目的 探討生脈注射液聯(lián)合潑尼松和環(huán)磷酰胺治療膜性腎病的臨床療效。方法 選擇2017年6月-2020年6月上海市第六人民醫(yī)院金山分院收治的53例膜性腎病的患者，隨機分為對照組（25例）和治療組（28例）。對照組口服潑尼松片，1 mg/kg，1次/d，8周后每2周減量5 mg，減至30 mg/d，再每2周減量2.5 mg，減至20 mg/d；再每4周減2.5 mg，至10 mg/d維持；并靜脈滴注注射用環(huán)磷酰胺，首月每半月600 mg加入生理鹽水100 mL，然后每月800 mg加入100 mL生理鹽水，1次/月，共6個月。治療組在對照組治療的基礎(chǔ)上靜脈滴注生脈注射液，40 mL加入250 mL生理鹽水，1次/d，治療14 d停藥16 d為1個療程，共6個療程。觀察兩組患者臨床療效，比較治療前后兩組患者24 h尿蛋白定量（24 h Upro）、C反應(yīng)蛋白（CRP）、降鈣素原（PCT）水平。結(jié)果 治療后，治療組總有效率為78.57%，顯著高于對照組64.00%（P<0.05）。治療3個月和6個月后，兩組患者24 h Upro水平顯著降低，但PCT、CRP升高（P<0.05），且治療組治療后24 h Upro、PCT、CRP水平低于對照組同期（P<0.05）。結(jié)論 生脈注射液聯(lián)合糖皮質(zhì)激素及環(huán)磷酰胺治療膜性腎病可以提高臨床療效，降低炎癥反應(yīng)的程度。

Objective To investigate the effect of Shengmai Injection combined with prednisone and cyclophosphamide in treatment of membranous nephropathy. Methods Patients (53 cases) with membranous nephropathy in Jinshan Branch of Shanghai the 6th People's Hospital from June 2017 to June 2020 were randomly divided into control (25 cases) and treatment (28 cases) groups. Patients in the control group were po administered with Prednisone Tablets, 1 mg/kg, once daily, reduced 5 mg every 2 weeks to 30 mg/d after 8 weeks, then reduced 2.5 mg every 2 weeks to 20 mg/d, and then reduced 2.5 mg every 4 weeks to 10 mg/d and maintained. At the same time, the control group iv administered with Cyclophosphamide for injection, 600 mg added into 100 mL normal saline in the first month, and then 800 mg added into 100 mL normal saline every month, once monthly, they were treated for 6 months. Patients in the treatment group were iv administered with Shengmai Injection, 40 mL added into 250 mL normal saline, once daily, 14 days of treatment and 16 days of withdrawal was a course of treatment for a total of 6 courses. After treatment, the clinical efficacy was evaluated, the levels of 24 h Upro, PCT and CRP in two groups before and after treatment were compared. Results After treatment, the clinical effective rate in the treatment group was 78.57%, which was significantly higher than 64.00% of the control group (P<0.05). After 3 and 6 months of treatment, the 24 h Upro level in two groups was significantly decreased, but PCT and CRP were increased (P<0.05). The 24 h Upro, PCT and CRP levels in the treatment group were lower than those in the control group (P<0.05). Conclusion Shengmai Injection combined with glucocorticoid and cyclophosphamide can improve the clinical curative effect and reduce the degree of inflammatory reaction.

R983

周錦明全國基層名老中醫(yī)藥專家傳承工作室建設(shè)項目；上海市金山區(qū)衛(wèi)生和計劃生育委員會項目（JSZY201806）