益肾健脾法对脾肾气虚型慢性尿酸性肾病干预的临床研究

发布时间：2018-04-14 20:44

本文选题：慢性尿酸性肾病 + 脾肾气虚　；参考：《福建中医药大学》2016年硕士论文

【摘要】：目的：通过临床观察以益肾健脾为治法的方剂(包括自拟方、时方、常用方)加减对慢性尿酸性肾病脾肾气虚型患者血尿酸的影响,并初步探讨降尿酸治疗对肾小球滤过率、24小时尿蛋白定量、血肌酐、血尿素氮等的影响。方法：将92例入选的脾肾气虚型的慢性尿酸性肾病患者随机分为中药组46例,西药组46例,西药组给予慢性尿酸性肾病健康教育、饮食控制、多饮水、碳酸氢钠碱化尿液,第二个月给予别嘌醇0.05g起始,每天1次,若无不良反应,2天后增量至O.1g每天1次控制血尿酸,保持饮水量每天不小于1.5L,并保持尿液PH值在6.0-7.0之间,血尿酸在男性及绝经女性控制在408umol/l以下、未绝经女性控制在360umol/l以下,后给予最低剂量维持；中药组慢性尿酸性肾病教育、饮食控制、饮水、碱化尿液要求同西药组,实验组第二个月起再给予以补益脾肾为治法方剂,常用中药如黄芪15g、党参15g、茯苓15g、白术6g、太子参15g、生地15g、山茱萸15g、山药15g、土茯苓15g、车前子15g、盐肤木15g等加减煎汤服用,中药水煎煮至200m1,分早晚服用,并定期复查血尿酸、血肌酐、血尿素氮、肾小球滤过率、24小时尿蛋白定量等变化,及治疗前后脾肾气虚患者中医证候的变化。结果：(1)中药组的治疗总有效率为84.78%,西药组为76.09%,两组有显著性差异(χ2=11.554,P=0.009,P0.01),中药组的疗效优于西药组；并且在改善临床证候方面,但中药组优于西药组(Z=-2.829,P=0.005,P0.01)。(2)单纯的给予严格控制饮食、多饮水及碱化尿液的除了在降低尿酸有显著的统计学意义(P0.05),在减低患者肌酐、尿素氮,提高eGFR,改善患者肾功能无明显效果(P0.05)。(3)无论是中药组还是西药组均有降低尿酸的作用(P0.01),并且两者降低尿酸的程度无差异(P--0.092,P0.05)。(4)中药组与西药组在血肌酐、尿素氮、eGFR、24h尿蛋白定量、24h尿酸排泄率、血β2微球蛋白、尿β2微球蛋白、尿RBC(个/HP)、尿RBC(个/u1)、尿蛋白定性、尿红细胞定性均有显著差异(P0.05),中药组的效果优于西药组。结论：(1)单纯的给予严格控制饮食、多饮水及碱化尿液的可显著的降低血尿酸的水平,但在降低患者肌酐、尿素氮,提高eGFR,改善患者肾功能无明显效果。(2)益肾健脾法对脾肾气虚的慢性高尿酸患者降低血尿酸的效果与别嘌醇无显著差异,其机制可能为促进尿酸的排泄。(3)益肾健脾法对脾肾气虚的慢性高尿酸患者可降低其血肌酐、血尿素氮、24h尿蛋白定量、血β2微球蛋白、尿β2微球蛋白、蛋白尿、血尿水平,提高患者肾小球滤过率,改善患者肾小球、肾小管功能的效果优于别嘌醇组。(4)益肾健脾法对脾肾气虚的慢性高尿酸患者改善临床症状方面优于别嘌醇组。
[Abstract]:Objective: to observe the effect of the prescription of tonifying kidney and invigorating spleen (including self-made prescription, Shi prescription, common prescription) on blood uric acid in patients with chronic uric acid nephropathy with deficiency of spleen and kidney qi through clinical observation.The effects of lowering uric acid on 24 hour urinary protein, serum creatinine and blood urea nitrogen were studied.Methods: 92 patients with chronic uric acid nephropathy with deficiency of spleen and kidney qi were randomly divided into Chinese medicine group (n = 46) and western medicine group (n = 46).The second month was given allopurinol 0.05g, once a day, if there was no adverse reaction 2 days later, increase to 0.1 g per day to control blood uric acid, keep drinking water not less than 1.5 L per day, and keep urine PH value between 6.0-7.0.Serum uric acid was controlled below 408umol/l in male and menopausal women, and below 360umol/l in premenopausal women, and then maintained at the lowest dose. Education of chronic uric acid nephropathy, diet control, drinking water and alkaline urine in Chinese medicine group were similar to those in western medicine group.From the second month, the experimental group was given with tonifying the spleen and kidney as the treatment prescription, commonly used Chinese medicine such as astragalus 15g, Codonopsis 15g, Poria cocos 15g, Atractylodes macrocephalae 6g, Radix princeliae 15g, raw land 15g, Cornus officinalis 15g, Chinese yam 15g, Thelia cocos 15g, Chenanzi 15g, Yanfumu 15g decoction, etc.The Chinese medicine decoction was boiled to 200ml and was taken in the morning and evening. The changes of serum uric acid, serum creatinine, blood urea nitrogen, glomerular filtration rate (GFR) and 24 hours urine protein were reviewed regularly, and the changes of TCM syndromes of patients with deficiency of spleen and kidney qi before and after treatment.Results the total effective rate of the Chinese medicine group was 84.78 and that of the western medicine group was 76.09. There was a significant difference between the two groups (蠂 ~ 2 / 11.554 / P ~ (0.009) P _ (0.01)). The curative effect of the Chinese medicine group was better than that of the western medicine group, and in improving the clinical symptoms, the traditional Chinese medicine group was better than the western medicine group (Z-2.829P _ (0.005) P _ (0.005) P _ (0.01) P _ (0.01)).In addition to reducing uric acid, there is a statistically significant difference between drinking water and alkaline urine (P 0.05), and in reducing creatinine and urea nitrogen in patients.Increasing eGFR, improving the renal function of patients had no obvious effect (P 0.05. 0. 0. 3) both the Chinese medicine group and the western medicine group had the effect of reducing uric acid (P 0. 01), and there was no difference in the degree of reducing uric acid between the two groups (P-0. 092, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, respectively).Serum 尾 2 microglobulin, urine 尾 2 microglobulin, urine 尾 2 microglobulin, urinary RBC (/ HPN), urine RBC (r / u 1), urine protein quality and urine erythrocyte quality were significantly different (P 0.05). The effect of Chinese medicine group was better than that of western medicine group.Conclusion (1) simple strictly controlled diet, drinking more water and alkaline urine can significantly reduce the level of serum uric acid, but in patients with creatinine, urea nitrogen,Improving eGFR and improving renal function. (2) there was no significant difference between tonifying kidney and invigorating spleen in reducing serum uric acid in chronic hyperuricemia patients with deficiency of spleen and kidney qi, and allopurinol.The mechanism may be to promote the excretion of uric acid.) tonifying the kidney and invigorating the spleen can reduce the serum creatinine, blood urea nitrogen 24h urinary protein, serum 尾 2 microglobulin, urine 尾 2 microglobulin, proteinuria, blood urine level in chronic hyperuricemia patients with deficiency of spleen and kidney qi.The effect of improving glomerular filtration rate and renal tubular function was better than that of allopurinol group.) the method of tonifying kidney and invigorating spleen was superior to allopurinol group in improving clinical symptoms of chronic hyperuricemia patients with deficiency of spleen and kidney qi.
【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】：2016
【分类号】：R277.5

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