Wang Zhen, Yu Chao, Zhou Li-Na, Chen Xin
Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine.
Department of Nephrology, Yancheng Third People's Hospital.
Biol Pharm Bull. 2017 Nov 1;40(11):1833-1838. doi: 10.1248/bpb.b17-00134. Epub 2017 Sep 1.
Although some new drugs have been developed, Tripterygium wilfordii HOOK F. (TWHF) has the merits of relatively lower price and fewer side effects. Unfortunately, the efficacy and safety of the TWHF (especially dosage 120 mg/d) in the immunoglobulin A (IgA) nephropathy (IgAN) are still lacking. A cohort study including 49 IgAN patients with heavy proteinuria who received induction therapy was undertaken. Patients were divided into three groups: Prednisone (PRE), conventional-dose TWHF (CTW) and double-dose TWHF (DTW). The clinical features, laboratory data, histological manifestations and outcomes of the groups were compared. We found that urinary protein excretion and rates of elevated n-acetyl-β-D-glucosaminidase (NAG) and retinol binding protein (RBP) were prominent in all groups. Neither histopathological changes nor the rates of renal insufficiency were significantly different among groups. Patients in the PRE (69.2%) and DTW groups (87.5%) achieved complete remission; none of the CTW group did. Furthermore, the total remission rate of the DTW group was substantially higher than that of the CTW group. The degree of hypoproteinemia, improved considerably in the PRE and DTW groups. Treatment was well tolerated in all patients, and no serious adverse events were observed. Our findings suggested that induction therapy with double dose TWHF significantly improved response rates in IgAN patients with heavy proteinuria, and did not considerably increase side effects.
尽管已经研发出了一些新药，但雷公藤多苷（TWHF）具有价格相对较低且副作用较少的优点。遗憾的是，TWHF（尤其是剂量为120mg/d时）在免疫球蛋白A（IgA）肾病（IgAN）中的疗效和安全性仍不明确。我们进行了一项队列研究，纳入了49例接受诱导治疗的重度蛋白尿IgAN患者。患者被分为三组：泼尼松（PRE）组、常规剂量TWHF（CTW）组和双倍剂量TWHF（DTW）组。比较了三组的临床特征、实验室数据、组织学表现和治疗结果。我们发现，所有组的尿蛋白排泄以及N-乙酰-β-D-氨基葡萄糖苷酶（NAG）和视黄醇结合蛋白（RBP）升高率均较为显著。各组之间的组织病理学变化和肾功能不全发生率均无显著差异。PRE组（69.2%）和DTW组（87.5%）的患者实现了完全缓解；CTW组无一例实现完全缓解。此外，DTW组的总缓解率显著高于CTW组。PRE组和DTW组的低蛋白血症程度有显著改善。所有患者对治疗耐受性良好，未观察到严重不良事件。我们的研究结果表明，双倍剂量TWHF诱导治疗可显著提高重度蛋白尿IgAN患者的缓解率，且不会显著增加副作用。
