雷公藤多苷片辅治原发性膜性肾病的疗效及对凝血纤溶系统、内皮细胞功能的影响

摘要

目的：观察雷公藤多苷片辅助治疗原发性膜性肾病（ IMN）的疗效及对凝血纤溶系统、内皮细胞功能的影响。方法选取2012年6月—2014年7月接受治疗的IMN患者240例，按入院顺序随机分为2组，对照组120例采用小剂量激素等综合治疗方案，观察组120例在对照组基础上加用雷公藤多苷片治疗（20 mg口服，3次／d）。随访6个月，观察对比2组疗效及不良反应，测定2组24 h尿蛋白定量、血清白蛋白（ Alb）、总胆固醇（ TC）以及三酰甘油（ TG）、丙氨酸氨基转移酶（ ALT）、天冬氨酸氨基转移酶（ AST）含量，并检查2组患者治疗前后血浆中组织纤溶酶原激活因子（ t－PA ）、I 型纤溶酶原激活因子抑制因子（ PAI－I ）以及内皮素－I （ ET－I ）水平。结果观察组总有效率为87．50％，明显高于对照组的54．17％（χ2＝32．27， P ＜0．05）。治疗后2组24 h尿蛋白、TC、TG明显低于治疗前，而Alb高于治疗前（ P ＜0．05）；且观察组改善情况均优于对照组（ P ＜0．05）。观察组治疗后PAI－I和ET－I均明显降低， t－PA明显升高（ P ＜0．05），对照组治疗前后t－PA、PAI－I、ET－I等3项指标差异均无统计学意义（ P ＞0．05），2组治疗后比较差异亦具有统计学意义（ P ＜0．05）。结论雷公藤多苷片辅助治疗IMN安全有效，能够改善凝血纤溶系统以及保护细胞内皮功能。%Objective To observe the effect of tripterygium glycosides tablet adjuvant treatment of idiopathic membra-nous nephropathy ( IMN) and the impact on blood coagulation fibrinolysis system and endothelial cells’ function.Methods From 2012 June to 2014 July, 240 IMN patients were randomly divided into 2 groups according to hospitalization order,120 cases in the control group received small dose of hormone and other comprehensive treatment, the observation group of 120 ca-ses based on the treatment of control group, also received tripterygium wilfordii glycoside tablet (2 mg by oral,3 times/d). Follow up of 6 months, and the adverse reactions of 2 groups were observed and the curative effect of 2 groups were compared, 24 h urine protein, serum albumin (Alb), total cholesterol (TC) and three acyl glycerides (TG), alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) levels were measured, and before and after treatment, plasma tissue plasminogen activator ( t-PA) , I type plasminogen activator inhibitor ( PAI-I ) and endothelin-1 ( ET-1 ) level were checked in the 2 groups.Results Total effective rate of observation group was 87.50%, which was significantly higher than that of control group’s 54.17%(χ2 =32.27, P <0.05).After treatment, 24 h urine protein TC, TG in the 2 groups were significantly lower than that before treatment, while Alb was higher than that before treatment;observation group were better than those in control group ( P <0.05).The observation group after treatment, PAI-I and ET-1 were decreased, t-PA was increased sig-nificantly ( P <0.05), before and after treatment in control group, t-PA, PAI-I, ET-1 did not show significant differences (P >0.05), after treatment, the 2 groups also showed statistically significant differences ( P <0.05).Conclusion Tripterygium wilfordii glycosides tablet adjuvant therapy for IMN is safe and effective, and can improve the coagulation fibri-nolysis system and protect endothelial cell function.