扶正清热利湿法治疗老年女性阳虚湿热型反复发作性下尿路感染的临床研究

发布时间：2018-09-11 20:04

【摘要】：目的：尿路感染为泌尿外科常见及多发病,易复发和再感染。尤其是老年女性反复发作性尿路感染,其治疗是临床上的难点。本研究旨在通过随机对照研究,观察治疗组和对照组在临床症状和实验室检查指标等方面的变化,探讨中医中药辨证治疗老年女性阳虚湿热型反复发作性下尿路感染的临床指导意义。通过研究证实扶正清热利湿法在缓解尿路感染主要临床症状、提高疾病痊愈率、降低复发率、改善机体免疫力及日常生活质量等方面具有显著的效果。方法：选取符合研究准入标准的阳虚湿热型反复发作性下尿路感染老年女性患者50例,进行随机分组,其中对照组25例,治疗组25例。对照组予以宁泌泰治疗,治疗组在宁泌泰基础上予加味八正散治疗,治疗8到12周。治疗结束后复查实验室指标和症状评分,将结果进行统计学分析研究,观察治疗前后下尿路感染患者主要症状、体征和实验室指标的变化,评估扶正清热利湿法的临床治疗效果。结果：(1)、运用扶正清热利湿法总体有效率为96%,显著优于对照组,P0.05,治疗后两组患者复发率相比较,治疗组明显小于对照组,P0.05,两者均有统计学意义。(2)、治疗后治疗组和对照组患者尿WBC、鳞状上皮细胞相比较,治疗组显著优于对照组,P0.05,有统计学意义。(3)、治疗后治疗组CD4、CD4/CD8均高于治疗前,P0.01,差异显著,有统计学意义；治疗后对照组CD4、CD4/CD8较治疗前无明显变化,差异无统计意义,P0.05；治疗前后治疗组和对照组CD8变化无明显差异,P0.05。(4)、治疗组中医症状积分比较,治疗前后下降显著,P0.01；对照组中医症状积分比较,治疗前后亦有所下降,P0.01,有统计学意义。治疗后治疗组与对照组中医症状积分相比较,治疗组明显小于对照组,P0.05,存在统计学意义。(5)、两组患者在治疗前后血常规、肝肾功能、心电图均未发现明显异常改变。结论：(1)、扶正清热利湿法治疗老年女性反复发作性下尿路感染临床疗效确切,总有效率局。(2)、扶正清热利湿法能显著提高机体免疫功能及临床痊愈率,降低下尿路感染的复发率、改善老年女性反复发作性下尿路感染的临床症状,缓解下尿路刺激症状和脾肾阳虚症状,提高患者生活质量。(3)、清热利湿中药方剂替代广谱抗生素治疗尿培养阴性的反复发作性下尿路感染亦有明显效果。(4)、扶正清热利湿法使用安全,无明显毒副作用。
[Abstract]:Objective: urinary tract infection is common and frequent in urology, easy to relapse and re-infection. In particular, the treatment of recurrent urinary tract infection in elderly women is a difficult point in clinic. The purpose of this study was to observe the changes of clinical symptoms and laboratory indexes in the treatment group and the control group through a randomized controlled study. To explore the clinical significance of TCM syndrome differentiation in the treatment of recurrent lower urinary tract infection in elderly women with yang deficiency, dampness and heat. Through the study, it was proved that the method of Fuzheng, Clearing Heat and removing dampness had remarkable effect in relieving the main clinical symptoms of urinary tract infection, increasing the cure rate of the disease, reducing the recurrence rate, improving the immunity of the body and the quality of daily life, and so on. Methods: fifty elderly women with recurrent lower urinary tract infection of Yang deficiency and damp-heat type were randomly divided into two groups: control group (n = 25) and treatment group (n = 25). The control group was treated with Ningmytai, and the treatment group was treated with Jiawei Bazheng Powder on the basis of Ningmetai for 8 to 12 weeks. After the treatment, the laboratory indexes and symptom scores were reviewed, and the results were analyzed statistically. The changes of the main symptoms, signs and laboratory indexes of the patients with lower urinary tract infection before and after treatment were observed. To evaluate the clinical effect of Fuzheng Qingre and dampness therapy. Results: (1) the total effective rate of Fuzheng, Qingre and dampness was 96, which was significantly better than that of the control group (P0.05). After treatment, the recurrence rate of the two groups was higher than that of the control group. The treatment group was significantly smaller than the control group (P 0.05), both of which had statistical significance. (2) after treatment, the urinary WBC, squamous epithelial cells were compared between the treatment group and the control group. The CD4,CD4/CD8 in the treatment group was significantly higher than that in the pre-treatment group (P 0.01), the difference was significant (P 0.05), the CD4,CD4/CD8 in the control group was not significantly different from that in the control group (P 0.05), and there was no significant difference between the two groups (P 0.05). There was no significant difference in the changes of CD8 between the treatment group and the control group before and after treatment (P0.05. (4). The scores of TCM symptoms in the treatment group decreased significantly before and after treatment, and the scores of TCM symptoms in the control group were also decreased before and after treatment (P 0.01), with statistical significance. After treatment, the scores of TCM symptoms in the treatment group and the control group were significantly lower than that in the control group (P 0.05). (5) there were no obvious abnormal changes in blood routine, liver and kidney function and electrocardiogram before and after treatment in the two groups. Conclusion: (1) the clinical effect of Fuzheng, Clearing Heat and removing dampness in treating elderly women with recurrent lower urinary tract infection is definite, and the total effective rate can be obtained. (2) the method of Fuzheng, Clearing Heat and removing dampness can significantly improve the immune function of the body and the clinical recovery rate, and reduce the recurrence rate of lower urinary tract infection. To improve the clinical symptoms of recurrent paroxysmal lower urinary tract infection in elderly women, to alleviate the symptoms of irritation of lower urinary tract and deficiency of spleen and kidney yang, Improve the quality of life of patients. (3) the treatment of repeated episodes of lower urinary tract infection with negative urine culture also has obvious effect. (4) it is safe to use the method of tonifying heat and removing dampness without obvious side effects.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.5

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