中文摘要

系统性红斑狼疮（SLE）是一种主要影响30-40岁女性的自身免疫性疾病，其中狼疮性肾炎（LN）是最常见的继发性肾小球肾炎类型，约有40%的SLE患者合并狼疮性肾炎（LN）。研究显示，10-30% 的狼疮性肾炎患者10年内进展为终末期肾病（ESRD）。有鉴于SLE 和 LN 的复杂病理特征，患者通常需要长期治疗，且可能因此面临股骨头坏死、骨折、白内障、高血糖/糖尿病和骨髓抑制等药物副作用的风险。因此，一些患者开始寻求中医药（TCM）作为辅助或替代治疗，以期能由此减轻西药使用剂量，并缓解顽固症状。

为了解中药与西药之间的相互作用（Herb-Drug Interactions, HDI），我们查阅了相关药理研究，发现虽然个别中药对常见代谢酶（如 CYP 450）有一定影响，但在复方中药的研究中并未发现CYP酶整体功能上的显著改变。现有研究亦揭示了某些单味中药的常见生化通路和分子靶点，但针对临床常用的多味中药复方，相关研究仍较为稀缺。尽管如此，比较中西药联合治疗LN与单用西药治疗LN的临床试验结果显示，中西药联合治疗LN在疗效和安全性方面具有良好表现。因此我们认为中药的使用并不会削弱西药的疗效。

根据中医理论，SLE多属“热毒”或“湿热”之邪，且常在“阴虚”体质（尤其是肾阴虚）的基础上发病。因此，治疗方向以滋阴清热、补肾为主。由于多数文献研究对象为病情处于稳定期或慢性期的患者，所使用的方药往往考虑到病情得到控制后可能出现的气血两虚、脾虚及阳虚证型的综合辨证。

总体而言，多数临床试验表明中西药联合治疗的安全性，且使用中药与否对于不良事件的发生率并无显著差异。尽管不同研究所采用的疗效评估指标不一，尚未有明确的总结能统一评估确切的中药疗效，但根据系统性红斑狼疮疾病活动指数（SLEDAI）评分显示，中医药干预可显著降低疾病活动度。基于现有的研究成果，未来临床研究中应采用更多标准化、被广泛认可的疗效评估指标，并开展更多大规模的临床试验，以进一步验证中医药对于LN管理中的疗效。

References

1. Musa R, Rout P, Qurie A. Lupus Nephritis. [Updated 2025 Jan 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499817/#
2. Rovin BH, Ayoub IM, Chan TM, et.al. KDIGO 2024 Clinical Practice Guideline for the management of LUPUS NEPHRITIS. Kidney International. 2024, 105(1), S1–S69. https://doi.org/10.1016/j.kint.2023.09.002
3. Almaani S, Meara A, Rovin BH. Update on Lupus Nephritis. Clin J Am Soc Nephrol. 2017 May 8;12(5):825-835. doi: 10.2215/CJN.05780616. Epub 2016 Nov 7. PMID: 27821390; PMCID: PMC5477208.
4. Seligman VA, Lum RF, Olson JL, Li H, Criswell LA. Demographic differences in the development of lupus nephritis: a retrospective analysis. Am J Med. 2002 Jun 15;112(9):726-9. doi: 10.1016/s0002-9343(02)01118-x. PMID: 12079714.
5. Sammaritano LR, Askanase A, Bermas BL, et.al. (2025) 2024 American College of Rheumatology (ACR) Guideline for the Screening, Treatment, and Management of Lupus Nephritis. Arthritis Care & Research. https://doi.org/10.1002/acr.25528
6. Nossent HC, Henzen-Logmans SC, Vroom TM, Berden JH, Swaak TJ. Contribution of renal biopsy data in predicting outcome in lupus nephritis. Analysis of 116 patients. Arthritis Rheum. 1990 Jul;33(7):970-7. doi: 10.1002/art.1780330708. PMID: 2369432.
7. Sciascia S, Mompean E, Radin M, Roccatello D, Cuadrado MJ.Rate of adverse effects of medium‐to high‐dose glucocorticoid therapy in systemic lupus erythematosus: a systematic review of randomized control trials. Clin Drug Invest. 2017;37(6):519‐
8. Tamirou F, Houssiau FA. Management of Lupus Nephritis. Journal of Clinical Medicine. 2021; 10(4):670. https://doi.org/10.3390/jcm10040670
9. American College of Rheumatology. 2024 American College of Rheumatology (ACR) Guideline for the Screening, Treatment, and Management of Lupus Nephritis. Arthritis Care & Research. 2025. 1-21. DOI 10.1002/acr.25528. Tamirou F, Houssiau FA. Management of Lupus Nephritis. Journal of Clinical Medicine. 2021; 10(4):670. https://doi.org/10.3390/jcm10040670
10. 盛梅笑.中医治疗狼疮性肾炎研究进展.中国中医药信息杂志.2003,10(6):90-92.
11. Heng M, Tu J, Hao Y, et al. Effects of integrated traditional Chinese and western medicine for the treatment of lupus nephritis: a meta‐analysis of randomized trials. Evid Based Complement Alternat Med. 2016;2016:1502107.
12. 宋庆良, 伍劲华, 马春成. 名中医伍劲华治疗狼疮性肾炎经验总结[J]. 亚太传统医药. 2023,19,(06):134-137.
13. 国家中医药管理局《狼疮性肾炎中医诊疗方案》（2018年版）
14. Liu L, Zhang L and Li M (2022),Application of herbal traditional Chinese medicine in the treatment of lupus nephritis. Front. Pharmacol. 13:981063. doi: 10.3389/fphar.2022.981063
15. Wang YJ, Li YX, Li S, et al.Progress in traditional Chinese medicine and natural extracts for the treatment of lupus nephritis. Biomedicine & Pharmacotherapy. 2022. 149:112799
16. 方剂学.邓中甲主编.2版. 北京：中国中医药出版社,2013.1(2014.10重印). 普通高等教育”十一五”国家级规划教材. ISBN 978-7-80156-322-4
17. Tachjian A, Maria V, Jahangir A. Use of herbal products and potential interactions in patients with cardiovascular diseases. J. Am. Coll. Cardiol. 55(6), 515–525 (2010).
18. Chan TY. Interaction between warfarin and danshen (Salvia miltiorrhiza). Ann. Pharmacother. 35(4), 501–504 (2001).
19. Shon Y.-H., Nam K.-S. Protective effect of Moutan cortex extract on acetaminophen-induced hepatotoxicity in mice. J. Ethnopharmacol. 2004;90:415–419. doi: 10.1016/j.jep.2003.11.004.
20. Ekiert H, Klimek-Szczykutowicz M, Szopa A. Paeonia × suffruticosa (Moutan Peony)-A Review of the Chemical Composition, Traditional and Professional Use in Medicine, Position in Cosmetics Industries, and Biotechnological Studies. Plants (Basel). 2022;11(23):3379. Published 2022 Dec 5. doi:10.3390/plants11233379
21. Lau C, Mooiman KD, Maas-Bakker RF, Beijnen JH, Schellens JH, Meijerman I. Effect of Chinese herbs on CYP3A4 activity and expression in vitro. J Ethnopharmacol. 2013 Sep 16;149(2):543-9. doi: 10.1016/j.jep.2013.07.014. Epub 2013 Jul 20. PMID: 23876595.
22. Zhang H, Ya G, Rui H. Inhibitory Effects of Triptolide on Human Liver Cytochrome Protective effect of Moutan cortex  Eur J Drug Metab Pharmacokinet. 2017 Feb;42(1):89-98. doi: 10.1007/s13318-016-0323-8. PMID: 26874845.
23. Yarnell, E., & Abascal, K. (2013). Herbs and Immunosuppressive Drugs: Calcineurin Inhibitors. Alternative and Complementary Therapies, 19(6), 315–322. doi:10.1089/act.2013.19605
24. Wang XQ, Wang L, Tu YC, Zhang YC. Traditional Chinese medicine for refractory nephrotic syndrome: strategies and promising treatments. Evid Based Complement Alternat Med. 2018;2018:8746349‐
25. Jiang Y, Zhang Q, Wang H, et.al. Expressions of IFN-γ and IL-4 before and after Treatment of Lupus Nephritis with Traditional Chinese Medicine Combined with Cyclophosphamide and Their Values for Efficacy Prediction and Evaluation. Iran J Public Health. 2020,49(5): 886-895.
26. 李兴锐, 李传平, 陈茂红,等. 清热活血化瘀方药治疗狼疮肾炎临床研究. 中医药临床杂志.2011, 27(3):601-602.
27. 苏晓,夏嘉,杨旭鸣,等. 养阴清热、活血利水中药组方治疗狼疮性肾炎的疗效观察. 辽宁中医杂志.2012,39(12): 2413-2417.
28. 白文汉. 中西医结合治疗狼疮性肾炎37例. 陕西中医学院学报. 2013,36(1):51-53.
29. 叶玉燕,潘兴成. 加减参芪地黄汤联合西药治疗气阴两虚型狼疮性肾炎的疗效观察-叶玉燕. 中华中医药学刊.2014.33(2):339-341
30. 邓晓蔚,熊有明,覃应媛. 参芪地黄汤加减联合泼尼松片治疗气阴两虚证活动期狼疮性肾炎疗效观察. 现代中西医结合杂志.2016, 25(33):3698-3700.
31. Wang Y,Han M, Pedigo CE, et.al. Chinese Herbal Medicine for Systemic Lupus Erythematosus: A Systematic Review and Meta-analysis of Randomized, Placebo-Controlled Trials. Chinese Journal of Integrative Medicine. 2021,27:778-787.
32. 帅 宗文,徐建华,刘炎. 白芍总贰辅助治疗系统性红斑狼疮的临床观察. 中国中西医结合杂志.2003,23(3):188-191.
33. 汪玉梅。滋阴狼疮胶囊治疗阴虚内热型SLE的疗效评价及对皮质激素撤减的影响2005 硕士论文（广州中医药大学）
34. 黄贵阳, 钟小劲. (2007). 六味地黄丸对霉酚酸酯联合激素治疗狼疮性肾炎的影响. 广东医学院学报. 25(6), 637-638.
35. Liao YN, Liu CS, Tsai TR, et.al. Preliminary study of a traditional Chinese medicine formula in systemic lupus erythematosus patients to taper steroid dose and prevent disease flare-up. Kaohsiung J Med Sc. 2011,27:251-257.
36. 徐翔峰,曲环汝,向珍蛹,等. 滋阴解毒祛瘀法对系统性红斑狼疮激素用量影响的随机双盲对照试验. 上海中医药杂志.201246(1):33-36.
37. 宋欣伟,唐伟杰,关天容,等. PMC方案联合狼疮扶正解毒胶囊治疗重度活动系统性红斑狼疮的临床观察. 中国中西医结合杂志.2013,33(10):1315-1319.
38. Zhong LL, Bian ZX, Gu JH, et.al. Chinese herbal medicine (Zi Shen Qing) for mild- to-moderate systematic lupus erythematosus: a pilot prospective, single-blinded, randomized controlled study. Evid Based Complement Alternat Med. 2013:327245.
39. 黄钢花,钟嘉熙,刘 叶,等. 清养透解合剂联合西药对系统性红斑狼疮患者血管损伤的影响. 中医杂志. 2014,55(12): 1029-1033.
40. 吴菲雅,苏晓. 复方生地合剂治疗系统性红斑狼疮(阴虚内热型)的疗效及安全性评价. 风湿病与关节炎.2017,6(8): 27-31.
41. 戴清漪,顾军花. 滋肾青芪颗粒联合常规疗法治疗轻中活动度系统性红斑狼疮的临床观察. 上海中医药杂志.2019,53(8):65-67.
42. Chang CM, Wu PC, Chiang JH, et.al. Integrative Therapy Decreases the Risk of Lupus Nephritis in Patients with Systemic Lupus Erythematosus: A Population-Based Retrospective Cohort Study, Journal of Ethnopharmacology. 2016. http://dx.doi.org/10.1016/j.jep.2016.12.016
43. Chen S, Dai Y, Zhao J, et.al (2018). A Mechanistic Overview of Triptolide and Celastrol, Natural Products from Tripterygium wilfordii Hook F. Frontiers in Pharmacology, 9. https://doi.org/10.3389/fphar.2018.00104
44. 刘雪梅, 刘志宏, 张晶, 等. 雷公藤临床应用及不良反应的研究进展[J]. 药学实践与服务, 2015, 33(2): 110-113. doi: 3969/j.issn.1006-0111.2015.02.004
45. 丹皮酚抗肿瘤作用机制的研究进展. (n.d.). ChemicalBook. https://www.chemicalbook.com/NewsInfo_17192.htm
46. 黄咏菁,陈建宏,吴元胜,等.中药狼疮Ⅱ号胶囊联合泼尼松治疗系统性红斑狼疮临床研究.岭南皮肤性病科杂志. 2007,14(6):337-340
47. 万焰,刁庆春.狼疮2号方治疗缓解期系统性红斑狼疮的临床研究.四川中医. 2012,30(8):82-83.
48. Lai N, Lu M, Chang H, etc.al. Association of Traditional Chinese Medicine Body Constitution and Health-Related Quality of Life in Female Patients with Systemic Lupus Erythematosus: A Cross-Sectional Study. Evidence-based Complementary and Alternative Medicine. 2021:1–11. https://doi.org/10.1155/2021/5568219
49. 申安平, 李桓, 王炳森, 李晓坤, 李松伟. 基于网络药理学初探雷公藤干预狼疮性肾炎的效-毒作用[J]. 中国药理学通报, 2022, 38(2): 275-281.
50. 雷公藤对肾脏的毒性与保护作用及机制的研究进展_参考网. (n.d.). https://www.fx361.cc/page/2024/0313/23138081.shtml
51. Wei C, Shen H, Yu H. Effects and core patterns of Chinese herbal medicines on hematologic manifestations in systemic lupus erythematosus: A systematic review and meta-analysis. EXPLORE. 2023, 20(2), 168–180.

Click to download PowerPoint