【摘要】 目的:对66例组织病理表现为局灶节段肾小球硬化的IgA肾病(IgAN-sFSGS)患者进行中西医结合治疗的对比研究,以评价该治疗方案的疗效。方法:将66例IgAN-sFSGS随机分组,治疗组35例采用中西医结合治疗方案,以补虚、散瘀、祛风湿中药+血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体Ⅱ拮抗剂(ARB)+糖皮质激素(GC)为基础用药,并根据病情需要不用或选用免疫抑制剂骁悉(MMF)或环磷酰胺(CTX);对照组31例采用ACEI/ARB+鱼油+对症治疗。结果:治疗组缓解24例、显效9例;对照组缓解3例、显效10例,两组比较治疗组明显优于对照组(P<0.01)。在不同病理损伤程度的患者之间比较:轻型病理损害者两组间疗效均优,中重型病理损害者治疗组疗效明显优于对照组(P<0.01)。重复肾活检结果:治疗组的疗后病理总积分与炎细胞浸润积分较疗前有下降,而对照组这两项指标疗后的积分较疗前有上升;肾脏病理图像分析结果显示:治疗后治疗组的肾小球指数(GI)、肾小管间质指数(T1)、血管指数(VI)有改善,两组比较有显著性差异(P<0.05)。结论:ACEI/ARB+鱼油+对症治疗对轻型IgAN-sFSGS疗效良好,但对中重型患者疗效却明显不及治疗组。联合用药方案对中重型IgAN-sFSGS患者尤其具有优越性。更多还原

【Abstract】 Objective:To judge the curative effect of integrated therapy of traditional and western medicine on 66 IgA nephropathy with secondly focal seg- mental glomerulosclerosis(IgAN-sFSGS). Methods:66 patients with IgA-sFSGS were divided into two groups randomly,35 patients were given integrated therapy of Chinese and west- ern medicine,31patients were only given western medicine. Results:24 patients in the treatment group were clinical cured and 9 cases were clinical availahility,3 patients in control were clinical cured and 10 cases were clinical availability,the curative effect of treatment group was better than that of control(P<0.01).Two therapies were no difference on curative effects at low-grade pathologic scathe patients,but the curative effect of treatment group was better than that of control at medium and sever-grade pathologic scathe patients(P<0.01).The renal biopsy results showed that the total pathologic score and the phl- ogistic cells soakage’s score descended obviously in the treatment group,the glomerulus index(GI),interregnal index(TI)and vas index (Ⅵ)turned better in the treatment group.Conclusion:Two therapies were good for low-grade pathologic scathe IgAN-sFSGS,the integrated therapy of traditional Chinese and west- ern medicine was better than western medicine for medium and severe-grade pathologic scathe patients.更多还原