健脾滋肾化瘀汤治疗气阴两虚型肾病综合征的临床研究

发布时间：2018-02-09 22:35

本文关键词： 健脾滋肾化瘀汤气阴两虚瘀热肾病综合征　出处：《云南中医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察和研究以中医健脾滋肾化瘀为治则,拟定的“健脾滋肾化瘀汤”联合醋酸泼尼松治疗气阴两虚为本,瘀热为标型肾病综合征的临床疗效,以及对气阴两虚为本,瘀热为标型肾病综合征患者相关临床指标的改善,进而客观科学地评价此法治疗气阴两虚为本,瘀热为标型肾病综合征的综合临床疗效。方法:1.选取原发性肾病综合征脾肾气阴两虚型患者68例,采用单盲法,按照随机分组(按照就诊次序随机分组,规定奇数为治疗组,偶数为对照组)、同期对照试验的原则分为对照组和治疗组,其中对照组34例,治疗组34例。2.在临床研究前,对治疗组、对照组病人的年龄、性别、病程、临床症状、疗效性指标等检验分析,确定两组之间的差别无统计学意义。3.服药方法:(1)常规治疗:水肿严重、存在低蛋白血症患者建议卧床休息。低盐(3g/d)、减少动物油脂的摄入、优质蛋白饮食(蛋白质摄入量为0.8-1.0g/(kgd))加足够热量,补钙,护胃,防治水、电解质及酸碱失衡。(2)对症治疗:实验过程中如发生全身水肿严重者予以利尿消肿(注意应用袢利尿剂防止低纳低钾低氯性碱中毒);有感染时予以抗感染治疗;有血栓、栓塞、急性肾损伤等并发症予积极的对症治疗。对照组:进行上述西医常规对症治疗加口服激素(醋酸泼尼松1mg/kg.d)治疗,遵循激素使用原则和方案;治疗组:在上述西医常规对症治疗加口服激素(醋酸泼尼松1mg/kg.d)治疗的基础上加用口服中药(健脾滋肾化瘀汤)。(4)疗程:以四周为一个疗程,连续观察三个疗程。(5)达到疗程后记录主要相关临床表现(包括相关的症状、体征、舌象、脉象)、24小时尿蛋白定量、血浆白蛋白、胆固醇、血常规、尿常规、肾功、肝功等,对服药的疗效及安全性作出客观评价。结果:1.68例患者(60例纳入本课题研究,8例被剔除),两组患者治疗前在年龄、性别、病程、症状等一般性资料方面无明显性差别(P㧐0.05)。2.经过三个疗程治疗后,治疗组的总有效率为93.33%;对照组总有效率为70.00%,两组比较有显著差异(P㩳0.05)。3.治疗组在改善面色少华,神疲乏力,或手心足心发热,腰酸腰痛或浮肿等中医临床症状,以及减少24小时尿蛋白、纠正低蛋白血症、降低胆固醇等方面,疗效均优于对照组(P㩳0.05)。4.对安全性指标,如生命体征(T、P、R、BP)、血常规(HB、RBC、WBC、PLT)、以及肝功(ALT)、肾功(BUN、SCr、Ccr)等,进行统计学分析,用药前治疗组、对照组组间比较无统计学意义(P㧐0.05);用药后两组组间比较亦无统计学意义(P㧐0.05)。结论:运用健脾滋肾化瘀汤联合醋酸泼尼松治疗气阴两虚为本,瘀热为标型肾病综合征的患者,在改善面色少华,神疲乏力,或手心足心发热,腰酸腰痛或浮肿等中医临床症状,以及减少24小时尿蛋白、纠正低蛋白血症、降低胆固醇等方面,治疗组疗效明显优于单用醋酸泼尼松。
[Abstract]:Objective: to observe and study the clinical effect of "Jianpi Zishen Huayu decoction" combined with prednisone acetate in treating Qi and Yin deficiency and blood stasis heat as standard nephrotic syndrome, and to treat Qi and Yin deficiency. Improvement of clinical indexes in patients with standard nephrotic syndrome, and objective and scientific evaluation of this method for treating deficiency of Qi and Yin. Methods 1. 68 cases of primary nephrotic syndrome with deficiency of spleen and kidney qi and yin were selected and divided randomly according to the single blind method. The control group was divided into control group and treatment group according to the principle of control group and treatment group, 34 cases in control group and 34 cases in treatment group. Before clinical study, the patients in treatment group and control group were treated with age, sex, course of disease, clinical symptoms, The difference between the two groups was not statistically significant. (1) routine treatment: edema was severe, patients with hypoproteinemia were advised to rest in bed, low salt was 3 g / d, and the intake of animal fat was reduced. Quality protein diet (protein intake 0.8-1.0 g / kg? Add enough calories, supplement calcium, protect stomach, prevent and cure water, Electrolyte and acid-base imbalance. 2) symptomatic treatment: if severe systemic edema occurs during the experiment, diuretic swelling should be given (note the use of loop diuretics to prevent hypotonic, low potassium and low chlorine alkalosis; antiinfective treatment when infected; thrombus, embolism, etc.). Acute renal injury and other complications were treated with active symptomatic therapy. Control group: routine western medicine treatment plus oral administration of prednisone acetate (prednisone acetate 1 mg / kg 路d) followed the principle and scheme of hormone use; Treatment group: add oral Chinese medicine (Jianpi Zishen Huayu decoction) course of treatment on the basis of routine treatment of western medicine and oral hormone (prednisone acetate 1 mg / kg 路d): take four weeks as a course, The clinical manifestations (including symptoms, signs, tongue picture, 24 hours urine protein, plasma albumin, cholesterol, blood routine, urine routine, renal function, liver function, etc.) were recorded after three consecutive courses of treatment. Results Sixty out of 1.68 patients were included in this study and 8 patients were excluded. There was no significant difference between the two groups in age, sex, course of disease, symptoms and other general data before treatment. After three courses of treatment, the total effective rate of the treatment group was 93.33, and the total effective rate of the control group was 70.00.There was a significant difference between the two groups. The curative effect of the treatment group is superior to that of the control group in improving the complexion of Shaohua, fatigue, fever of the palms and feet, low back pain or swelling, reducing 24 hours urine protein, correcting hypoproteinemia, lowering cholesterol, etc., the therapeutic effect of the treatment group is better than that of the control group. The safety indexes, such as vital signs, blood routine test (HBT), blood routine test (HBC), and liver function (ALT), renal function (BUNN) SCrCcrs, were analyzed statistically. There was no significant difference between the control group and the treatment group before the treatment. There was no significant difference between the two groups in the treatment group and the control group (P > 0.05), and there was no significant difference between the control group and the treatment group (P > 0.05), and there was no significant difference between the control group and the treatment group before the use of the drug. There was no significant difference between the two groups after treatment. Conclusion: using Jianpi Zishen Huayu decoction combined with prednisone Acetate to treat the patients with deficiency of Qi and Yin and blood stasis and heat as the standard nephrotic syndrome can improve the complexion, fatigue, or fever of the palms and feet. The curative effect of the treatment group was better than that of prednisone acetate alone in the aspects of low back pain or swelling of lumbar acid, reducing 24 hours urine protein, correcting hypoproteinemia and lowering cholesterol.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.5

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