健脾益肾方联合西药治疗气阴两虚夹瘀型狼疮性肾炎的临床研究

发布时间：2018-06-19 07:35

本文选题：狼疮性肾炎 + 健脾益肾方　；参考：《广西中医药大学》2017年硕士论文

【摘要】：目的:观察健脾益肾方联合西药治疗气阴两虚夹瘀型狼疮性肾炎(LN)的临床疗效,为临床治疗狼疮性肾炎提供新的方法。方法:将2014年10月1日至2016年8月31日在广西中医药大学第一附属医院风湿病科、肾病科门诊及住院治疗的辩证为气阴两虚夹瘀型的LN首诊患者66例随机分为治疗组和对照组,两组各33例。对照组给予醋酸泼尼松、环磷酰胺(CTX)治疗,治疗组在对照组治疗基础上服用健脾益肾方,两组均连续治疗12周。观察两组患者治疗前后SLEDAI评分、中医证候积分、血常规(HGB、WBC、PLT)、24小时尿蛋白定量、红细胞沉降率(ESR)、肝功能(ALB)、肾功能(Sc r、BUN)、补体(C3、C4)、抗ds-DNA抗体指标及不良反应。结果:(1)两组临床疗效的比较:治疗组总有效率为87.10%,对照组总有效率为73.33%,治疗组优于对照组(P0.05)。(2)两组中医证候疗效的比较:治疗组总有效率为87.10%,对照组总有效率为66.67%,治疗组优于对照组(P0.01)。(3)两组病情积分的比较:两组治疗后SLEDAI积分、中医证候积分均较治疗前下降,差异有统计学意义(P0.01),且治疗组优于对照组(P0.01或P0.05)。(4)两组实验室指标比较:血常规:两组治疗后HGB均升高(P0.05),且治疗组优于对照组(P0.05)。两组治疗前后WBC、PLT均无明显差异(P0.05)。24小时尿蛋白定量:两组治疗后24小时尿蛋白定量均较治疗前降低,差异有统计学意义(P0.01),且治疗组优于对照组(P0.05)。ESR:两组治疗后ESR均下降(P0.01),但治疗后组间比较差异无统计学意义(P0.05)。肝功能、肾功能:两组治疗后ALB均升高,Scr、BUN均下降,差异有统计学意义(P0.01或P0.05),且治疗组优于对照组(P0.05)。免疫指标:两组治疗后补体C3均上升,抗ds-DNA抗体均下降,差异有统计学意义(P0.01),且治疗组优于对照组(P0.05)。两组治疗前后补体C4均无明显变化(P0.05)。(5)两组患者不良反应发生率比较:治疗组感染、痤疮的不良反应发生率少于对照组,差异有统计学意义(P0.05)。结论:健脾益肾方联合西药治疗气阴两虚夹瘀型狼疮性肾炎能提高疗效,减轻临床症状,改善贫血、肾功能,降低免疫炎症指标及疾病活动度,减少感染、痤疮不良反应的发生。
[Abstract]:Objective: to observe the clinical effect of Jianpi Yishen recipe combined with western medicine in the treatment of lupus nephritis with deficiency of qi and yin and blood stasis, and to provide a new method for the treatment of lupus nephritis. Methods: from October 1, 2014 to August 31, 2016, 66 cases of LN with syndrome of Qi and Yin deficiency and stasis were randomly divided into treatment group and control group in the Department of Rheumatology, Department of Rheumatology, first affiliated Hospital of Guangxi University of traditional Chinese Medicine. There were 33 cases in each group. The control group was treated with prednisone acetate and cyclophosphamide (CTX), the treatment group was treated with Jianpi Yishen recipe on the basis of the control group, both groups were treated continuously for 12 weeks. The SLEDAI score, TCM syndromes score, 24 hour urine protein quantification, erythrocyte sedimentation rate (ESRR), liver function (ALB), renal function (SC rn) BUNN, complement C 3n C 4, anti-ds-DNA antibody index and adverse reactions were observed before and after treatment. Results comparison of clinical efficacy between the two groups: the total effective rate of the treatment group was 87.10, the total effective rate of the control group was 73.33, and the treatment group was superior to the control group (P0.05, P0.05.Y2) the total effective rate of the treatment group was 87.10, the total effective rate of the control group was 66.67, the total effective rate of the treatment group was 87.10, the total effective rate of the control group was 66.67, and the total effective rate of the treatment group was 73.33. The treatment group was better than the control group (P 0.01). The comparison between the two groups: after treatment, the SLEDAI score of the two groups, The scores of TCM syndromes were all decreased compared with those before treatment, and the difference was statistically significant (P 0.01 or P 0.05). The laboratory indexes of the treatment group were better than that of the control group (P 0.01 or P 0.05). The blood routine: the HGB of the two groups increased after treatment, and the treatment group was superior to the control group (P 0.05). There was no significant difference between the two groups before and after treatment. The difference was statistically significant (P 0.01), and the treatment group was superior to the control group (P 0.05). ESR was decreased in both groups after treatment, but there was no significant difference between the two groups after treatment (P 0.05). Liver function, renal function: after treatment, ALB increased and Scrn bun decreased in both groups, the difference was statistically significant (P 0.01 or P 0.05), and the treatment group was superior to the control group (P 0.05). Immunological index: after treatment, complement C3 increased and anti-ds-DNA antibody decreased in both groups, the difference was statistically significant (P 0.01), and the treatment group was superior to the control group (P 0.05). There was no significant change in complement C4 between the two groups before and after treatment. (P 0.05) the incidence of adverse reactions in the treatment group was lower than that in the control group, and the difference was statistically significant (P 0.05). Conclusion: Jianpi Yishen prescription combined with western medicine can improve the curative effect, alleviate clinical symptoms, improve anemia, renal function, reduce immune inflammation index and disease activity, and reduce infection in the treatment of lupus nephritis with Qi and Yin deficiency and blood stasis. The occurrence of acne adverse reactions.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R593.242

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