加味五苓散对肾病综合征水肿患者肾小管功能影响的临床研究

发布时间：2018-01-11 05:28

本文关键词：加味五苓散对肾病综合征水肿患者肾小管功能影响的临床研究　出处：《福建中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:主要观察加味五苓散对脾肾阳虚型原发性肾病综合征水肿患者的临床疗效、水电解质及肾小管损伤的影响,进一步探讨其可能的作用机理。研究方法:将符合原发性肾病综合征合并水肿的脾肾阳虚型患者70例,随机分为试验组和对照组,对照组以常规西药治疗,试验组在对照组治疗基础上加加味五苓散颗粒剂(猪苓9g、泽泻15g、白术9g、茯苓9g、桂枝6g、党参12g、黄芪12g、益母草9g、附子(黑顺片)3g),全成分,日1剂,每剂与50ml开水冲服,2次/天,疗程为2周;治疗期间,每天监测患者体重、尿量及浮肿变化情况,同时检测治疗前后血清白蛋白、24h尿蛋白定量、电解质(钾、钠)及肾小管损害标志物(β2-MG、NAG、NGAL)。研究结果:1、两组患者经治疗后水肿症状均有减轻,脾肾阳虚的中医症状减轻,但试验组疗效明显优于对照组。2、治疗后两组血清白蛋白、24h尿蛋白定量均有显著差异,其中在升高血清白蛋白、降低24h尿蛋白方面试验组效果优于对照组。3、治疗后两组电解质紊乱(低钾、低钠的发生率)具有显著差异,其中试验组疗效优于对照组。4、治疗后两组在降低NAG、NGAL方面具有显著差异,其中试验组的效果明显优于对照组;而治疗后两组在降低β2-MG方面两组没有显著差异。研究结论:加味五苓散联合西药可有效降低西药利尿治疗过程中肾小管的损伤程度,还可减少电解质紊乱的发生,总体上改善脾肾阳虚型PNS水肿患者的临床症状。加味五苓散的临床应用过程中未发现明显副作用,具有临床实用价值。
[Abstract]:Objective: to observe the effect of Jiawei Wuling Powder on the edema of primary nephrotic syndrome with deficiency of spleen and kidney yang and the effect of water electrolyte and renal tubule injury. Methods: 70 patients with primary nephrotic syndrome complicated with edema of spleen and kidney yang deficiency were randomly divided into experimental group and control group, and the control group was treated with routine western medicine. The experimental group was treated with modified Wuling Powder granules (9 g, 15 g, 9 g, 9 g, 6 g, 12 g, 12 g, 12 g, 9 g, 9 g). Radix aconite (Radix aconite 3 g / d, total component, 1 dose per day, 2 times a day with 50 ml boiled water), the course of treatment was 2 weeks; During the treatment, the changes of body weight, urine volume and swelling were monitored every day. At the same time, serum albumin 24 hours urine protein and electrolyte (potassium) were measured before and after treatment. Sodium) and renal tubular damage marker (尾 2-MGN NAGN NGALL). The results showed that the edema symptoms of the two groups were alleviated after treatment, and the TCM symptoms of deficiency of spleen and kidney yang were alleviated. However, the therapeutic effect of the test group was significantly better than that of the control group. After treatment, there were significant differences between the two groups in serum albumin 24 hours urine protein quantification, among which the serum albumin was increased. The effect of the test group was better than that of the control group in reducing 24h urine protein. After treatment, there was a significant difference between the two groups in electrolyte disorder (low potassium, low sodium incidence), and the effect of the test group was better than that of the control group. There was significant difference between the two groups in reducing NGAL after treatment, and the effect of the experimental group was better than that of the control group. However, there was no significant difference between the two groups in reducing 尾 2-MG after treatment. Conclusion: Jiawei Wuling Powder combined with western medicine can effectively reduce the degree of renal tubular injury in the course of diuretic therapy. It can also reduce the occurrence of electrolyte disturbance, improve the clinical symptoms of PNS edema patients with spleen and kidney yang deficiency, and no obvious side effects were found in the clinical application of Jiawei Wuling Powder, which is of clinical practical value.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.5

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