中醫藥對成人原發性IgA腎炎的療效研究

The Therapeutic Effect of Chinese Medicine on Primary Adult IgA Nephritis

IgA腎炎在1968 年被Berger and Hinglais 所發現，它被認為是世界上最普遍型式的腎炎。這疾病並不像最初所認為是良性的，大約有的15~20%的病例在發病後五至十年發展成腎衰竭，甚至高達25~40%，需要支持性的透析治療來幫助。本病在西醫方面尚無有效的治療方法，而IgA腎炎雖然其真正的致病機轉不明，但已確認是一種免疫複合體疾病。眾所遇知，中醫藥可以調節身體免疫功能的異常，因而興起以中醫藥治療的動機。本研究篩選成人原發性IgA腎炎的患者（病理腎穿刺證實屬c1ass Ⅲ）32 例，男性24 例，女性8例，而其中30例是年齡小於40歲。IgA 腎炎患者有血尿症狀，中醫的治療是針對此症而來，用中醫的「辨證論治」來治療，輔以現代的生化檢驗方法來評估其療效。研究的結果統計顯示：臨床症狀與徵象顯著的改善，治療血尿有效率89.3%，蛋白尿有效率86.7%，生化功能在中醫藥治療後在正常範圍內，血中IgA值、高血壓有意義的降低(p< 0.001)。選擇中醫藥對成人原發性IgA腎炎是一種有效的治療途徑，關於其治病機轉，則仍需結合基礎研究，方能進一步得知。

IgA nephritis, discovered by Berger and Hinglais in 1968, is considered to be the most common nephritis in the world. This disease is not benign as it was considered to be at first. In about 15-20%, even 25-40%, of cases, renal failure develops 5-10 years after the first episode, and the patients need supportive dialysis. Western medicine still has no effective treatment for this disease. Although the real pathogenic mechanism of IgA nephritis is not c1ear, it is identified as one kind of immunocomplex disease. Chinese medicine is known to regu1ate the abnormal immune function of the human body, and hence there is gocd motive for investigating Chinese medical treatment as a therapeutic solution. Thirty-two cases of the primary IgA nephritis patients identified through kidney biopsies as Class Ⅲ were selected in this research. Of the total, 24 were males and 8 females, and 30 were under the age of 40. IgA nephritis patients have hematuria, which provides a basis in Chinese medicine for identifying patterns and determining treamtent (bian zheng lun zhi), and the therapeutic effect can be evaluated by modem laboratory tests. The results show that Chinese medical therapy improved clinical symptoms and signs markedly. It was effective for hematuria in 89.3% of cases, and for proteinuria in 86.7% of cases. It brought biochemical function back to normal. The reduction in the IgA concentration in the blood and hypertension was biostatistically significant (p＜0.001). Chinese medical therapy for adult primary IgA nephritis is effective. Further basic research is needed to understand the mechanisms.