黄荣贵 牙秋艳 蒙兰芬

【摘要】目的观察甲泼尼龙联合雷公藤多甙片治疗老年肾病综合征的临床疗效。方法选择2013年3月至2015年3月收治的老年肾病综合征患者81例，随机分为三组，对照组27例给予利尿、调脂、抗凝等对症支持治疗（非特异治疗），观察组27例在对照组治疗基础上给予甲泼尼龙联合环磷酰胺治疗，治疗组27例在对照组治疗基础上给予甲泼尼龙联合雷公藤多甙片治疗，疗程结束后，统计对比三组临床疗效，比较24 h尿蛋白定量（24 h upro）、血浆白蛋白（Alb）、血肌酐（Scr）变化情况以及治疗期间不良反应发生情况。结果三组临床疗效比较差异有统计学意义（P<0.05），其中，治疗组疗效优于对照组（P<0.05）。治疗前三组24 h upro、Alb、Scr比较差异无统计学意义（P>0.05），治疗后，三组24 h upro、Alb、均较治疗前改善（P<0.01），观察组、治療组较对照组改善更明显（P<0.01），治疗组较观察组改善更明显（P<0.01）。三组患者治疗前后Scr变化不明显（P>0.05）。三组均出现不良反应，给予对症治疗或不予特殊干预后症状均消失，未严重影响继续治疗。治疗组共7例出现不良反应，发生率为25.93%，观察组共5例出现不良反应，发生率为18.52%，对照组共3例出现不良反应，发生率为11.11%。三组不良反应发生率比较差异无统计学意义（P>0.05）。结论雷公藤多甙有助于提升甲泼尼龙对老年肾病综合征的治疗效果，且不会导致更多的不良反应，值得推广。

【关键词】甲泼尼龙；雷公藤多甙；肾病综合征；临床疗效

中图分类号：R692.3文献标识码：ADOI：10.3969/j.issn.10031383.2018.02.011

Analysis of the value of methylprednisolone combined with tripterygium

glycosides in the treatment of senile nephrotic syndrome

HUANG Ronggui，YA Qiuyan，MENG Lanfen

（Department of Nephropathy，Liuzhou Hospital of Traditional Chinese Medicine，Liuzhou 545001，China）

【Abstract】ObjectiveTo observe the clinical effect of methylprednisolone combined with tripterygium glycosides in the treatment of senile nephrotic syndrome.Methods81 elderly patients with nephrotic syndrome admitted to hospital from March，2013 to March，2015 were randomly divided into three groups：27 cases in control group were given diuresis，lipid regulation and anticoagulatio（nonspecific treatment），27 cases in observation group were treated with methylprednisolone combined with cyclophosphamide on the basis of control group，and 27 cases in treatment group were given methylprednisolone combined with tripterygium glycosides tablets on the basis of control group.After the course of treatment，the clinical effects of the three groups were counted and compared.Meanwhile，the changes of 24 h urinary protein quantity （24 h upro），plasma albumin（Alb），serum creatinine（Scr） and adverse reactions during treatment were compared.ResultsThe difference of clinical curative effects among the three groups was statistically significant（P<0.05），and the curative effect of the treatment group was better than that of the control group（P<0.05）.Before treatment，there was no statistically significant difference in 24 h upro，Alb and Scr between the three groups （P>0.05）.After treatment，24 h upro and Alb between the three groups significantly improved as compared with that before treatment （P<0.01），and improvement in the observation group and the treatment group was more significant than that in the control group（P<0.01）.There was no significant change in Scr before and after treatment in the three groups （P>0.05）.Adverse reactions occurred in the three groups，and the symptoms disappeared after treatment with symptomatic treatment or no special intervention，and the continued treatment was not seriously affected.Adverse reactions were found in 7 cases（25.93%） in the treatment group，5 cases （18.52%） in the observation group，and 3 cases （11.11%） in the control group.The difference of incidence of adverse reactions between the three groups was not statistically significant（P>0.05）.ConclusionTripterygium glycosides helps to improve the efficacy of methylprednisolone in the treatment of senile nephrotic syndrome，so it has certain promotion value.

【Key words】methylprednisolone；tripterygium glycosides；nephrotic syndrome；clinical efficacy

肾病综合征为老年常见肾脏疾病之一，国内357%～66.7%的肾活检老年患者均以此类症状为首发表现[1]。病理类型以膜性肾病为多见，与非老年患者相似，应用肾上腺皮质激素联合免疫抑制剂仍为其主要治疗方案[2]，但老年患者身体基础功能差，往往合并多种全身疾病，故治疗方案的选择受到多种限制，常规应用甲泼尼龙等激素类药物，往往难以达到较好的疗效[3]，且易发生各种激素副反应。我……