肾炎2号方治疗气阴两虚、湿热内蕴型IgA肾病的临床观察

发布时间：2018-03-17 07:30

  本文选题：IgA肾病　切入点：益气养阴、清热利湿法　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:IgA肾病是指肾脏免疫病理检查以肾小球系膜区IgA或IgA为主的免疫复合物沉积为特征的肾小球肾炎,是世界上最常见的一种肾小球疾病,于1968年由法国学者Berger与Hinglais首次描述,又称为Berger病。临床表现具有多样性,多数患者表现为反复发作的肉眼血尿、无症状血尿及蛋白尿,部分患者可合并有水肿、高血压、肾功能不全。本病发病率高,是一种进展性疾病,是我国终末期肾病的首要原因。目前发病机制尚未完全阐明,临床治疗上尚无统一的方案及特效药物,多采用对症治疗,视病理类型及病情发展选择性使用糖皮质激素和(或)免疫抑制剂,但病情容易反复,同时激素及免疫抑制剂有较大的毒副作用。近年来大量的实验研究及临床实践表明,中医药在辨证治疗IgA肾病方面取得了卓越成效。导师檀金川教授结合多年临床经验,在辨证论治的基础上,结合患者个体情况,以益气养阴、清热利湿为治疗大法,自拟肾炎2号方治疗该病,临床疗效显著,为IgA肾病的中医药治疗提供了理论依据及研究思路。方法:本研究全部病例均选自2015年7月-2017年1月就诊于河北省中医院肾内科门诊部的原发性IgA肾病患者,按照诊断标准、纳入标准以及排除标准选取病例60例,采用随机数字表法,将病例随机分为治疗组30例,对照组30例。两组患者在治疗前临床参数无统计学差异,所有患者均给予相同的基础治疗(即一般治疗和对症治疗),在此基础上,治疗组予以肾炎2号方加减,日一剂,水煎两次,共取汁300毫升,分早晚两次分服;对照组予以口服黄葵胶囊,每次5粒,每日3次。疗程均为3个月。观察患者尿红细胞计数、24小时尿蛋白定量、血浆白蛋白(ALB)、血脂(CHOL、TG)、肾功能(BUN、Scr、UA)、血和尿β2-微球蛋白(β2-MG)及中医症状积分在治疗前后的变化,以评价该药临床疗效。结果:1治疗组总有效率86.67%,对照组总有效率63.33%。两组的总有效率比较,有统计学差异(P0.05)。2治疗组在治疗1个月、3个月的症状积分与治疗前比较,治疗前为31.40±8.71,治疗1个月为27.80±6.13,3个月为14.86±6.42,均有显著性差异(P0.01);治疗组与对照组治疗后(21.93±7.29)比较,有显著性差异(P0.01)。3从病理分级所占比例来看,Lee氏Ⅲ级最高,Ⅱ级次之,Ⅰ级最低。病理分级疗效分析Ⅰ级与Ⅱ级,Ⅰ级与Ⅲ级,Ⅱ级与Ⅲ级相比均P0.05,没有统计学差异,治疗效果没有明显的差别。4治疗组在减轻蛋白尿、血尿,升高血浆白蛋白,调节血脂,降低血尿酸水平、降血和尿β2-微球蛋白等方面优于对照组,有统计学意义(P0.05)。结论:1以益气养阴、清热利湿为治疗原则,肾炎2号方为主方治疗IgA肾病,能明显的降低患者临床症状积分,改善临床症状,其作用明显优于对照组。2肾炎2号方能减轻蛋白尿、血尿,提高血浆白蛋白含量,调节血脂,降尿酸,保护肾功能。3肾炎2号方能降低血清及尿液中β2-微球蛋白水平,逆转早期肾损害,改善肾小管的功能,延缓IgA肾病病情进展。
[Abstract]:Objective: IgA nephropathy refers to immune complex deposition in kidney by pathological examination in glomerular mesangial IgA or IgA glomerulonephritis characterized by glomerular disease is a most common in the world, in 1968 by the French scholar Berger and Hinglais first described, also known as Berger disease. Clinical manifestations are diversified. The majority of patients presenting with recurrent hematuria, asymptomatic hematuria and proteinuria, some patients with edema, hypertension, renal insufficiency. The high incidence of the disease, is a progressive disease, is a leading cause of end-stage renal disease in China. At present, the pathogenesis has not been fully elucidated, and special effects drug in clinical treatment and no uniform, with symptomatic treatment, pathological types and the progression of the disease as the selective use of corticosteroids and immunosuppressive agents (or), but the condition is easily repeated at the same time, hormones and immunosuppressive agents Have sideeffects. Show that a large number of experimental studies and clinical practice in recent years, Chinese medicine in the treatment of IgA nephropathy syndrome and achieved remarkable results. Professor Tan Jinchuan combined with years of clinical experience, on the basis of syndrome differentiation and treatment, combined with individual cases, with Replenishing Qi and nourishing Yin, clearing heat and removing dampness for treatment of the disease. Treatment of Shenyan No. 2, clinical curative effect, provide a theoretical basis and research method for the treatment of IgA nephropathy in traditional Chinese medicine. Methods: in this study, all cases were selected from July 2015 January -2017 year visits to the nephrology clinic department of Hebei Province Hospital of traditional Chinese medicine in patients with primary IgA nephropathy, according to diagnostic criteria, inclusion criteria and exclusion the standard selection of 60 cases, using the method of random number table, the patients were randomly divided into treatment group of 30 cases, 30 cases in the control group. Two groups of patients before treatment. There were no significant differences in clinical parameters, all patients were given 浜堢浉鍚岀殑鍩虹��娌荤枟(鍗充竴鑸�娌荤枟鍜屽�圭棁娌荤枟),鍦ㄦ�ゅ熀纭�涓，

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