益肾清利法治疗慢性肾炎蛋白尿的疗效观察及对预后的影响

发布时间：2018-01-20 07:10

本文关键词： 慢性肾炎蛋白尿预后因素回顾性研究　出处：《南京中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：观察益肾清利法治疗慢性肾炎蛋白尿的临床疗效及对预后的影响。方法：采用回顾性队列研究的方法。收集2010.05-2015.12江苏省中医院肾科门诊随访9个月以上的慢性肾炎患者99例,其中包含有肾活检资料的89例,予中药益肾清利方治疗,24小时尿蛋白定量超过1.0g或单用益肾清利方3个月无效者加用雷公藤多苷片。观察治疗前后蛋白尿、血压、肾功能、血脂、血尿酸等指标的变化,比较蛋白尿分层和不同肾脏病理蛋白尿的疗效,采用Cox比例风险回归模型分析该治法对疾病预后的影响。结果：①疾病总体疗效：治疗3个月、6个月、9个月的总有效率分别为81.8%、86.9%、90.9%；②治疗后蛋白尿的变化：蛋白尿从治疗3个月开始明显减少,9个月达到最佳疗效,组内不同时间点尿蛋白定性(PRO)、24小时尿蛋白定量(UTP)的变化有统计学意义(P0.05)；③蛋白尿分层的疗效：蛋白尿程度较低的患者治疗后UTP下降更明显(P0.05)；④不同肾脏病理类型的疗效：IgA肾病(IgAN)、局灶节段性肾小球硬化(FSGS)、膜性肾病(MN)患者UTP治疗后均呈下降趋势,组内比较IgAN、FSGS患者治疗9个月与治疗前比较差异有统计学意义(P0.05),MN患者治疗前后比较差异无统计学意义(P0.05)；⑤治疗后肾功能及其他指标的变化：尿素氮(Bun)、血肌酐(Scr)、估计肾小球率过滤(eGFR)、平均动脉压(MAP)、血红蛋白(Hb)、血清白蛋白(Alb)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、血尿酸(UA)治疗前后比较差异无统计学意义(P0.05)；⑥对预后的影响：IgAN预后的独立危险因素包括高血压(HR: 1.7, P=0.013)、UTP基线2.5g/d (HR:3.6, P=0.000)、治疗3个月UTP下降率30%(HR:1.9,P=0.000)、eGFR60ml/min/1.73m2 (HR:4.3, P=0.018)、高尿酸血症(HR: 3.2, P=0.023):MN预后的独立危险囚素包括高血压(HR:3.5, P=0.003)、UTP基线2.5g/d (HR:6.8, P=0.000)、治疗3个月UTP下降率30%(HR：2.7,P=0.000)。结论：①采用益肾清利法治疗慢性肾炎有较好的减少蛋白尿的作用,治疗9个月有效率为90.9%,治疗期间肾功能稳定；②益肾清利法治疗对蛋白尿程度较低者疗效较好；③益肾清利法治疗对IgAN和FSGS疗效较好；④UTP基线高和治疗3个月UTP下降率低是影响慢性肾炎预后的因素之一,采用益肾清利法控制蛋白尿将有助于延缓慢性肾炎病情进展。
[Abstract]:Objective: to observe the clinical effect of Yishen Qingli method in the treatment of chronic nephritis proteinuria and its influence on prognosis. A retrospective cohort study was conducted to collect 99 patients with chronic glomerulonephritis who had been followed up for more than 9 months in the Department of Kidney, Jiangsu Provincial Hospital of traditional Chinese Medicine, 2010.05-2015.12. Among them, 89 cases with renal biopsy data were treated with Yishen Qingli prescription. 24 hours urine protein quantity more than 1.0 g or only Yishen Qingli prescription for 3 months were treated with Tripterygium wilfordii polyglycoside tablets. The changes of proteinuria, blood pressure, renal function, blood lipid and serum uric acid were observed before and after treatment. The effects of proteinuria stratification and different renal pathological proteinuria were compared. Cox proportional risk regression model was used to analyze the effect of the treatment on the prognosis of the disease. The total effective rate of 9 months was 81.8% and 86.9%, respectively. (2) changes of proteinuria after treatment: proteinuria decreased obviously from 3 months after treatment, and reached the best curative effect at 9 months. Urinary protein qualitative analysis was performed at different time points in group A (P < 0.05). The change of 24 hour urine protein quantitative UTP was statistically significant (P 0.05). 3Therapeutic effect of proteinuria stratification: the decrease of UTP in patients with lower proteinuria was more obvious after treatment (P0.05A); 4Therapeutic effects of different renal pathological types in patients with IgA nephropathy, focal segmental glomerulosclerosis (FSS) and membranous nephropathy (MN) showed a decreasing trend after UTP treatment. There was no significant difference before and after treatment in patients with IgANG FSGS before and after treatment. (5) changes of renal function and other indexes after treatment: urea nitrogen Bunn, serum creatinine creatinine (scr), estimated glomerular rate filtration, mean arterial pressure (map), hemoglobin (HB). Serum albumin (Alb), total cholesterol (TC), triglyceride (TGN), low density lipoprotein (LDL-C). There was no significant difference between two groups before and after treatment (P 0.05). 6 the independent risk factors affecting the prognosis of IgAN include hypertension HR1. 7, P0. 013 UTP baseline 2.5 g / d, HR-: 3.6. After 3 months of treatment, the rate of decline of UTP was 30% HR1.9 / 0.000% eGFR 60 ml / min / 1.73 m2 / HR4.3. The independent risk factors for prognosis of P0. 018, hyperuricemia: 3. 2, P0. 023: MN included hypertension HR3. 5, P0. 003). The baseline of UTP was 2.5 g / d (HR6: 6.8, P < 0. 000). The decline rate of UTP was 30 / 2.7 after 3 months of treatment. Conclusion the treatment of chronic nephritis with Yishen Qingli method has a good effect on reducing proteinuria, the effective rate is 90.9 in 9 months, and the renal function is stable during the treatment. 2the therapeutic effect of Yishen Qingli method on the patients with lower proteinuria was better; (3) Yishen Qingli method has better effect on IgAN and FSGS; 4High UTP baseline and low UTP decline rate were one of the factors influencing the prognosis of chronic glomerulonephritis, and the control of proteinuria by Yishen Qingli method would help to delay the progression of chronic glomerulonephritis.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.5

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