加味清心莲子饮治疗激素撤减期原发性肾病综合征的临床疗效观察

发布时间：2018-04-17 15:25

本文选题：原发性肾病综合征 + 糖皮质激素　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的:通过观察加味清心莲子饮对原发性肾病综合征气阴两虚型患者的临床疗效,探讨其可能的作用机制,为中医药治疗原发性肾病综合征提供一个新的思路。方法:病例来源于2015年07月至2016年12月在福建中医药大学附属人民医院肾病科及南京军区福州总医院肾内科住院及门诊已采用标准激素方案为主治疗6-8周的PNS患者74例,按随机数字表法分为对照组38例,试验组36例。对照组(38例)按标准激素治疗方案,按首量足,维持时间长,减药缓慢为原则,即泼尼松起始剂量为1.Omg/(Kg· d),最大用量不超过80mg/d,每日晨起顿服,对严重消化道水肿或肝功能异常者改用相同剂量的甲泼尼龙静脉滴注,症状改善后改为口服给药。对于病理类型诊断为膜性肾病(Membranous nephropathy,MN)或局灶节段性肾小球硬化(Focal segmental glomerulosclerosis,FSGS)等的患者,联合使用其他免疫抑制剂,具体用法按照中国成人肾病综合征免疫抑制治疗专家共识(2014)执行。试验组(36例)在对照组治疗基础上,加用加味清心莲子饮口服治疗,每日一剂。两组疗程为2个月。观察两组治疗前后24小时尿蛋白定量、清晨8点血清皮质酵、上呼吸道感染发生次数情况,并观察治疗前后两组气阴两虚证候积分、血清白蛋白、甘油三酯、总胆固醇、血肌酐等的变化情况,并进行相关统计分析。结果:1.两组患者治疗前性别、年龄、气阴两虚证候积分、相关实验室检测指标比较无统计学意义(P0.05),有可比性。2.治疗后两组患者中医气阴两虚证候积分均有明显降低,且试验组显著优于对照组(P0.01)。3.治疗后两组患者ALB、SC较治疗前均有升高,TG、24hUV、TC、LDL-C均有所降低,差异具有统计学意义(P0.05),治疗后两组Scr差异无统计学意义(P0.05)。4.治疗后试验组ALB、TG、24hUV、SC、临床转归判定优于对照组(P＜0.05),其中ALB显著优于对照组(P0.01)。5.试验组在观察期内上呼吸道感染的发生率明显少于对照组,差异有统计学意义(P0.05)。结论:1.加味清心莲子饮联合标准激素方案为主的治疗可以从整体上改善PNS激素撤减期气阴两虚证候积分,改善患者的临床症状,且中医临床证候疗效改善程度显著高于标准激素方案。2.加味清心莲子饮能够显著改善PNS激素撤减期气阴两虚型患者的ALB、TG、24hUV、SC水平,表现为更好的促进血清白蛋白的合成,调节脂代谢紊乱,减少蛋白尿,改善HPA系统的功能紊乱,更好的促进肾上腺皮质功能的恢复。3.加味清心莲子饮能够更好的减少原发性肾病综合征激素撤减期上呼吸道感染的发生,更好的改善患者的临床转归。4.加味清心莲子饮在改善PNS激素撤减期气阴两虚型患者的TC、LDL-C、Scr与标准激素方案为主的治疗差异不显著。
[Abstract]:Objective: to observe the clinical effect of Jiawei Qingxinlianzi decoction on patients with deficiency of Qi and Yin in primary nephrotic syndrome and to explore its possible mechanism so as to provide a new idea for the treatment of primary nephrotic syndrome with traditional Chinese medicine.Methods: from July 2015 to December 2016, 74 PNS patients were treated with standard hormone regimen in Renal Department of Renal Hospital affiliated to Fujian University of traditional Chinese Medicine and Department of Renal Medicine of Fuzhou General Hospital of Nanjing military region.According to the random digital table method, 38 cases in control group and 36 cases in test group were divided into two groups.The control group (n = 38) was treated with standard hormone regimen, according to the principle of first dose, long maintenance time and slow drug reduction. The initial dose of prednisone was 1.Omg/(Kg DX, the maximum dose was not more than 80 mg / d, and the dosage was taken daily from morning to morning.The patients with severe digestive tract edema or abnormal liver function were given the same dose of methylprednisolone, and the symptoms were improved by oral administration.Patients with membranous nephropathy (MNs) or focal segmental glomerulosclerosis (FSGSs) were treated with other immunosuppressants in accordance with the consensus of immunosuppressive therapy for adult nephrotic syndrome in China (2014).The trial group (36 cases) was treated with modified Qingxinlianzi decoction once a day on the basis of control group.The course of treatment was 2 months.Before and after treatment, 24 hours urine protein quantification, 8 am serum cortical leaven and the frequency of upper respiratory tract infection were observed. The syndromes of qi and yin deficiency, serum albumin, triglyceride, total cholesterol were observed before and after treatment.The changes of serum creatinine were analyzed.The result is 1: 1.Two groups of patients before treatment gender, age, Qi and Yin deficiency syndrome score, related laboratory indicators were not statistically significant (P 0.05), comparable. 2.After treatment, the scores of Qi and Yin deficiency syndrome in both groups were significantly decreased, and the experimental group was significantly better than the control group (P 0.01). 3.After treatment, the Scr of the two groups was significantly lower than that of the control group (P 0.05). There was no significant difference in Scr between the two groups after treatment.After treatment, the clinical outcome of the experimental group was better than that of the control group (P < 0.05), and the ALB was significantly better than that of the control group (P < 0.01).The incidence of upper respiratory tract infection in the experimental group was significantly lower than that in the control group (P 0.05).Conclusion 1.The treatment of modified Qingxinlianzi decoction combined with standard hormone regimen can improve the integral of Qi and Yin deficiency syndrome in the period of withdrawal of PNS hormone, improve the clinical symptoms of patients, and improve the curative effect of TCM clinical syndrome significantly higher than that of standard hormone regimen. 2.Jiawei Qingxinlianzi decoction could significantly improve the level of PNS TGG in patients with deficiency of both qi and yin in the period of withdrawal of PNS hormone, which could promote the synthesis of serum albumin, regulate lipid metabolism disorder, reduce proteinuria, and improve the functional disorder of HPA system.Better promote the recovery of adrenocortical function. 3.Jiawei Qingxin Lianzi decoction can better reduce the incidence of primary nephrotic syndrome hormone withdrawal of upper respiratory tract infection, better improve the clinical outcome of patients. 4.There was no significant difference between modified Qingxinlianzi decoction and standard hormone regimen in the treatment of patients with deficiency of qi and yin in the period of withdrawal of PNS hormone.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.5

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