中西医结合治疗原发性膜性肾炎肾病综合征的临床观察

目的：探讨中西医结合治疗原发性膜性肾炎肾病综合征的临床疗效。方法：对48例原发性膜性肾炎肾病综合征分为治疗组和对照组。治疗组24例，用强的松、环磷酰胺并辨证加用中药；对照组24例，单纯用西药治疗，观察临床缓解率和副反应。结果：治疗组完全缓解率为54．11％，总缓解率为91．6％；对照组完全缓解率41．6％，总缓解率66．6％。治疗组总缓解率高于对照组（P＜0．05）；治疗组副反应率25％，对照组为66．6％。治疗组副反应低于对照组（P＜0．01）。结论：中西医结合是治疗原发性膜性肾炎肾病综合征的有效方法。     

中西医结合治疗成人原发性 系膜增生性肾炎肾病综合征的临床观察

目的探讨中西医结合治疗成人原发性肾病综合征(NS)病理类型为系膜增生性肾炎(MesPGN)临床疗效。方法对48例成人原发性系膜增生性肾炎肾病综合征(MesPGN－INS)分为治疗组和对照组。治疗组24例用强的松和环磷酰胺(CTX)，并辨证加用中药；对照组24例单纯用西药治疗，观察临床缓解率和副反应。结果治疗组完全缓解率为54.1％，总缓解率为91.6％；对照组完全缓解率为33.3％，总缓解率为62.4％。治疗组完全缓解率和总缓解率显著优于对照组(P＝0.016；P＝0.008)。治疗组副反应率为37.5％，对照组为87.5％；治疗组副反应极显著低于对照组(P＜0.001)。结论中西医结合是治疗MsPGN－INS的有效方法。     

中西医结合治疗原发性难治性肾病综合征的临床观察

目的 :观察中西医结合治疗原发性难治性肾病综合征 (ⅡNS)的临床疗效。方法 :6 2例ⅡNS患者随机分为治疗组和对照组。两组患者均给予激素及环磷酰胺治疗 ,治疗组 (31例 )辨证的基础上加用中药治疗。观察临床缓解率、副反应率及复发率。结果 :治疗组完全缓解率 (5 8.1% ) ,对照组 (4 5 .2 % ) ,两组比较无统计学差异 (P >0 .0 5 ) ;治疗组总缓解率 (87.1% ) ,对照组 (5 8.1% ) ,两组比较有统计学差异 (P <0 .0 1)。治疗组副反应率 (4 5 .2 % ) ,与对照组(83.9% )比较有统计学差异 (P <0 .0 1)。治疗组复发率 (2 2 .2 % )与对照组 (5 0 % )比较有统计学差异 (P <0 .0 1)。结论 :中西医结合治疗ⅡNS优于单纯西医治疗     

中西医结合治疗老年人肾病综合征98例疗效观察

目的 :比较中西医结合和单纯西医治疗老年人原发性肾病综合征 (PNS)的临床疗效。方法 :98例老年人PNS随机分为治疗组和对照组。治疗组 (4 9例 )用强的松、环磷酰胺 (CTX)并分阶段辨证配合中药治疗。对照组(4 9例 )单用西药治疗。观察临床缓解率、不良反应率、复发率及缓解时间。结果 :治疗组完全缓解率 (5 9.2 % )和总缓解率 (85 .7% )均显著高于对照组 (38.7%、6 3.2 % ,P <0 .0 5 )。治疗组不良反应率 (36 .7% )明显低于对照组 (80 .1% ,P <0 .0 1)。随防 (4 2± 11.6 4 )月后 ,治疗组复发率 (10 .3% )与对照组 (2 1% )比较无统计学差异 (P >0 .0 5 )。但治疗组平均缓解期为 (36 .7± 4 .6 )月 ,较对照组 (15 .2± 4 .4 )月显著延长 (P <0 .0 1)。结论 :中西医结合治疗老年人肾病综合征优于单纯西医治疗。     

补气活血护肾方合他克莫司治疗特发性膜性肾病的临床观察

目的:探讨补气活血护肾方合他克莫司治疗特发性膜性肾病(IMN)的疗效及不良反应。方法:选择42例于2014年1月~2015年6月期间在河南中医学院第一附属医院肾脏病诊疗中心就诊,临床表现为肾病综合征,排除继发因素,并经肾活检证实的特发性膜性肾病患者。随机分入治疗组(n=23)和对照组(n=19),两组均口服他克莫司、五酯软胶囊,治疗组加用补气活血护肾中药复方。观察两组患者治疗6个月后的疗效及不良反应情况,每个月检测24 h尿蛋白定量、血清白蛋白、谷丙转氨酶、谷草转氨酶、血清肌酐及血糖。结果:治疗6个月,治疗组完全缓解6例(26.09%),部分缓解10例(43.49%),对照组完全缓解5例(26.32%),部分缓解7例(36.84%),治疗组和对照组总缓解率分别是:69.58%,63.16%(P0.05)。两组血清肌酐、血糖、谷丙及谷草转氨酶比较差异无统计学意义(P0.05)。结论:他克莫司合五酯软胶囊是治疗膜性肾病的有效方案,而在此治疗方案基础上加用补气活血护肾方具有更好的临床疗效,不良反应少。     

中西医结合治疗成人激素依赖性原发性肾病综合征40例疗效观察

目的 :探讨中西医结合治疗成人激素依赖性 (SD)原发性肾病综合征 (PNS)的临床疗效。方法 :4 0例成人SD -PNS予中西医结合治疗 (简称治疗组 ) ,对照组 4 2例单纯西医治疗 (简称对照组 ) ,观察两组治疗后缓解率、复发率、不良反应率。结果 :治疗组总缓解率为 77.2 % ,对照组为 35 .7% ,有统计学差异 (P <0 .0 1)。治疗组 6个月、12个月、4 8个月时复发率分别为 0 ,3.2 3% ,9.6 8% ;对照组为 13.3% ,2 0 % ,33.3% ,2组比较有统计学差异 (P <0 .0 5 ) ;治疗组不良发生率为 32 .7% ,对照组为 6 9.2 % ,治疗组显著低于对照组 (P <0 .0 1)。结论 :中西医结合治疗成人激素依赖性原发性肾病综合征疗效满意。     

中西医结合治疗尿酸性肾病的临床观察

目的:观察中西医结合治疗尿酸性肾病的临床疗效 .方法:将45例尿酸性肾病患者随机分为结合组和西医组.结合组23 例用中药补肾化湿通络汤加西药别嘌呤醇.西医组22例单纯用西药别嘌呤醇治疗,两组8周后观察疗效.结果:结合组总缓解率86.9%,显效率47.8%,西医组总缓解率54.5%,显效率22.3%.结合组与西医组比较有统计学差异(P＜ 0.05).结论:中西医结合治疗痛风性肾病疗效显著,尤其是改善肾功能疗效肯定.     

成人常复发性原发性肾病综合征的中西医结合治疗疗效观察

目的 :比较中西医结合疗法和单纯西医药疗法治疗成人常复发性原发性肾病综合征 (FRNS)的疗效。方法 :6 0例FRNS病人随机分为治疗组 (30例 ,采用中西医结合治疗 )和对照组 (30例 ,采用单纯西药治疗 ) ,比较二组患者临床疗效。结果 :治疗组完全缓解率为 76 .7% ,缓解后 6个月、1年、4年复发率分别为 0、4 .3%、17.4 % ,平均缓解期为 (33.7± 3.6 )月 ,激素不良反应发生率 2 6 .7% ;对照组缓解率为 4 0 % ,6个月、1年、4年复发率分别为 16 .7%、4 1.7%、5 8.3% ,平均缓解期为 (12 .5± 3.6 )月 ,激素不良反应发生率为 6 3.3%。治疗组均明显优于对照组 ,P <0 .0 1。结论 :中西医结合治疗FRNS疗效较为满意。     

激素抵抗性肾病综合征的中西结合治疗

目的:探讨激素抵抗性肾病综合征(NS)有效的治疗方法.方法:将60例激素抵抗性肾病综合征患者随机分为中西医结合治疗组(治疗组)和西医治疗组(对照组).治疗组30例在规范应用西药的基础上再加用中药治疗.对照组30例则单纯用西药治疗.结果:治疗组完全缓解率为30%,总有效率为80%;对照组的完全缓解率为10%,总有效率为55%.治疗组明显优于对照组(P<0.01).治疗组的副反应率为20%,对照组为90%,明显高于治疗组(P<0.01).结论:中西医结合治疗不仅可以提高激素抵抗性NS的有效率,还可以降低西药的毒副反应.     

中西医结合治疗IgA肾病的临床观察

目的 :探讨中西医结合治疗IgA肾病的临床疗效。方法 :对 6 2例IgA肾病分为治疗组和对照组。治疗组 32例 ,用西医对症治疗加服中药 ;对照组 30例 ,单纯用西药治疗。结果 :治疗组总有效率为 84 .38% ,对照组总有效率为 2 3.33% ,治疗组疗效明显优于对照组 (P <0 .0 1)。结论 :中西医结合是治疗IgA肾病的有效方法     

黄芪与丹参注射液联合治疗狼疮肾炎的临床观察

目的 :观察黄芪与丹参注射液联合治疗狼疮肾炎的疗效。方法 :将 6 6例患者随机分为治疗组 34例和对照组 32例 ,两者均使用激素标准疗程和环磷酰胺冲击治疗 ,治疗组加黄芪和丹参注射液静脉滴注 ,对照组用潘生丁和复合维生素B治疗。结果 :治疗组有效率 94 .12 % ,对照组有效率 71.875 % (P <0 .0 5 ) ;治疗组复发率 8.82 % ,对照组复发率 2 8.13% (P <0 .0 5 )。结论 :黄芪和丹参注射液联合静点治疗狼疮性肾炎可以降低激素和环磷酰胺的副作用 ,减少感染等并发症发生率 ,降低复发率     

Predictive factors analysis of the efficacy of cyclophosphamide combined with glucocorticoids in the treatment of idiopathic membranous nephropathy

Objective To investigate the predictive factors affecting the efficacy of cyclophosphamide (CTX) combined with glucocorticoids in the treatment of idiopathic membranous nephropathy (IMN), and to evaluate the efficacy of calcineurin inhibitor (CNI) adjustment due to poor treatment. Methods A retrospective cohort study was conducted. Two hundreds and twenty-eight patients with IMN diagnosed by renal biopsy in the People's Hospital of Guangxi Zhuang Autonomous Region from January 1, 2007 to December 1, 2016 were enrolled. All subjects were treated with CTX in combination with glucocorticoids. The patients were divided into two groups: remission group and no remission group. Multivariable logistic regression analysis was used to determine the baseline clinical-pathological influencing factors for the remission of IMN in the enrolled patients. Results The number of total remission (including complete and partial remission) of the first CTX combined with glucocorticoid treatment in 228 patients with IMN was 188(82.5%). Among them, 141 patients (61.8%) had complete remission (CR), the median time for CR was 8(6, 12) months, and the median time for partial remission (PR) was 3(1, 4) months. The median follow-up time for this study was 25(13, 43) months. Compared with the remission group, the serum albumin level was lower in the non-remission group, the 24-hour urine protein content, the blood complement C3 and C4 levels were higher, and the pathological stage was milder (all P﹤0.05). Multivariate logistic regression analysis suggested that the levels of baseline serum albumin, complement C4, and pathological stage were independent predictors of clinical remission in IMN patients. Twenty-four non-remission patients were treated with CNI. The overall response rate was 66.7%(16/24) at 6 months and 77.3%(17/22) at 12 months. Conclusions The levels of baseline albumin, blood complement C4, and pathological stage were independent predictors of clinical remission in IMN patients treated with CTX plus glucocorticoids. The non-remission patients with CTX combined with glucocorticoid therapy can still achieve a higher response rate after adjusting for CNI.     

中西医结合治疗IgA肾病54例临床观察

目的 :比较西医常规疗法和中西医结合疗法治疗IgA肾病的临床疗效 ,并探讨中医辨证分型与疗效的关系。方法 :将 72例患者按 3∶1比例随机分为治疗组和对照组。对照组用常规西医治疗 ,治疗组在对照组基础上辨证服用中药 ,疗程 2个月。观察两组临床疗效及尿分析、肾功能等变化 ,并分析中医辨证分型与疗效的关系。结果 :治疗组总有效率为 90 .7% ,而对照组仅为 6 6 .7% ,有统计学差异 (P <0 .0 5 )。两组在减少 2 4h尿蛋白定量方面 ,有统计学差异 (P <0 .0 0 1)。两组均能减少尿RBC计数 ,且治疗组有统计学差异 (P <0 .0 0 1) ,而对照组无统计学差异 (P >0 .0 5 )。两组治疗后Scr、BUN有所下降 ,但与治疗前比较 ,无统计学差异 (P >0 .0 5 )。治疗组在减少 2 4h尿蛋白定量和尿RBC计数方面优于对照组 ,有统计学差异 (P <0 .0 1和P <0 .0 0 1)。中医辨证分型中疗效以风邪袭肾最好 ,脾肾阳虚最差 ,但无统计学差异 (P >0 .0 5 )。结论 :中西医结合疗法治疗IgA肾病 ,疗效优于单纯西医疗法。中医辨证分型与疗效关系不大 ,有待进一步研究     

来氟米特与环磷酰胺治疗膜性肾病的疗效比较

目的：评价来氟米特（LEF）与环磷酰胺（CTX）分别联合泼尼松（PED）治疗成年人特发性膜性肾病（IMN）的疗效及安全性。方法：80例原发性肾病综合征患者经肾活检确诊为IMN,在诊断上排除了继发性膜性肾病,随机分两组：LEF组40例采用LEF＋PED治疗,CTX组40例采用CTX＋PED治疗。治疗期间及治疗前后,监测血常规、尿常规、24h尿蛋白定量、血白蛋白、血脂、肝肾功能,6个月后行疗效和安全性的评价。结果：（1）LEF组40例中失访1例,完成6个月治疗39例。CTX组40例中因不耐受药物不良反应中途退出7例,完成6个月治疗33例;（2）治疗3个月后LEF组的完全缓解率显著低于CTX组（χ2=4.3516,P〈0.05）,LEF组的未缓解显著高于CTX组（χ2=4.9059,P〈0.05）;治疗6个月后两组的完全缓解率、未缓解率差异无统计学意义（P均〉0.05）;（3）治疗6个月后,两组患者的24hUpro、Alb、TC、TG均较治疗前显著改善（LEF组：t=7.0841,9.0998,8.4412,7.7942;CTX组：t=8.7823,9.2826,7.1252,6.9731,P均〈0.01）,CTX组的改善略微优于LEF组（t=1.8112,1.6780,0.9881,1.6778,P均〉0.05）,但差异均无统计学意义;（4）CTX组中因不良反应中途退出的比率（7/40）显著高于LEF组（0/40）,（χ2=5.6360,P〈0.05）;LEF组不良反应发生率（5/39）显著低于CTX组（13/40）,（χ2=4.3468,P〈0.05）,差异均有统计学意义。结论：来氟米特治疗膜性肾病,与环磷酰胺的临床疗效相似,不良反应较少,但起效稍慢。     

Tacrolimus versus cyclophosphamide for patients with idiopathic membranous nephropathy and treated with steroids: a systematic review and meta-analysis of randomized controlled trials

BackgroundThe therapeutic effects of tacrolimus (TAC) versus cyclophosphamide (CTX) were not fully illustrated for patients with idiopathic membranous nephropathy (IMN).MethodsThe PubMed, EmBase, Cochrane library, and CNKI were systematically searched throughout March 2020 for randomized controlled trials evaluating the therapeutic effects of TAC versus CTX for IMN patients treated with steroids. The pooled relative risks (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using the random-effects model.ResultsTwelve trials recruited a total of 868 IMN patients were identified and contained in final meta-analysis. Patients in TAC group was associated with an increased incidence of overall remission (12 trials: 868 patients; RR: 1.21; 95% CI: 1.11–1.31; p < 0.001) and complete remission (12 trials: 868 patients; RR: 1.50; 95% CI: 1.25–1.80; p < 0.001). Moreover, we noted TAC therapy significantly reduced urinary protein excretion (9 trials: 567 patients; WMD: −1.06; 95%CI: −1.41 to −0.71; p < 0.001), and increased serum albumin (9 trials: 567 patients; WMD: 5.37; 95%CI: 2.97 to 7.77; p < 0.001) than CTX therapy. Furthermore, no significant difference between TAC and CTX for serum creatinine was detected (6 trials: 378 patients; WMD: 0.15; 95%CI: −3.46 to 3.75; p = 0.936). Finally, the risk of alopecia (p = 0.008), infection (p = 0.045), leukocytosis (p = 0.002), and elevated ALT/AST (p = 0.011) in TAC group was significantly lower than CTX group, whereas TAC was associated with an increased risk of tremor than CTX (p = 0.010).ConclusionsThis study found IMN patients treated with TAC combined with steroids provides a better therapeutic effect and less adverse events than those treated with CTX combined with steroids, with moderate-certainty evidence.     

中西医结合治疗原发性肾病综合征180例观察

目的：为了探讨原发性肾病综合征（PNS）的治疗措施,提高其疗效,方法：将1995年3月－2000年3月PNS患随机分组,进行分析研究,结果：（1）中西医结合组完全缓解63．89％,部分缓解24．44％,总有效率为88．33％,显高于单纯西药组的42．15％,19．01％和61．16％（P＜0．01）。（2）中西医结合组复发率及激素不良反应发生率分别为17．39％和18．33％,明显低于单纯西药组的68．63％和78．51％（P＜0．01）。结论：中西医结合治疗PNS疗效满意。     

环孢霉素A与环磷酰胺联合激素治疗膜性肾病的疗效比较

目的：比较环孢霉素A（CSA）与环磷酰胺（CTX）联合激素治疗成年人特发性膜性肾病（IMN）的疗效和安全性。方法：76例原发性肾病综合征患者经肾活检确诊为IMN,在诊断上排除了继发性膜性肾病,单用激素治疗无效或复发,随机分两组分别予CSA联用糖皮质激素治疗（CSA组）或CTX联用糖皮质激素治疗（CTX组）,疗程至少12个月。观察各组的24h尿蛋白定量、血浆白蛋白、肾功能、血糖、白细胞总数及其不良反应,以及治疗前后的完全缓解率、部分缓解率。全部患者且在正式进入研究治疗前未用或已停用类固醇激素和细胞毒药物达半年以上。结果：治疗3个月末,CsA组的24h尿蛋白、胆固醇、三酰甘油显著低于CTX组（P均〈0.01）,血清白蛋白显著高于CTX组（P〈0.01）。两组患者的血肌酐比较差异无统计学意义（P〉0.05）,而CTX组的WBC显著低于CsA组（P〈0.01）。CsA组完全缓解率显著高于CTX组（χ2=4.6317,P〈0.05）。治疗12个月末两组的完全缓解率差异无统计学意义（χ2=1.2575,P〉0.05）。CsA组的不良反应发生率（8/40=20.0%）显著低于CTX组（15/36=41.7%）（χ2=4.2146,P〈0.05）。结论：与CTX相比,CsA联用糖皮质激素对IMN治疗12个月的总体疗效相当,但CsA起效更快,近期疗效更好,不良反应更小。CsA≤5mg.kg-1.d-1用于肾功能正常IMN患者是安全有效的。     

狼疮性肾炎中西医结合疗法的临床疗效：荟萃分析

目的：探讨狼疮性肾炎（lupus nephritis,LN）中西医结合（traditional chinese medicine and western medicine,TCM-WM）疗法的临床疗效。方法：对1999年～2011年12年间为中国期刊全文数据库、万方数据资源系统所收录的核心期刊,具有西药对照的中西医结合治疗LN论文进行荟萃分析。结果：最终有12篇文献被纳入研究,共对742例LN患者包括治疗组409例,对照组333例进行分析。中西医结合治疗LN疗效显著OR=0.22（0.14～0.35,P〈0.00001）。中西医结合治疗总有效率高于对照组,主要表现为较高的完全缓解率OR=2.59（1.78～3.59,P〈0.00001）,及较高的显著缓解率OR=1.37（1.01～1.85,P〈0.05）。结论：中西医结合治疗LN较单纯西药治疗有明显优势。     

The efficacy and safety of tacrolimus monotherapy in adult-onset nephrotic syndrome caused by idiopathic membranous nephropathy

Introduction: The purpose of the study is to evaluate the efficiency and safety of tacrolimus (TAC) monotherapy in the treatment of nephrotic idiopathic membranous nephropathy (IMN) compared with the protocol of cyclophosphamide (CTX) combined with corticosteroids.

Methods: In total, 58 patients with nephrotic syndrome and biopsy-proven IMN were included in this study. 30 patients received TAC monotherapy with an initial dose of 0.05–0.1?mg/kg/day. 28 patients received transvenous CTX at a dose of 0.5–0.75?g/m² once in every month initially for 6?months and once in every 2 or 3?months for the later period, and the regimen was combined with corticosteroids (prednisone 1?mg/kg/d). All patients were observed for the treatment effects, recurrence and side effects.

Results: Twelve months after the initial treatment, a total of 24 (80%) patients in the TAC group and 23 (82.1%) patients in the CTX group achieved remission (either partial or complete remission). The survival curve of the probability of remission and complete remission were similar between the two groups (p?>?.05). Proteinuria (based on 24?h urinary protein excretion) was significantly decreased, and serum albumin was significantly increased after immunosuppressive treatment in both the groups. Estimated glomerular filtration rate (eGFR) was comparable between before and after treatment. The main adverse effects in TAC treatment were glucose intolerance, diabetes and abnormal aminotransferase.

Conclusions: TAC monotherapy is an alternative therapeutic regimen for patients with nephrotic IMN. Its short-term efficiency and patient tolerance are both acceptable.