中药复方痹宁汤治疗痛风性肾病的临床研究

发布时间：2018-04-18 17:20

本文选题：痛风 + 尿酸　；参考：《黑龙江中医药大学》2017年硕士论文

【摘要】：目的:导师在治疗痛风性关节炎的临床研究的课题中发现,许多痛风性关节炎患者除有关节炎的改变外,尿酸盐对肾脏也有程度不同的损坏,通过对中药复方痹宁汤治疗早期痛风性肾病患者的观察,研究该方剂对痛风性关节炎早期的肾损害的防治作用及其可能的作用机制。方法:该课题通过搜集2015年9月～2017年3月期间黑龙江中医药大学附属第一医院风湿科门诊,诊断为痛风性肾病的患者,共30例。按随机的原则分为治疗组(复方痹宁汤+西药别嘌醇片)和对照组(西药别嘌醇片),各组分别15例患者,1月为1个疗程,共2疗程;分别对两组病人的一般情况、尿蛋白、尿潜血、尿白细胞、尿红细胞;C-反应蛋白、红细胞沉降率;血尿酸、血β2-微球蛋白、尿β2-微球蛋白等相关指标结果经统计学处理、分析。结果:1.治疗组组治疗痛风性肾病总有效率为93.3%,对照组的总有效率为66.67%,治疗组的治疗效果改善明显(P0.05)。2.中医证候积分:治疗前,治疗组与对照组比较,P0.05,具有可比性。治疗后,治疗组、对照组的两个时间点的组内分别比较,P0.01,差异显著。治疗后,两组组间的两个时间点的疗效各自比较,P0.05,有明显差异,治疗组的中医证候积分改善优于对照组。3.观察指标:(1)治疗前,血尿酸组间比较,P0.05,无差异;血尿酸各组的治疗前、治疗1月后组间、组内相比,P0.05,有差异,有统计学意义;血尿酸各组的治疗前、治疗2月后组内、组间相比,P0.01,有显著的差异,有统计学意义。(2)血β2-MG、尿β2-MG:血β2-MG、尿β2-MG治疗前各组组间相较,P0.05,结果无差异;治疗后,血β2-MG、尿β2-MG治疗组内相较,P0.01,有显著性差异;血β2-MG、尿β2-MG对照组内相较,P0.05,有明显差异;血β2-MG、尿β2-MG两组组间相较,P0.05,效果有差异性,说明治疗组的治疗效果优于对照组。(3)尿蛋白、尿潜血两组间治疗前后比较,P0.05,对照组结果差于治疗组,有统计学意义;对尿蛋白、尿潜血的治疗组、对照组的组内分别进行对比,P0.05,说明治疗后较治疗前症状减轻,有统计学意义;红细胞、白细胞的治疗前两组分别进行相比,P0.05,无差异;红细胞、白细胞的治疗组与对照分别对比,P0.05,有差异性,有统计学意义;红细胞、白细胞的治疗后分别于其相应组的治疗前对比,P0.01,有显著差异。(4)C-反应蛋白、血沉治疗前各组组间相较,P0.05,具有统计学意义;各组治疗后与治疗前相较,P0.05,有差异性;各组治疗后组间相较,P0.05,无统计学意义。结论:痛风性关节炎反复发作可引起肾功能的损伤;中药复方痹宁汤可使痛风病人的临床表现和体征得到有效改善;使病人的BUA水平下降,减少尿潜血、蛋白尿和尿中白细胞,降低血β2-MG、尿β2-MG。在降低血沉、C-反应蛋白方面治疗效果不明显。中药复方痹宁汤对痛风患者早期性肾损害有确切的临床疗效,在预防痛风性肾病的进一步发展有疗效,可对痹宁汤行进一步深入的研究,可在临床广泛应用。
[Abstract]:Objective: in the course of clinical research on the treatment of gouty arthritis, our tutor found that many patients with gouty arthritis have different degrees of kidney damage in addition to the changes of arthritis.By observing the treatment of early gouty nephropathy with compound Bining decoction, the preventive and therapeutic effects of the prescription on early renal damage in gouty arthritis and its possible mechanism were studied.Methods: from September 2015 to March 2017, 30 patients with gouty nephropathy were collected from the Department of Rheumatology of the first affiliated Hospital of Heilongjiang University of traditional Chinese Medicine.According to the random principle, they were divided into treatment group (compound binning decoction and western medicine allopurinol tablet) and control group (western medicine allopurinol tablet).Urine occult blood, urine leukocyte, urine erythrocyte C-reactive protein, erythrocyte sedimentation rate, blood uric acid, blood 尾 _ 2-microglobulin, urine 尾 _ 2-microglobulin were analyzed by statistical analysis.The result is 1: 1.The total effective rate of gouty nephropathy was 93.3in the treatment group and 66.67 in the control group.TCM syndrome score: before treatment, the treatment group compared with the control group P 0.05, comparable.After treatment, the two time points in the treatment group and the control group were significantly higher than that in the control group (P 0.01).After treatment, the curative effect of two time points in the two groups was significantly different (P 0.05), and the improvement of TCM syndrome integral in the treatment group was better than that in the control group. 3.Observation measure: 1) before treatment, there was no difference in serum uric acid group (P 0.05); before treatment, after 1 month treatment, there was significant difference in blood uric acid group (P 0.05), and there was significant difference in blood uric acid group (P 0.05) before and after treatment for 2 months (P 0.05), and there was significant difference in blood uric acid group (P 0.05) before and after treatment for 2 months (P 0.05).There was significant difference in blood 尾 2-MG, urine 尾 2-MG: blood 尾 2-MG: urine 尾 -MG: urine 尾 -MG: compared with P0.05 before and after treatment, there was no significant difference in blood 尾 2-MGG, urine 尾 -MGG, urine 尾 -MGG, urine 尾 -MGG and urine 尾 -MGG, and there was significant difference in blood 尾 2-MGG, urine 尾 -MGG and urine 尾 -MGG, compared with P0.01 after treatment, there was no significant difference between the two groups before and after treatment.Serum 尾 2-MG and urine 尾 2-MG were significantly different in control group compared with control group P0.05, blood 尾 2-MG and urine 尾 2-MG were significantly higher than that of control group P0.05, indicating that the therapeutic effect of the treatment group was better than that of the control group (P 0.05), and the effect of urine protein in the treatment group was better than that in the control group.The results of the control group were worse than that of the treatment group (P 0.05), the urine protein, urine occult blood treatment group and the control group were compared with each other before and after treatment (P0.05), which indicated that the symptoms were alleviated after treatment.Before the treatment of red blood cells and white blood cells, there was no difference between the two groups; the treatment group of red blood cells and white blood cells were compared with the control group (P 0.05), there was difference, there was statistical significance; red blood cells, red blood cells, red blood cells, red blood cells, red blood cells, white blood cells, red blood cells,The leukocytes were compared with P0.01 before and after treatment in the corresponding group. There was a significant difference in C- reactive protein between the two groups, there was significant difference between the two groups before and after ESR treatment (P 0.05), there was significant difference between the two groups after treatment and before treatment, and there was a significant difference between the two groups before and after treatment, and there was no significant difference between the two groups before and after treatment.There was no significant difference between groups after treatment (P 0.05).Conclusion: repeated attack of gouty arthritis can cause damage to renal function, compound Chinese medicine Bining decoction can effectively improve the clinical manifestations and signs of gout patients, decrease the level of BUA in patients, and reduce urine occult blood, proteinuria and white blood cells in urine.Serum 尾 2-MG and urine 尾 2-MG were decreased.The effect of treatment on reducing ESR C-reactive protein was not obvious.Compound Bining decoction has definite clinical effect on early renal damage in gout patients, has curative effect in preventing the further development of gouty nephropathy, and can be further studied on Bining decoction, which can be widely used in clinic.
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R589.7;R692

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