证属气阴两虚更为适宜。     

健脾补肾通络方治疗脾肾阳虚兼瘀型、进展性IgA肾病临床观察

目的：观察中药健脾补肾通络方干预脾肾阳虚兼瘀型、进展性IgA肾病的临床疗效。方法：回顾性分析2009年1月～2012年6月间,中医辨证为脾肾阳虚兼瘀型、进展性的原发性IgA肾病共75例。依据治疗方法,将IgA肾病患者分为单纯中药治疗组与中西结合治疗组,分析两组患者的疗效。结果：中药组有效率为68.42%,中西结合组有效率为67.57%。两组与治疗前相比较,对于降低尿蛋白、尿红细胞及升高eGFR方面差异都具有统计学意义（P〈0.05）,但对于不同的病理分级,两组的疗效不同。结论：健脾补肾通络方治疗脾肾阳虚兼瘀型进展性IgA肾病有一定疗效。     

尿激酶联合缬沙坦对IgA肾病尿检异常型的疗效分析

目的小剂量尿激酶联合缬沙坦治疗IgA肾病尿检异常型的临床疗效。方法将60例经肾脏组织活体检查并结合临床诊断为原发性IgA肾病尿检异常的患者,分为尿激酶联合缬沙坦治疗组（治疗组）和单用缬沙坦治疗组（对照组）,每组各30例。比较2组的临床疗效。结果治疗组尿红细胞（RBC）计数与24h尿蛋白定量在第3、6及12个月均较治疗前明显下降（P〈0.05）,而对照组尿RBC计数与24h尿蛋白定量在治疗前后比较虽有下降,但无统计学意义（P〉0.05）。结论通过尿激酶联合缬沙坦治疗,能有效减少IgA肾病尿检异常患者的蛋白尿和镜下血尿。     

Urinary liver-type fatty acid-binding protein: discrimination between IgA nephropathy and thin basement membrane nephropathy

BACKGROUND: Microscopic hematuria without proteinuria is a common clinical finding in cases of immunoglobulin A (IgA) nephropathy and of thin basement membrane nephropathy. Liver-type fatty acid-binding protein (L-FABP) is expressed in renal proximal tubules and is reported to be a useful marker of the progression of chronic glomerulonephritis. AIM: To assess urinary L-FABP levels for differential diagnosis in patients with microscopic hematuria but without proteinuria. METHODS: This was a multi-center retrospective study. Thirty adult patients who underwent renal biopsy for microscopic hematuria and 20 healthy adult volunteers were included in this study. Urinary L-FABP levels were measured by enzyme-linked immunosorbent assay and compared, particularly between those diagnosed with IgA nephropathy and those diagnosed with thin basement membrane nephropathy. RESULTS: Twelve (40%) patients had IgA nephropathy, 6 (20%) had thin basement membrane nephropathy and 12 (40%) had normal biopsy findings. The urinary L-FABP level was significantly higher in patients with IgA nephropathy (38.4 +/- 26.8 microg/g Cr) than in healthy subjects (5.8 +/- 4.0 microg/g Cr) (p < 0.01); however, the level in patients with thin basement membrane nephropathy or normal biopsy results was comparable to that in healthy subjects. Follow-up data were available for 11 of the 12 patients with IgA nephropathy who initially had no proteinuria. After 24 months, 4 of the 11 were found to have proteinuria, and the urinary L-FABP level had increased from 40.6 +/- 30.5 microg/g Cr to 58.8 +/- 40.5 microg/g Cr (p < 0.01). CONCLUSIONS: Our data suggest that the urinary L-FABP level can be used to discriminate between IgA nephropathy and thin basement membrane nephropathy in patients with microscopic hematuria.     

Clinicopathological features and the prognosis of IgA nephropathy in Japanese children on long-term observation

AIMS: Clinicopathological features were investigated to clarify the ultimate prognosis and prognostic indicators for patients with IgA nephropathy in Japanese children. METHODS: We evaluated the outcomes of 181 patients in whom IgA nephropathy was diagnosed before the age of 15 years since September 1979 and followed-up at least for three years with regard to clinical data at the onset of symptoms and renal histologic data. RESULTS: After mean follow-up of 7.3 years from onset, 91 patients of 181 (50.3%) were in clinical remission at the last examination, 24 (13.2%) had isolated hematuria, 59 (32.6%) had hematuria and proteinuria. Eighteen of 59 (9.9%) had proteinuria more than 1 g per 24 hours. Hypertension was observed in 12 cases and 7 (3.9%) developed end-stage renal disease. Except 7, no patient had reduced renal function and elevated serum creatinine at the final follow-up. Predicted renal survival rate from onset was 92.3% at 10 years and 89.1% at 20 years. In multivariable analysis, age at onset and chronic changes of tubulointerstitium were associated with poor outcome. CONCLUSIONS: Of 181 children with IgA nephropathy, 50% regressed, remaining 46% had hematuria and/or proteinuria and 4% of patients lapsed into end-stage renal disease. Our results indicate that childhood IgA nephropathy has a benign course and the risk for end-stage renal disease is lower than that of adults. Age at onset and tubulointerstitial lesions were the strong predictors of a progressive course of childhood IgA nephropathy.     

Randomised controlled trial of leflunomide in the treatment of immunoglobulin A nephropathy

AIM: To investigate the effect of leflunomide for treatment of immunoglobulin A (IgA) nephropathy. METHODS: Sixty IgA nephropathy patients were divided into two groups at random. Patients in the test group received leflunomide and patients in the control group received fosinopril. Clinical data were obtained at weeks 2, 4, 6, 8, 12, 16, 20, 24 and 28. RESULTS: The complete remission rate was 62.1% and the total effectiveness rate was 72.4%. In the leflunomide group, proteinuria significantly decreased from 1.66 +/- 0.42 g to 0.60 +/- 0.68 g (P < 0.05). The efficacy rate of leflunomide compared with fosinopril in treating IgA nephropathy was not statistically different (P > 0.05). Side-effects were mild in both treatment groups. CONCLUSION: These preliminary results are encouraging, but further randomised studies are required before leflunomide can be recommended for the treatment of IgA nephropathy.     

Proposal of remission criteria for IgA nephropathy

Background

The remission criteria of immunoglobulin A (IgA) nephropathy have varied depending on the clinical study. Therefore, nephrologists cannot make a uniform assessment of treatment outcomes and the standardization of explanations of the condition is difficult in patients with IgA nephropathy. This study aims to propose clinical remission criteria for IgA nephropathy based on a nationwide opinion survey in Japan regarding IgA nephropathy remission/relapse.

Method

This nationwide survey was sent to 312 teaching facilities of the Japanese Society of Nephrology by Progressive Renal Disease Research, Research on Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan.

Results

Valid answers were obtained from 193 facilities (61.9 %) (136 internal medicine facilities and 57 pediatric facilities), of which 134 (69.4 %) thought that both hematuria and proteinuria should be used in the remission standards. Approximately half of the survey respondents shared the opinion on standards of negative results for hematuria and proteinuria and the duration and frequency of these conditions.

Conclusion

In this paper, we propose a standardized set of criteria for defining IgA nephropathy remission: three consecutive negative results over a 6-month period in urinary occult blood tests; urinary sediment red blood cell count of <5/high-power field (hematuria remission); and urinary protein of <0.3 g/day (g/g Cr; proteinuria remission). Clinical remission is defined as cases with both hematuria and proteinuria remission. These consensus-based remission criteria should be verified in future studies. In the meantime, they may be useful in predicting therapeutic outcome in cases of IgA nephropathy.     

Discriminant analysis of clinical markers before renal biopsy in patients with IgA nephropathy

Discriminant analysis of clinical markers before renal biopsy in patients with IgA nephropathy is described. Sixty eight patients with IgA nephropathy (IgA nephropathy group) and 66 patients with other chronic glomerulonephritis (non-IgA nephropathy group) were examined. The discriminant analysis was applied to separate those two groups by using twenty clinical parameters as well as binding capacity of serum IgA to the glomeruli of renal specimens. Binding of serum IgA of patients to the glomeruli obtained from patients with IgA nephropathy was performed using avidin-biotin immunofluorescence. Among twenty clinical markers, the levels of serum IgA and creatinine, and degree of microhematuria in IgA nephropathy group were significantly higher than those in non-IgA nephropathy group Furthermore, the positive incidence of serum IgA binding of IgA nephropathy group was significantly higher than that of serum IgA binding of non-IgA nephropathy group. The correct classification rate were 79.10% using five clinical markers including serum IgA, microhematuria, serum C4, quantitation of proteinuria and degree of proteinuria. It is indicated that the levels of serum IgA and the binding of serum IgA to the glomeruli were considered to be major markers for clinical diagnosis of patients with IgA nephropathy It was concluded that the discriminant analysis before renal biopsy was useful for diagnosis of IgA nephropathy.     

儿童隐匿性肾炎的临床和病理研究

目的：探讨儿童隐匿性肾炎的临床和肾组织病理改变特点及其关系。方法：回顾性分析肾活检的323例隐匿性肾炎患儿的临床和肾组织病理改变情况。结果：323例隐匿性肾炎患儿中，单纯性血尿229例，单纯性蛋白尿19例，血尿伴蛋白尿75例。肾组织病理改变类型包括：轻微病变103例（31，89％）、基本正常74例（22．91％）、IgA肾病（IgAN）73例（22．60％）、薄基底膜病（TBMN）27例（8．36％）、系膜增生性肾炎（MsPGN）18例（5．57％）、局灶增生性肾炎（FPGN）10例（3．10％）、膜性肾病（MN）8例（2，48％）、局灶节段肾小球硬化（舢）8例（2．48％）、微小病变（MCD）1例（0，31％）、IgM肾病（IgMN）1例（0．31％）。单纯性血尿组中肾组织结构基本正常的比例较血尿伴蛋白尿组明显偏高（P〈0，01）；血尿伴蛋白尿组中IgAN的比例高于单纯性血尿组和单纯性蛋白尿组（分别P〈0．01、P〈0．05）。IgAN的Lee分级：单纯性血尿组中Ⅰ、Ⅱ级85．00％，Ⅲ级及以上15．00％；血尿伴蛋白尿组中Ⅰ、Ⅱ级58．10％，Ⅲ级及以上41．90％，明显高于单纯性血尿组（x^2=6．47，P〈0．05）。结论：儿童隐匿性肾炎的病理以轻微病变、基本正常、IgAN为常见表现，血尿伴蛋白尿患儿病变较单纯性血尿患儿为重。     

Steroid pulse therapy combined with tonsillectomy in a patient with IgA nephropathy complicated with tuberculous pleurisy

We report a case of IgA nephropathy with tuberculous pleurisy that was treated with steroid pulse therapy combined with tonsillectomy. A 27-year-old female was referred to our hospital because of hematuria and proteinuria. Her urinalysis showed mild proteinuria (0.7 to 0.9 g/day) with dysmorphic red blood cells and cellular casts. Her serum creatinine level was within the normal range. Renal biopsy specimens revealed mild mesangial proliferation with cellular crescent and adhesion of glomeruli to the Bowman's capsule. Tubulointerstitial changes including mononuclear cell infiltration and tubular atrophy were also observed. Immunohistochemical staining of IgA and C3 was detected in the mesangial area, leading to the diagnosis of IgA nephropathy. She had a past history of tuberculous pleurisy at 13 years of age and had taken antituberculosis drug for one and a half year. Although treatment with angiotensin receptor antagonist was started, the amount of proteinuria was not changed. Steroid pulse therapy with tonsillectomy followed by oral prednisolone 20 mg/day was conducted. Proteinuria and hematuria gradually decreased. Her respiratory status and chest X-ray had been closely followed up by her respiratory physician. After one and a half years of treatment with low-dose prednisolone, her urinalysis became almost normal. Recurrence of tuberculosis was not observed during the follow-up period. The successful outcome of this case encouraged us to treat IgA nephropathy with a past history of tuberculosis using interventions including steroid pulse therapy.     

伴有新月体形成的原发性IgA肾病的临床与病理特点及预后分析

目的观察伴有新月体形成的原发性IgA肾病的临床、病理特点,分析其对激素及环磷酰胺治疗的反应。 方法收集包头医学院第一附属医院1997年8月至2015年04月收治的80例经肾活检确诊为原发性IgA肾病并伴新月体形成的患者,并依据新月体累及的肾小球比例进行分组,新月体占受累肾小球比例≥50% (A组) 24例;新月体累及的肾小球比例<50%(B组) 56例。肾小球系膜增生、肾小管间质病变采用R.Katafuchi标准积分量化。对两组的临床及病理特点进行比较。治疗方案：将A、B两组再分为单纯糖皮质激素(激素)治疗组,激素＋环磷酰胺治疗组,分别比较不同治疗方案对各组的疗效。A、B组各有24例患者接受了随访。应用SPSS软件进行统计学分析。 结果①临床方面：32例(40%)患者有镜下血尿＋蛋白尿,76例(95%)患者尿蛋白≥2 g/24 h,32例(40%)患者有肉眼血尿;水肿、高血压、肾功能异常者超过半数。A组尿蛋白量及血清肌酐明显高于B组(t＝1.890,t＝2.570; P<0.05),血清白蛋白及肾小球滤过率明显低于B组(t＝2.681, t＝3.014;P<0.05)。②病理方面：所有受累肾小球的新月体面积百分比为5.92%～88.9%,其中A组为52.6%～88.9%, B组为5.92%～48.9%;与B组比较A组肾小管间质损害更严重,两组比较差异有统计学(P<0.05)。③治疗情况：A组及B组经激素或激素＋环磷酰胺治疗后,尿蛋白定量均明显减少(P<0.05) ;单纯激素治疗后A组血清肌酐较治疗前有明显下降(t＝3.243,P<0.05)。随访2～4年时,A组8例患者出现血清肌酐升高,达透析指征,1例死亡;B组2例患者出现血清肌酐升高(1例原有轻度升高,1例新出现血清肌酐升高)。 结论IgA肾病患者随着新月体占受累肾小球比例的增加,肾小管间质病理损害及临床表现亦逐渐加重且预后不佳;激素治疗可减少伴有大新月体形成的原发性IgA肾病的蛋白尿并有可能改善其肾功能。