过敏性紫癜性肾炎中医证型、方药的文献研究及中西医结合治疗效果评价

发布时间：2018-02-09 09:59

本文关键词： 过敏性紫癜性肾炎中医辨证论治临床观察 Meta分析　出处：《湖北中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究过敏性紫癜性肾炎(Henoch-schonlein purpura nephritis HSPN)中医或中西医结合治疗的相关现代文献中的辨证规律、方剂及药物的使用规律。系统评价中西医结合治疗过敏性紫癜性肾炎的疗效。方法:计算机检索清华同方CNKI系列数据库、万方系列数据库、维普网中文科技期刊数据库,对符合纳入标准的文献进行统计分析。运用方剂计量学对所纳入研究的中医辨证分型、方剂、中药及中药四气、五味、归经、功效等特点进行统计,总结出现代医家在治疗过敏性紫癜性肾炎时的辨证方药规律。并系统评价中西医结合治疗本病的临床疗效。其中,所选药物的四气、性味、归经、功效均依据新世纪(第二版)全国高等中医药院校规划教材《中药学》[1]。结果:1.共纳入国内2003年-2016年公开发表的期刊文献71篇[2-72],共论及方剂(不包括自拟方)74首,中药244味,统计中药2990次。将71篇文献中辨证分型予以汇总,基本可归为血热妄行、风热伤络、湿热内蕴、脾肾两虚、气阴两虚、肝肾阴虚、脾虚不摄、血热夹瘀、湿瘀互结、瘀血内阻、卫外不固11种,并将各个证型频次进行统计。2.各证型治疗使用频次最高的方剂分别是银翘散、犀角地黄汤、三仁汤、参芪地黄汤、真武汤、知柏地黄汤、三仁汤和桃红四物汤、犀角地黄汤、归脾汤、玉屏风散、补阳还五汤和桃红四物汤。3.对本研究统计的各证型中使用频次较高的药物进行四气特性的统计分析提示,寒性药物的使用频次最多,热性药物使用频次最少。对本研究统计的各证型中使用频次较高的药物进行五味特性的统计分析提示,苦味药物的使用频次最多,甘味次之,咸味药物频次最少。对本研究统计的各证型中使用频次较高的药物进行归经的统计分析提示,归肝经、心经、肾经、肺经和脾经的药物较多。4.对纳入研究的27篇[51,52,55,56,72-94]文献进行中西医结合治疗过敏性紫癜性肾炎疗效的Meta分析示,在降低血肌酐、尿红细胞计数水平、24小时尿蛋白定量和提高血清白蛋白水平方面中西医结合治疗均优于单纯西医治疗并可减少肝功能异常、感染和胃肠道反应等不良反应的发生。结论:1.本病证型分布特点、方药的选用与中医对本病病因病机的认识基本一致。2.中医治疗本病常用方剂为银翘散、犀角地黄汤、三仁汤、参芪地黄汤、真武汤、知柏地黄汤、桃红四物汤、归脾汤、玉屏风散、补阳还五汤。3.Meta分析提示中西医结合治疗过敏性紫癜性肾炎优于单纯西医治疗。
[Abstract]:Objective: to study the syndromes differentiation of Henoch-schonlein purpura nephritis HSPNs in modern literature related to the treatment of Henoch-schonlein purpura nephritis. Systematic evaluation of the efficacy of combination of traditional Chinese and western medicine in the treatment of Henoch-Schonlein purpura nephritis. Methods: the database of Tsinghua Tongfang CNKI series, Wanfang series database, Weipu Web Chinese science and technology periodical database were searched by computer. Statistical analysis of the literature that meets the inclusion criteria. The characteristics of TCM syndrome differentiation, prescription, traditional Chinese medicine and four qi, five flavors, meridians, efficacy, etc., which are included in the study, are statistically analyzed by means of prescription metrology. This paper summarizes the law of TCM prescriptions in the treatment of Henoch-Schonlein purpura nephritis, and systematically evaluates the clinical efficacy of integrated traditional Chinese and western medicine in the treatment of this disease. Efficacy was based on the new century (the second edition) of the Chinese medicine college planning textbook < Pharmacology of Chinese Medicine] [1]. Results: 1. A total of 71 articles of periodicals published from 2003 to 2016 in China [2-72] were included, and the prescriptions (not including 74 prescriptions and 244 flavors of traditional Chinese medicine) were discussed. Statistics of Chinese herbal medicine 2990 times. 71 articles of syndrome differentiation and classification can be classified as blood heat, wind heat injury collaterals, damp-heat accumulation, spleen and kidney deficiency, qi and yin deficiency, liver and kidney yin deficiency, spleen deficiency, blood stasis, dampness and blood stasis, blood stasis, blood stasis, blood stasis, internal obstruction of blood stasis. The most frequently used prescriptions for each syndrome type are Yinqiao Powder, Rhino Corner Rehmannia decoction, Sanren decoction, Shenqi Dihuang decoction, Zhenwu decoction, Zhibai Dihuang decoction, Sanren decoction and Taohong Siwu decoction. Rhino Corner Rehmannia decoction, Guipi decoction, Yupingfeng Powder, Buyang Huanwu decoction and Taohong Siwu decoction .3.The statistical analysis of the four gas characteristics of the drugs with high frequency used in each syndrome type of this study indicates that the use of cold drugs is the most frequent. The statistical analysis of the five flavor characteristics of the drugs with higher frequency in each syndrome type of this study indicates that the bitter drugs are used the most frequently, and the sweet taste is the second. The frequency of saltwater drugs is the least. The statistical analysis of the drugs with higher frequency in each syndrome type of this study indicates that the drugs belong to the liver, heart and kidney meridians. The drugs of lung meridian and spleen meridian were more .4.The Meta analysis of the curative effect of combination of traditional Chinese and western medicine in treating Henoch-Schonlein purpura nephritis (Henoch-Schonlein purpura nephritis) with combined traditional Chinese and western medicine was carried out in 27 articles [51n 52n 55556J 72-94] which were included in the study. In the aspects of urine erythrocyte count level, 24 hour urinary protein quantification and raising serum albumin level, integrated traditional Chinese and western medicine treatment is superior to western medicine treatment alone and can reduce liver function abnormality. The occurrence of adverse reactions such as infection and gastrointestinal reaction. Conclusion 1. The distribution of syndromes, the choice of prescription and the understanding of etiology and pathogenesis of this disease in traditional Chinese medicine are basically consistent. 2. Yinqiao Powder, Rhino Corner and Rehmannia decoction, Sanren decoction are commonly used in the treatment of this disease. Shenqi Dihuang decoction, Zhenwu decoction, Zhibai Dihuang decoction, Taohong Siwu decoction, Guipi decoction, Yupingfeng San, Buyang Huanwu decoction. 3. Meta analysis indicates that the treatment of Henoch-Schonlein purpura nephritis by combination of traditional Chinese and Western medicine is superior to that of western medicine alone.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.34

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