加味真武汤联合激素治疗原发性肾病综合征的临床观察

发布时间：2018-05-19 11:42

本文选题：原发性肾病综合征 + 加味真武汤　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的:本文的主要研究目的是通过观察加味真武汤联合激素治疗原发性肾病综合征的临床治疗效果,探讨中西医结合治疗本病的新方法和治疗机理。方法:将符合原发性肾病综合征脾肾阳虚型诊断的来自天津市第三中心医院及天津权健肿瘤医院门诊及住院病人60例,采用随机数字表法分为治疗组和对照组进行临床观察,每组各30例。对照组病人给予西医糖皮质激素治疗,药物选用醋酸泼尼松按1mg/kg.d晨起顿服。治疗组在对照组激素治疗基础上给予加味真武汤水煎剂150ml一日二次口服,疗程30天。观察比较两组病人在中医症状积分、中医症状(水肿、畏寒肢冷、腰膝酸软等)、24小时尿蛋白定量、血浆白蛋白、血总胆固醇、血甘油三脂等临床实验室指标的改变情况,对两组患者治疗后的临床疗效进行对比,评估药物的安全性及不良反应情况。结果:(1)临床综合疗效:经过临床观察治疗组病人中完全缓解有8例,基本解11例,有效6例,无效5例,总有效率为83.33%;对照组病人完全缓解6例,基本缓解8例,显效5例,无效11例,总有效率为63.3%,总有效率明显高于对照组,两组间临床治疗效果具有明显差异(p0.05)。(2)两组病人治疗后中医症状与治疗前相比较都有明显减轻,中医症状总积分下降(p0.05),中医证候的总有效率分别为76.67%和56.7%,治疗组的中医治疗效果与对照组相比更为显著(p0.05)。(3)治疗后两组病人24小时尿蛋白定量组内比较均较治疗前下降,两组间比较经统计学分析,有统计学意义(p0.05),两组间治疗后24小时尿蛋白变化有显著差异,治疗组优于对治疗组。(4)两组治疗后血TC、TG组内比较均较治疗前有所下降,两组间比较经统计学统计分析,有统计学意义(p0.05),说明两组间治疗后血TC、TG变化有显著差异,治疗组优于对照组。(5)安全性方面,两组在治疗过程中均未出现过敏、肝肾损害等不良反应和药物毒副作用,说明加味真武汤在临床较为安全有效,无不良反应。结论:经过临床观察证实,加味真武汤联合激素在肾病综合征治疗上优于对照组,能够明显减轻患者临床症状,能够维持肾小球滤过膜稳定性,提高血浆白蛋白,调节脂代谢紊乱,提高机体抗病能力。临床用药安全,无不良反应发生,值得临床推广应用。
[Abstract]:Objective: to observe the clinical effect of Jiawei Zhenwu decoction combined with hormone in the treatment of primary nephrotic syndrome and to explore the new method and treatment mechanism of integrated traditional Chinese and western medicine for the treatment of primary nephrotic syndrome. Methods: sixty outpatients and inpatients from Tianjin third Center Hospital and Tianjin Quanjian tumor Hospital were divided into treatment group and control group by random digital table. There were 30 cases in each group. The patients in the control group were treated with western glucocorticoid and prednisone acetate was taken in the morning according to 1mg/kg.d. The treatment group was treated with Jiawei Zhenwu decoction 150ml twice a day on the basis of hormone therapy in the control group for 30 days. To observe and compare the clinical laboratory indexes such as symptom score of TCM, symptoms of TCM (edema, cold limbs, tender waist and knee, etc.) 24 hours urine protein quantitative, plasma albumin, serum total cholesterol, serum triglyceride, and so on. The safety and adverse reactions of the two groups were evaluated. Results: in the clinical observation group, there were 8 cases of complete remission, 11 cases of basic release, 6 cases of effective, 5 cases of ineffectiveness, and 83.33% of total effective rate, while the control group had 6 cases of complete remission, 8 cases of basic remission and 5 cases of remarkable effect. The total effective rate was 63.3%, and the total effective rate was significantly higher than that of the control group. The total score of TCM symptoms decreased p0.05A, the total effective rate of TCM syndromes were 76.67% and 56.7%, respectively. The therapeutic effect of TCM in the treatment group was more significant than that in the control group. The difference between the two groups was statistically significant (p 0.05). There was a significant difference between the two groups in the changes of urinary protein at 24 hours after treatment, and the treatment group was superior to the treatment group. The comparison between the two groups was statistically significant (p 0.05), indicating that there was a significant difference between the two groups in the changes of blood TCU TG after treatment, and the safety of the treatment group was superior to that of the control group. There was no allergy in the two groups during the course of treatment. Adverse reactions such as liver and kidney damage and side effects of drugs showed that Jiawei Zhenwu decoction was safe and effective in clinical practice without adverse reactions. Conclusion: after clinical observation, Jiawei Zhenwu decoction combined with hormone is superior to the control group in the treatment of nephrotic syndrome, it can obviously alleviate the clinical symptoms of the patients, maintain the stability of glomerular filtration membrane, and improve the plasma albumin. Regulate the disorder of lipid metabolism and improve the disease resistance of the body. Clinical drug use is safe, no adverse reactions occur, and it is worth popularizing.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692

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