Abstract: Background　IgA nephropathy is the most common primary glomerular disease in the world and a common cause of end-stage renal failure.Currently，Tripterygium glycosides（TG），irbesartan and other immunosuppressants are major drugs used for clinical treatment，but it has not been proved that whether the combination of TG and irbesartan has synergistic effects in thoroughly alleviating the progress of IgA nephropathy.Objective　To discuss the curative effect of TG and irbesartan on IgA nephropathy with increased urinary podocyte excretion.Methods　From Henan Provincial People's Hospital from January 2014 to December 2016，128 IgA nephropathy patients were enrolled according to the inclusion and exclusion criteria of this study，and were divided into the TG group（n=42），irbesartan group（n=40）and combination group（n=46），receiving TG tablets（20 mg，three times a day），irbesartan tablets（150 mg，twice a day），and TG tablets（20 mg，three times a day）combined with irbesartan tablets（150 mg，twice a day），respectively，for 12 weeks.The general information，data concerning blood pressure（systolic and diastolic pressure），laboratory indices〔serum creatinine（Scr），blood urea nitrogen（BUN），serum uric acid（SUA），serum albumin（Alb），total cholesterol（TC），estimated glomerular filtration rate（eGFR），24-hour urinary protein level〕and the number of urinary podocytes before and after the treatment of all participants were collected.Post-treatment improvement in 24-hour urinary protein and adverse reactions caused by treatment were also obtained.Results　Intergroup comparisons demonstrated that combination group presented much higher Alb level and much lower 24-hour urinary protein level compared with other two groups（P<0.05）．Compared with baseline，all groups showed significantly decreased Scr and 24-hour urinary protein levels and obviously increased Alb and eGFR levels after treatment（P<0.05）．The combination group also showed much lower BUN and SUA levels（P<0.05）．The number of urinary podocytes decreased significantly in all groups after treatment（P<0.05）．The combination group had much less urinary podocytes than other two groups after treatment（P<0.05）．The combination group had a notable higher clinical response than other groups（P<0.05）．There was no difference in the incidence of adverse reactions among the three group（P>0.05）．Conclusion　For IgA nephropathy with increased urinary podocyte excretion，TG combined with irbesartan is superior to TG or irbesartan alone.The combination treatment can produce a synergistic effect in reducing the injury of renal podocytes，thereby delaying the progression of the disease.

Key words: Glomerulonephritis, IGA；Tripterygium；Irbesartan；Treatment outcome；Podocytes

摘要： 背景　IgA肾病是全球最常见的原发性肾小球疾病，也是导致终末期肾功能衰竭（ESRD）的常见原因。目前临床上主要采用雷公藤多苷、厄贝沙坦等免疫抑制剂进行治疗，但两者是否具有协同作用从根源上缓解IgA肾病的进展尚未被证实。目的　探讨雷公藤多苷联合厄贝沙坦治疗IgA肾病患者的疗效及其对尿足细胞排泄的影响。方法　根据纳入与排除标准，选取2014年1月—2016年12月河南省人民医院收治的IgA肾病患者128例为研究对象。根据治疗方式，将研究对象分为雷公藤多苷组（42例）、厄贝沙坦组（40例）和联合治疗组（46例）。雷公藤多苷组口服雷公藤多苷片20 mg/次，3次/d；厄贝沙坦组口服厄贝沙坦片150 mg/次，2次/d；联合治疗组同时服用雷公藤多苷片（20 mg/次，3次/d）和厄贝沙坦片（150 mg/次，2次/d）；所有患者治疗12周。收集患者一般资料，治疗前后血压（收缩压、舒张压）、实验室指标〔血肌酐（Scr）、血尿素氮（BUN）、血尿酸（SUA）、血清清蛋白（Alb）、总胆固醇（TC）、估算肾小球滤过率（eGFR）、24 h尿蛋白〕，尿蛋白缓解效果及不良反应，治疗前后尿足细胞。结果　联合治疗组治疗后Alb高于雷公藤多苷组、厄贝沙坦组，治疗后24 h尿蛋白低于雷公藤多苷组、厄贝沙坦组（P<0.05）。雷公藤多苷组、厄贝沙坦组、联合治疗组治疗后Scr、24 h尿蛋白均低于本组治疗前，治疗后Alb、eGFR均高于本组治疗前（P<0.05）；联合治疗组治疗后BUN、SUA低于本组治疗前（P<0.05）。联合治疗组治疗有效率高于雷公藤多苷组、厄贝沙坦组（P<0.05）。3组不良反应发生率比较，差异无统计学意义（P>0.05）。联合治疗组治疗后尿足细胞少于雷公藤多苷组、厄贝沙坦组（P<0.05）。雷公藤多苷组、厄贝沙坦组、联合治疗组治疗后尿足细胞均少于本组治疗前（P<0.05）。结论　雷公藤多苷联合厄贝沙坦治疗IgA肾病患者疗效及减少尿足细胞排泄的效果优于单一雷公藤多苷或厄贝沙坦治疗方案，即二药联用对肾足细胞损伤具有更好的协同保护作用，从而延缓了病情的进展。

关键词: 肾小球肾炎, IGA；雷公藤属；厄贝沙坦；治疗结果；足细胞