以黄芪为主的中药制剂二步序贯法配合西药治疗狼疮性肾炎的临床研究

发布时间：2018-07-01 15:15

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

【摘要】：目的:通过观察以黄芪为主的中药制剂二步序贯法配合西药治疗狼疮性肾炎的临床疗效,探讨以黄芪为主的中药制剂二步序贯法配合西药治疗狼疮性肾炎的有效性及安全性,为中西医结合治疗狼疮性肾炎提供一种简便、安全、有效的方法。方法:选取在广西中医药大学附属瑞康医院就诊的60例IV型狼疮性肾炎患者,用随机数字表法随机分为对照组(A组)、黄芪方药组(B组)、二步序贯组(C组)各20例,A组采用西医常规治疗,即强的松加环磷酰胺(CTX);B组在A组治疗的基础上,予CTX冲击时当天即予加服复方黄芪颗粒至12周;C组同样在A组治疗基础上,予CTX冲击时,先用黄芪注射液50ml加入5%葡萄糖注射液250ml中静脉滴注,连用1周后序贯每天服用复方黄芪颗粒至第4周,反复使用3次。3组共同疗程均为12周。通过观察三组患者治疗前后白细胞(WBC)、血红蛋白(HGB)、24h尿蛋白定量、血肌酐(Scr)、血清白蛋白(ALB)、T细胞亚群(CD4+、CD8+、CD4+/CD8+)、补体C3与C4、血沉(ESR)、雌二醇(E2)、促卵泡刺激素(FSH)、促黄体生成素(LH)、睾酮(T)、泌乳素(PRL)、孕酮(P)、谷丙转氨酶(ALT)、谷草转氨酶(AST)等疗效指标,同时观察患者临床症状、体征的改善状况,并进行疗效及安全性评价。结果:在治疗过程中,有2例患者脱落,其中A组与B组各1例,脱落的2例病例不参与数据分析。结果如下:1、治疗后三组患者疾病疗效总有效率分别为:73.68%、78.95%、90.00%,中医证候疗效总有效率分别为:78.95%、84.21%、95.00%,结果表明C组疗效总有效率优于A组与B组(P0.05),而B组与A组相比无明显差异(P0.05)。2、三组患者SLEDAI积分、中医症候积分经治疗后均较治疗前下降(P0.05),C组较A组及B组下降更为明显(P0.05),而B组与A组相比无明显差异(P0.05)。3、三组经CTX冲击后WBC均较前下降(P0.05),而C组WBC较A组与B组恢复快(P0.05),B组与A组相比无明显差异(P0.05);A组及B组治疗后HGB改变不明显(P0.05),而C组HGB明显升高(P0.05)。4、三组治疗后24h尿蛋白定量、Scr均较前下降(P0.05),C组、B组24h尿蛋白定量均较A组下降明显(P0.05),但C组优于B组(P0.05),B组Scr与A组比较无明显差异(P0.05);A组及B组治疗后ALB改变不明显(P0.05),而C组ALB明显升高(P0.05)。5、三组治疗后CD4+、CD4+/CD8+比值均较前升高(P0.05),而C组升高更明显(P0.05),B组与A组相比无明显差异(P0.05);三组治疗后CD8+与治疗前无明显差异(P0.05)。6、三组治疗后C3、C4均升高(P0.05),但C组较A组及B组升高明显(P0.05),B组与A组相比无明显差异(P0.05);三组治疗后ESR均较前下降(P0.05),C组和B组ESR均较A组下降明显(P0.05),而C组ESR下降幅度较B组更大(P0.05)。7、治疗后三组E2均较前下降(P0.05),而C组下降幅度较A组和B组小(P0.05);三组治疗后FSH、LH均较前上升(P0.05),而C组上升幅度较A组和B组小(P0.05),B组E2、FSH、LH与A组相比无明显差异(P0.05);三组治疗后T、PRL、P较治疗前均无明显差异(P0.05)。8、治疗后C组在感染、肝功能异常、痤疮、血糖升高、上消化道出血等不良反应的发生率均低于A组和B组(P0.05),B组与A组相比无明显差异(P0.05)。结论:1、以黄芪为主的中药制剂二步序贯法配合西药治疗狼疮性肾炎疗效确切,可增强机体免疫功能,改善肾功能,减少激素及免疫抑制剂所引起的不良反应,提高患者整体生活质量。2、中西医结合治疗狼疮性肾炎具有协同作用,疗效优于单独运用西医治疗。
[Abstract]:Objective: To observe the clinical efficacy of the two step sequential method of traditional Chinese medicine with Astragalus and Western medicine in the treatment of lupus nephritis, and to explore the efficacy and safety of the two step sequential method of traditional Chinese medicine with Astragalus and Western medicine in the treatment of lupus nephritis, and provide a simple, safe and effective prescription for the combination of Chinese and Western medicine in the treatment of lupus nephritis. Methods: 60 patients with type IV lupus nephritis were randomly divided into the control group (group A), the Astragalus prescription group (group B), the two step sequential group (group C) 20 cases, and the A group using western medicine routine treatment, namely, prednisone plus cyclophosphamide (CTX), and B group on the basis of A group treatment, and B group were given CTX. In the same day, the Compound Huangqi granule was added to 12 weeks, and the C group was also treated with the A group on the basis of the treatment of group A, and the astragalus injection 50ml was first added to the intravenous drip of Glucose Injection 250ml. After 1 weeks, the Compound Huangqi granule was taken for fourth weeks, and the common course of the 3.3 group was repeated for 12 weeks. Three groups were observed. WBC, HGB, 24h urine protein, serum creatinine (Scr), serum albumin (ALB), T cell subgroup (CD4+, CD8+, CD4+/CD8+), complement C3 and C4, erythrocyte sedimentation (ESR), follicle stimulating hormone, progesterone, prolactin, prolactin, prolactin, glutamic pyruvine aminotransferase, glutamic pyruvic transaminase, and serum albumin (ALB), T cell subgroup (CD4+, CD8+, CD4+/CD8+), (AST) and other therapeutic indicators, at the same time, the clinical symptoms and signs of the patients were observed, and the efficacy and safety were evaluated. Results: during the treatment, 2 cases were dropped, including 1 cases in group A and B, and 2 cases were not involved in data analysis. The results were as follows: 1, the total effective rate of the three groups of patients after treatment was 73.68%, 78, respectively. .95%, 90%, the total effective efficiency of TCM syndrome was 78.95%, 84.21%, 95%. The results showed that the total effective efficiency of group C was better than that of group A and group B (P0.05), but there was no significant difference between group B and A group (P0.05).2, and the three group of SLEDAI integral, after treatment, the TCM syndrome score decreased more obviously than that before treatment (P0.05), and the decrease of C group was more obvious than that of group and group. There was no significant difference (P0.05) between group B and A group (P0.05).3, and WBC decreased after CTX shock (P0.05), and C group WBC was faster than A group and B group (P0.05). The 24h urine protein in C group and B group decreased significantly (P0.05), but the C group was superior to that of the A group (P0.05), but the C group was better than the B group (P0.05), and the Scr in the B group was not significantly different from that of the A group, while the three groups were significantly higher than those in the A group. There was no significant difference (P0.05) between group B and group A (P0.05), and there was no significant difference between the three groups after treatment (P0.05).6, C3, C4 increased (P0.05) in the three groups after treatment, but there was no significant difference between the C group and the A group and the group. The three groups were all lower than those in the previous group. The decrease of ESR in group C was larger than that in group B (P0.05).7, and the E2 in the three groups after treatment was lower than that in the former (P0.05), but the decrease in the C group was smaller than that in the A group and B group (P0.05). L, P had no significant difference (P0.05).8 before treatment. After treatment, the incidence of adverse reactions such as infection, abnormal liver function, acne, hyperglycemia, upper gastrointestinal bleeding were lower than that of group A and B group (P0.05), and there was no significant difference between the B group and the A group (P0.05). Conclusion: 1, the two step sequential method of traditional Chinese medicine with Astragalus was combined with western medicine to treat lupus kidney. The effect of inflammation is accurate. It can enhance the immune function of the body, improve the function of the kidney, reduce the adverse reactions caused by the hormone and immunosuppressant, and improve the overall quality of life of the patients with.2. The combination of traditional Chinese and Western medicine has a synergistic effect on the treatment of lupus nephritis. The curative effect is better than the treatment of Western medicine alone.
【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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