加减参芪地黄汤治疗成人原发性局灶节段硬化性肾小球肾炎蛋白尿的回顾性研究

发布时间：2018-04-24 04:01

  本文选题：局灶节段性肾小球硬化 + 加减参芪地黄汤　； 参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的:局灶节段硬化性肾小球肾炎(Focal segmental glomurular sclerosis,FSGS)是临床上常见的肾小球疾病中的一种病理类型,是以足细胞变性,肾小球毛细血管襻闭塞和细胞外基质增多共见、内皮细胞和系膜细胞节段性增生、肾间质纤维化等一系列病变为特征,以血尿、蛋白尿和肾病综合征为主要临床表现,并朝着终末期肾病发展的疾病。该病常见于儿童的肾小球疾病,成人的发病率占所有原发性肾小球疾病的8%左右。西医治疗以降压、抗凝、控制蛋白尿和阻止硬化发展为主,肾上腺皮质激素的使用也是治疗该病的有效手段之一,但有近半数患者经激素治疗后效果不明显且副作用较大。国内已有相关研究表明,中医中药治疗在改善FSGS患者各项症状、体征、延缓病情发展、提高患者生活质量等方面有很好的效果,尤其是在控制本病的蛋白尿方面有其独特的优势。研究对象和方法:收集了2012年9月至2016年11月来自湖北省中医院肾病专科的住院部和门诊的病历资料,患者均于外院已行肾脏穿刺活检确诊为FSGS,并对继发性因素排除后,年龄≥18周岁,经中医四诊合参辨证后认为属于以气阴两虚为主要证候者,进行口服加减参芪地黄汤煎剂或(和)中西医结合基础治疗的病例共40份,其中使用中西医结合基础治疗共17例,使用中西医结合基础治疗合并加减参芪地黄汤煎剂治疗共23例。监测患者尿常规、24小时尿蛋白量及安全性指标(血脂、血白蛋白、血肌酐等)情况,记录患者的症状体征变化,进行中医证候量化评分,各项检查指标通过统计学分析比较,采用SPSS 21.0版本统计软件进行数据统计,评价该方对FSGS引发的蛋白尿的治疗效果。本研究旨在观察加减参芪地黄汤对pFSGS蛋白尿的临床疗效。结果:采用自我对照的方法,采纳用药前后及用药期间的各项检查指标作出对比。根据局灶节段硬化性肾小球肾炎气阴两虚型中医量化评分得出:总有效率67.5%,对照组有效率47.06%,治疗组有效率78.26%,两组比较有统计学意义(p小于0.05)。两组用中药治疗后积分均与治疗前积分相比具有统计学意义(p小于0.05);两组治疗前后的24小时尿蛋白定量、血脂、血白蛋白经自我对照后差异有统计学意义(p小于0.05)。结论:加减参芪地黄汤配合中西医结合基础治疗FSGS能显著改善患者临床症状,疗效高于对照组,并可调节脂质代谢、降低尿蛋白、升高血浆白蛋白、提高患者的生活质量,是一种比较安全的治疗手段,从而显示了中西医结合治疗FSGS的优势。
[Abstract]:Objective: focal segmental glomurular glomerulonephritis (FSGS) is a common pathological type of glomerular disease, which is characterized by podocyte degeneration, glomerular capillary loop occlusion and increase of extracellular matrix. A series of pathological changes, such as segmental proliferation of endothelial cells and Mesangial cells and renal interstitial fibrosis, are characterized by hematuria, proteinuria and nephrotic syndrome. The disease is common in children with glomerular disease, and the incidence of adult glomerular disease is about 8% of all primary glomerular diseases. Western medicine is mainly used to reduce blood pressure, anticoagulant, control proteinuria and prevent the development of sclerosis. The use of adrenocortical hormone is also one of the effective methods for the treatment of the disease. Relevant studies in China have shown that traditional Chinese medicine treatment has a good effect in improving the symptoms and signs of patients with FSGS, delaying the development of the disease, improving the quality of life of patients, and so on. Especially in the control of proteinuria has its unique advantages. Subjects and methods: from September 2012 to November 2016, we collected the medical records of hospitalized and outpatient patients of nephropathy in Hubei traditional Chinese Medicine Hospital. All patients were diagnosed as FSGSby renal biopsy in other hospitals, and the secondary factors were excluded. The age 鈮，

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