2018年6月13日 星期三

[研究發表][臨床病例報告] 中西醫整合治療紅斑性狼瘡腎炎病例報告 Integrated Therapy Improve Urinary Total Protein in Patients with Lupus Nephritis: A Case Report


[臨床病例報告] 

中西醫整合治療紅斑性狼瘡腎炎病例報告

題目:Integrated Therapy Improve Urinary Total Protein in Patients with Lupus Nephritis: A Case Report
期刊:Complementary Therapies in Medicine


本病例是一位55歲女性,自民國89年確診為紅斑性狼瘡(Systemic Lupus Erythematosus, SLE),接受口服類固醇治療,規律追蹤至民國105年初,開始出現雙小腿水腫,抽筋,反覆泌尿道感染,以及小便伴隨泡沫,經風濕免疫科診斷為狼瘡性腎炎(Lupus Nephritis, LN),患者服用西藥同時併用中醫藥治療,有效改善水腫以及24小時尿液蛋白(Urine Total Protein, M-TP)明顯減少,從1367.9 mg/24 h 減少至 143.6 mg/24 h.,病情趨於好轉。


這是我第一篇投稿國際SCI期刊的Systemic Lupus Erythematosus 紅斑性狼瘡病例報告,也是我指導學生完成的第一篇PAPER,這幾天正式獲國際期刊接受並刊出。

中醫藥治療腎炎很困難,治療免疫性疾病造成的腎炎更是困難。
雖然只是一篇小小的病例報告,但其實讓我想起我剛念碩士班的時候,一開始是做過敏性鼻炎,後來被張恒鴻指導教授指派去接手SLE-LC複方中醫藥臨床試驗,然後試驗完成才開始正式進行博士班修格蘭氏症中醫藥臨床試驗。

因為指導教授安排我回去幫大學生上課,主題為「大學生如何進行中醫專題研究」,讓我回顧了這10年來我到底在幹麻?沒想到我SLE還做了不少,從SLE問卷一致度、中藥改善狼瘡性腎炎資料庫、LC複方改善SLE患者血管內皮細胞,到這一篇的中西醫整合治療紅斑性狼瘡腎炎病例報告

最近回顧發現,
1.Systemic Lupus Erythematosus 紅斑性狼瘡研究進行了:資料庫、臨床試驗、臨床病例報告
2.Sjögren's syndrome 修格蘭氏症研究進行了:資料庫、臨床試驗

不管是Systemic Lupus Erythematosus 紅斑性狼瘡還是Sjögren's syndrome 修格蘭氏症研究,都從資料庫一直做到臨床,一直朝著我的理想中研究邁進,也能夠將研究轉譯轉化為臨床回饋給患者,再從臨床患者轉饋回研究,相輔相成。

非常感謝各位受試者和臨床門診患者的支持與鼓勵,希望能持續努力,為中醫藥實證醫學與中醫藥治療風濕免疫疾病能墊上一塊磚!
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https://www.sciencedirect.com/science/article/pii/S0965229918301948


Complementary Therapies in Medicine. 2018 

Integrated Therapy Improve Urinary Total Protein in Patients with Lupus Nephritis: A Case Report

Pei-Wen Wu, Po-Hsuan Shih, Yen-Ying Kung, Fang-Pey Chen, Ching-Mao Chang*

Objectives
To report on the potential effectiveness of Chinese herbal medicine (CHM) as part of an integrated treatment for lupus nephritis.

Clinical features and outcome
A 55-year-old female with systemic lupus erythematosus had experienced bilateral lower-limbs edema for half a year. Her urinary total protein (M-TP) was 1367.9 mg/24 h. Lupus nephritis (LN) was suspected by the Division of Rheumatology without a renal biopsy. Oral corticosteroid medication did not improve the edema; therefore, the patient requested CHM for integrated therapy, and was subsequently treated for seven months with a modified CHM prescription mainly composed of Zhi-Bo-Di-Huang-Wan, Gui-Shao-Zhi-Mu-Tang, and Zhu-Ling-Tang. After three days of CHM, her bilateral lower-limbs edema significantly improved, and after 143 days, her M-TP decreased from 1367.9 mg/24 h to 143.6 mg/24 h.

Conclusions
Integrated therapy could significantly improve proteinuria by reducing this LN patients’ urinary total protein, which further implies that CHM may have a protective effect against the progression of LN in this patient.