激素治疗成人原发性肾病综合征各阶段中医证候探讨

发布时间：2018-11-14 14:49

【摘要】：目的:通过临床收集成人原发性肾病综合征(Primary Nephrotic Syndrome,PNS)患者在使用糖皮质激素(以下简称“激素”)各个阶段出现的症状、体征等,总结其中医证型、症状变化特点,为中西医结合辨证论治治疗原发性肾病综合征提供临床诊疗依据。方法:制定统一的观察表,将符合激素使用适应症及已经正规接受激素治疗的PNS患者的症状、体征及舌苔脉象如实地记录在观察表中。病例收集结束后,由研究人员按照统一的辨证标准进行证候类型判定,并做相应的统计学分析及描述,探讨激素治疗成人原发性肾病综合征不同阶段中医证候的特点。结果:截至研究结束共收集病例142例,其中用药前38例,足量期32例,减量期37例,维持期35例。具体研究结果如下:一、在本虚证方面,患者在使用激素前以脾肾气虚型为主(55.3%),其次可见脾肾阳虚型(26.3%)、肺肾气虚型(18.4%);激素足量期则多见肝肾阴虚型(56.3%)、气阴两虚型(25.0%),脾肾气虚型明显减少(12.5%);激素减量期,中医证型转变为气阴两虚为主(51.4%),肝肾阴虚次之(35.1%),脾肾气虚型(8.1%)、肺肾气虚型(5.4%)相差无几;在激素维持期,以阴阳两虚型(51.4%)为主,气阴两虚型(22.9%)次之,肝肾阴虚型未见。二、在标实证方面,患者使用激素前以血瘀证(31.6%)、水湿证(28.9%)为主;激素足量期则以湿热证(40.6%)、血瘀证(40.6%)为主;在激素减量期,湿浊证(40.5%)患者明显增加,其次为湿热证(24.3%)、血瘀证(27.0%)并见;至激素维持期则以湿浊证(28.6%)、血瘀证(28.6%)为主,在整个发病过程中湿邪、血瘀全程皆可见较高比重。结论:在以激素治疗成人原发性肾病综合征的过程中,其中医证型随着药物的剂量、疗程的变化而随之出现明显的动态变化。本虚证方面,分别为:脾肾气虚型为主→肝肾阴虚型为主→气阴两虚为主→阴阳两虚型为主。标实证方面,分别为血瘀证、水湿证为主→湿热证、血瘀证为主→湿浊证为主→湿浊证、血瘀证为主,其中,血瘀证几乎贯穿疾病全程。
[Abstract]:Objective: to collect the symptoms and signs of adult patients with primary nephrotic syndrome (Primary Nephrotic Syndrome,PNS) at different stages of glucocorticoid use, and to summarize their TCM syndromes and symptom changes. To provide clinical basis for the treatment of primary nephrotic syndrome. Methods: the symptoms, signs and tongue coating pulse of PNS patients who met the indication of hormone use and received regular hormone therapy were recorded truthfully in the observation table. At the end of the case collection, according to the unified syndrome differentiation criteria, the researchers determined the syndrome types, and made the corresponding statistical analysis and description to explore the characteristics of hormone treatment of adult primary nephrotic syndrome in different stages of TCM syndromes. Results: up to the end of the study, 142 cases were collected, including 38 cases before medication, 32 cases in adequate period, 37 cases in decrement period and 35 cases in maintenance period. The specific results are as follows: 1. In this deficiency syndrome, the patients were mainly spleen and kidney qi deficiency (55.3%) before the use of hormones, followed by spleen and kidney yang deficiency (26.3%), lung and kidney qi deficiency (18.4%); Deficiency of liver and kidney yin (56.3%), deficiency of qi and yin (25.0%), deficiency of spleen and kidney qi (12.5%) were more common in hormone stage. In the period of hormone reduction, TCM syndrome changed into deficiency of qi and yin (51.4%), liver and kidney yin deficiency (35.1%), spleen and kidney qi deficiency (8.1%), lung and kidney qi deficiency (5.4%). In the hormone maintenance period, Yin and Yang deficiency type (51.4%), Qi and Yin deficiency type (22.9%), liver and kidney yin deficiency type was not seen. Secondly, in the aspect of standard evidence, blood stasis syndrome (31.6%), water dampness syndrome (28.9%), dampness and heat syndrome (40.6%) and blood stasis syndrome (40.6%) were the main factors before hormone use. In the period of hormone reduction, dampness and turbid syndrome (40.5%) increased significantly, followed by damp-heat syndrome (24.3%) and blood stasis syndrome (27.0%). In the period of hormone maintenance, dampness and turbid syndrome (28.6%) and blood stasis syndrome (28.6%) were the main factors. The proportion of dampness pathogen and blood stasis were higher in the whole process. Conclusion: in the course of treating adult primary nephrotic syndrome with hormone, the TCM syndromes have obvious dynamic changes with the change of dosage and course of treatment. In terms of this deficiency syndrome, respectively: spleen and kidney qi deficiency type mainly and liver and kidney yin deficiency type are mainly Qi and yin deficiency and deficiency of yin and yang deficiency type. In the aspect of standard evidence, blood stasis syndrome, water dampness syndrome, dampness and heat syndrome, blood stasis syndrome and blood stasis syndrome are respectively used in the whole process of the disease.
【学位授予单位】：山西省中医药研究院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.5

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