补脾益肾清热活血法治疗特发性膜性肾病的临床观察

发布时间：2018-04-26 04:02

本文选题：特发性膜性肾病 + 补脾益肾清热活血法　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:膜性肾病(Membranous Nephropathy,MN)是以肾小球基底膜上皮细胞下免疫复合物沉积伴基底膜弥漫增厚为特征的一组疾病。特发性膜性肾病(Idiopathic Membranous Nephropathy,IMN)的病因及发生机制尚不明确,临床上多表现为肾病综合征。目前西医治疗包括非特异性对症治疗和应用糖皮质激素、免疫抑制剂等的特异性治疗。长期应用糖皮质激素、免疫抑制剂,部分患者会出现副作用及不良反应。本研究采用补脾益肾、清热活血中药联合糖皮质激素、环磷酰胺治疗IMN,通过观察总蛋白(Total Protein,TP)、白蛋白(Albumin,ALB)、总胆固醇(Cholesterol,CHOL)、甘油三酯(Triglyceride,TG)、24小时尿蛋白定量(24 hours urinary total protein,24h-UTP)、尿素氮(Blood Urea Nitrogen,BUN)、血肌酐(Creatinine,CREA)、尿酸(Uric Acid,UA)、中医(Traditional Chinese Medicine,TCM)证候积分等指标的变化,探讨中西医结合治疗IMN的有效性和安全性。方法:纳入河北省中医院和河北医科大学第三医院门诊及住院的IMN患者50例,按随机数字法分为试验组和对照组各25例。对照组应用糖皮质激素、环磷酰胺及对症治疗。试验组在对照组治疗的基础上加用补脾益肾、清热活血中药。疗程6个月。观察治疗前后TP、ALB、CHOL、TG、24h-UTP、BUN、CREA、UA、中医证候积分及血常规、肝功能、心电图,计算总有效率以评判疗效及副作用发生情况。结果:治疗前,两组中医证候总积分、各证候积分、TP、ALB、CHOL、TG、24h-UTP等均无统计学差异(P0.05),具有可比性。1临床疗效:试验组总有效率88%,对照组总有效率60.9%,组间比较有统计学意义(P0.05);2中医证候积分:两组治疗后,中医证候总积分均显著下降(P0.01),治疗后组间比较试验组明显优于对照组(P0.01)。治疗后两组各中医证候积分比较,试验组中部分证候积分与对照组比较有差异(P0.05)。3 TP、ALB:两组治疗3个月、6个月与治疗前比较,TP、ALB均显著升高(P0.01);治疗3个月、6个月组间比较有统计学意义(P0.05,P0.01)。4 24h-UTP:两组治疗3个月、6个月与治疗前比较,24h-UTP均显著下降(P0.01),治疗3个月、6个月组间比较有统计学意义(P0.05,P0.01)。5 CHOL、TG:两组治疗6个月与治疗前比较,CHOL、TG下降有统计学意义(试验组P0.01,对照组P0.05),治疗6个月组间比较试验组CHOL、TG均较对照组下降有统计学意义(P0.05)。6肾功能:两组治疗前后,BUN、CREA、UA均未见异常。7副作用发生情况:试验组5例出现副作用,出现副作用6例次;对照组11例出现副作用,出现副作用15例次。试验组低于对照组。结论:应用中西医结合较单纯西医治疗IMN,能有效降低患者24h-UTP和血脂,升高血浆总蛋白和白蛋白,改善主要临床症状,提高临床疗效,同时减少应用糖皮质激素、环磷酰胺所致的毒副作用,具有较高的临床价值,值得进一步研究。
[Abstract]:Aim: membranous Nephropathy (MN) is a group of diseases characterized by the deposition of subcellular immune complex in glomerular basement membrane epithelium and diffuse thickening of basement membrane. The etiology and pathogenesis of idiopathic Membranous Nephropathy are not clear, and the clinical manifestations are nephrotic syndrome. At present, western medicine treatment includes non-specific treatment and specific treatment of glucocorticoid and immunosuppressant. Long-term use of glucocorticoids, immunosuppressants, some patients will have side effects and adverse reactions. In this study, combined with glucocorticoid, Chinese herbal medicine of tonifying spleen and tonifying kidney, clearing heat and activating blood circulation, Cyclophosphamide was used to treat IMNs by observing the changes of total protein, Albumin, Cholesterolol, triglyceride-24 hours urinary total protein24h-UTPN, urea nitrogen, blood Urea, creatinine To explore the efficacy and safety of integrated traditional Chinese and western medicine in the treatment of IMN. Methods: fifty IMN patients were enrolled in the outpatient and inpatient department of Hebei traditional Chinese Medicine Hospital and the third Hospital of Hebei Medical University. According to the random number method, they were divided into two groups: the experimental group (n = 25) and the control group (n = 25). The control group was treated with glucocorticoid, cyclophosphamide and symptomatic therapy. Experimental group in the control group on the basis of the treatment plus tonifying spleen and kidney, clearing heat and activating blood Chinese medicine. The course of treatment was 6 months. The syndromes score, blood routine, liver function, electrocardiogram and total effective rate were observed before and after treatment to evaluate the curative effect and side effects. Results: before treatment, the total integral of TCM syndromes in the two groups, There was no statistical difference in all syndromes between the two groups (P 0.05). The clinical efficacy was comparable. 1 the total effective rate of the trial group was 880.The total effective rate of the control group was 60.9. There was statistical significance between the two groups in the score of TCM syndromes: after treatment, the total effective rate of the two groups was 60.9, and there was a significant difference between the two groups in the score of TCM syndromes: after the treatment of the two groups, the total effective rate of the two groups was higher than that of the control group. The total integral of TCM syndromes decreased significantly (P 0.01), and the comparison between the two groups was better than that in the control group (P 0.01). After treatment, the scores of TCM syndromes in the two groups were compared, The scores of some syndromes in the trial group were significantly higher than those in the control group (P 0.05), and there were significant differences between the two groups in 3 months, 6 months and 6 months, respectively, and there was significant difference between the two groups in terms of P0.05, P0.01and 24h-UTP: 3 months of treatment and 6 months of treatment. [WT5BZ] the results of the study were as follows: (1) there was a significant difference between the two groups in the scores of syndromes and syndromes in the test group (P 0.05). Compared with before treatment, 24 h-UTP decreased significantly in month, 6 months and 3 months after treatment. There was significant difference between the two groups in terms of P0.05, P0.01, and 5 Choll TG: there was a significant decrease in TG of CHOLG in the two groups after 6 months of treatment (P0.01 in the experimental group, P0.05in the control group, in the treatment group, in the control group, in the treatment group, in the control group, and in the treatment group. Compared with the control group, CHOLTG in the test group was significantly lower than that in the control group in 6 months. The renal function was significantly lower than that in the control group. There were no abnormal 7. 7 side effects in both groups before and after treatment: 5 cases in the trial group had side effects. There were 6 side effects in the control group and 15 side effects in the control group. The experimental group was lower than the control group. Conclusion: the combination of traditional Chinese and western medicine can effectively reduce 24h-UTP and blood lipid, increase plasma total protein and albumin, improve main clinical symptoms, improve clinical efficacy, and reduce glucocorticoid use. The toxic side effects of cyclophosphamide have high clinical value and are worthy of further study.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.5

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