内科理论与实践

内科理论与实践 ›› 2025, Vol. 20 ›› Issue (01): 1-6.doi: 10.16138/j.1673-6087.2025.01.01

• 论著 •    下一篇

双白片和厄贝沙坦治疗慢性肾小球肾炎蛋白尿的疗效分析

陈孜瑾a,*, 俞海瑾a,*, 王朝晖a, 马骏a, 汪知玉a, 王洁b, 徐耀文a, 郑岚b(), 陈晓农a()   

  1. 上海交通大学医学院附属瑞金医院 a.肾脏内科; b.中医内科，上海 200025
  • 收稿日期:2024-05-20 出版日期:2025-02-28 发布日期:2025-04-30
  • 通讯作者: 郑岚,陈晓农 E-mail:windy9453@126.com;cxn10419@rjh.com.cn
  • 作者简介:第一联系人：*:陈孜瑾和俞海瑾为共同第一作者
  • 基金资助:
    上海市卫生健康委员会课题(ZHYY-ZXYJHZX-2-04);上海市临床重点专科(shslczdzk02502);国家自然科学基金项目(81600590);上海交通大学“交大之星”医工交叉项目(YG2024QNB07)

Efficacy analysis of Shuangbai tablets and irbesartan in treatment of proteinuria in chronic glomerulonephritis

CHEN Zijina,*, YU Haijina,*, WANG Zhaohuia, MA Juna, WANG Zhiyua, WANG Jieb, XU Yaowena, ZHENG Lanb(), CHEN Xiaononga()   

  1. a. Department of Nephrology; b. Department of Traditional Chinese Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine,Shanghai 200025, China
  • Received:2024-05-20 Online:2025-02-28 Published:2025-04-30
  • Contact: ZHENG Lan, CHEN Xiaonong E-mail:windy9453@126.com;cxn10419@rjh.com.cn

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摘要：

目的：比较双白片和厄贝沙坦降低蛋白尿的疗效和安全性。方法：回顾性收集2016年1月至2018年2月于上海交通大学医学院附属瑞金医院门诊就诊的慢性肾小球肾炎患者119例，均接受厄贝沙坦（厄贝沙坦组54例）或双白片（双白片组65例）单药治疗。所有患者均进行中医辨证分型。收集患者临床资料和基线及治疗4、8、12、24周的诊室血压及实验室指标。结果：119例患者的中医辩证分型主要为脾肺气虚证(56.3%)、脾肾阳虚证(20.2%)和气阴两虚证(21.8%)。厄贝沙坦组基线24 h尿蛋白定量为704(448,1 090) mg/d，4、8、12和24周分别降至456(300,660)、428(288，793)、510(327，949)和446(273，801) mg/d（均P<0.05）。双白片组基线24 h尿蛋白定量571(390，1 049) mg/d，4、8、12和24周分别降至491(200，861)、432(252，925)、478(267，858)和420(175，742) mg/d（均P<0.05）。治疗4、8、12和24周后,2组间蛋白尿差异无统计学意义。不同中医证型患者疗效差异无统计学意义。治疗12周后，双白片组腰酸（59.3%比13.8%， P<0.001）和口干咽燥（24.1%比6.2%, P=0.005）症状改善率显著高于厄贝沙坦组。厄贝沙坦组治疗12周和24周血压较入组时明显下降。双白片组治疗期间无明显不良反应。结论：双白片可有效降低慢性肾小球肾炎患者尿蛋白水平，改善腰酸和口干咽燥症状，不良反应发生率更低，可作为血压正常、血管紧张素转化酶抑制剂（angiotensin-converting enzyme inhibitor，ACEI）/血管紧张素受体阻滞剂（angiotensin receptor blocker， ARB）不耐受或未行肾穿刺慢性肾小球肾炎患者的替代治疗。

关键词: 蛋白尿, 慢性肾小球肾炎, 双白片, 厄贝沙坦

Abstract:

Objective To compare the efficacy and safety of Shuangbai tablets and irbesartan in the treatment of proteinuria. Methods A retrospective analysis was conducted on patients with chronic glomerulonephritis who visited the outpatient department of Ruijin Hospital from January 2016 to February 2018. All the patients received irbesartan or Shuangbai tablets as monotherapy and were classified with syndrome differentiation of traditional Chinese medicine(TCM). Their clinical information, blood pressure and laboratory test were performed at 0, 4, 8, 12, and 24 weeks. Results One-hundred and nineteen patients were enrolled in the study, in which 54 cases were in the irbesartan group and 65 cases were in the Shuangbai tablet group. In all patients, the main TCM types were “pifeixiqu” type (56.3%), “pishenyangxu” type (20.2%), and “qiyinliangxu” type (21.8%). The 24-hour urinary protein of baseline level in the irbesartan group was 704 (448，1 090) mg/d, and it was significantly decreased to 456 (300,660), 428 (288,793), 510 (327,949), and 446 (273,801) mg/d at 4, 8, 12, and 24 weeks, respectively. The 24-hour urine protein level of baseline in the Shuangbai tablet group was 571 (390,1 049) mg/d, and it was significantly decreased to 491 (200，861), 432 (252，925), 478 (267，858) mg/d and 420 (175，742) mg/d at 4, 8, 12, and 24 weeks, respectively. There was no significant difference in proteinuria between the two groups. There was no statistical difference in the therapeutic effect among patients with different TCM syndrome types. The symptoms of lower back pain (59.3% vs 13.8%, P<0.001) and dry mouth and throat (24.1% vs 6.2%, P=0.005) in the Shuangbai tablet treatment group were significantly improved compared to those in the irbesartan group. The blood pressure of patients in the irbesartan treatment group decreased significantly at 12 and 24 weeks compared to it at enrollment. There were no significant adverse reactions in the Shuangbai tablet treatment group. Conclusions Shuangbai tablets can effectively reduce the urine protein level in chronic glomerulonephritis patients. It can also significantly improve the symptoms of lower back pain, dry mouth and throat in patients. Shuangbai tablet treatment showed a lower incidence of adverse reactions and can be used as an alternative medicine for patients with normal blood pressure, angiotensin-converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB) intolerance, or chronic glomerulonephritis without renal biopsy.

Key words: Proteinuria, Chronic glomerulonephritis, Shuangbai tablet, Irbesartan

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