加味补肾活血方治疗各型狼疮肾炎患者疗效观察及免疫功能影响

Effects of “Modified Bushen Huoxue Decoction” on curative and immunological condition in patients with different types of lupus nephritis

关键词:  加味补肾活血方  狼疮肾炎  免疫学

Key words:  "Modified Bushen Huoxue Decoction"  lupus nephritis  immunology

摘要:

[目的] 探讨加味补肾活血方对红斑狼疮肾炎（LN）患者治疗效果及对免疫功能影响。[方法] 102例LN患者随机分为基础治疗组（51例）及联合治疗组（51例），两组均应用甲基泼尼松及环磷酰胺（CTX）或甲基泼尼松及吗替麦考酚酯（MMF）治疗，联合治疗组同时应用加味补肾活血方治疗，4个月后观察两组患者系统性红斑狼疮（SLE）疾病活动指数（SLEDAI）、补体C3、C4、24 h尿蛋白定量、内生肌酐清除率（Ccr）水平，同时运用流式细胞术检测CD3⁺、CD4⁺、CD8⁺水平。[结果] 联合治疗组患者的Ccr水平升高，CD8⁺水平下调，与基础治疗组比较有统计学差异（P<0.05）。增殖型LN经联合治疗后，24 h尿蛋白定量下降、Ccr，与基础治疗组相比，差异有统计学意义（P<0.05）。混合型LN经联合治疗后，Ccr，与基础治疗组相比，差异有统计学意义（P<0.05）。[结论] 加味补肾活血方能够改善LN患者肾滤过功能，对增值型及混合型LN疗效明显，能有效减少糖皮质激素及免疫抑制剂应用剂量，并可在一定程度上纠正免疫功能紊乱。

Abstract:

[Objective] To observe the clinical curative efects of "Modified Bushen Huoxue Decoction" on immunological condition in patients with lupus nephritis (LN).[Methods] 102 LN patients were randomly divided into foundation treatment group (n=51) and combined treatment group (n=51);steroids and cyclophosphamide (CTX) or steroids and Mycophenolate Mofeil (MMF) were administered to all patients,while "Modified Bushen Huoxue Decoction" were only administered to patients in the mixed treatment group.After 4-months later,SLE disease activity index score (SLEDAI Score),C3,C4,24 h urine protein quantity,endogenous creatinine clearance rate (Ccr),T lymphocytes subsets (CD3+、CD4+、CD8+) were detected in both groups.[Results] Compaired with foundation treatment group, combined treatment group could significantly elevate Ccr and down-regulate the level of CD8+ T cell (P<0.05). Proliferative LN with combined treatment could significantly elevate Ccr and decrease 24 h urine protein(P<0.05),whereas mixed pathological types of LN elevate Ccr with mixed treatment(P<0.05).[Conclusion] "Modified Bushen Huoxue Decoction" could significantly ameliorate kidney filtration function of LN patients,especially proliferative and mixed pathological types.It also could reduce the applied dose of steroids and immunosuppressants by correcting immune dysfunction.