金芪膜肾方联合雷公藤多苷片治疗特发性膜性肾病疗效观察
发布时间：2018-11-23 08:53
【摘要】：目的：以环磷酰胺(CTX)治疗作对照组,观察金芪膜肾方联合雷公藤多苷片(TW)治疗特发性膜性肾病(IMN)的临床疗效,探讨中医治疗IMN的手段与治疗机制。方法：2014年03月至2015年12月江苏省中医院门诊及住院患者共40例,符合IMN诊断条件,分为治疗组与对照组各20例,在糖皮质激素、ACEI/ARB、控制血压、调脂等治疗基础上,治疗组予金芪膜肾方联合TW,对照组予CTX,平均观察时间为6个月,观察治疗前后两组24hUTP、Scr、Alb、TC、TG、LDL-C、WBC、ALT、AST指标的变化及不良反应。结果：①疾病综合疗效：治疗组完全缓解2例(10%),部分缓解14(70%)例,未缓解4例(20%),总有效率为80%；对照组完全缓解4例(20%),部分缓解13(65%)例,未缓解3例(15%),总有效率为85%,差别无统计学意义(P0.05)。②中医证候疗效：治疗组与对照组总有效率分别为90%、60%,差别有统计学意义(P0.01),治疗组疗效优于对照组。③蛋白尿：治疗第3、6个月后两组患者24hUTP较治疗前均显著下降(P0.01),组间比较差别无统计学意义(P0.05)。④Scr：治疗组Scr差别有统计学意义(P0.05),对照组Scr差别无统计学意义(P0.05)。⑤其他实验室指标：两组血Alb均得到显著改善(P0.01)；治疗组改善更明显,组间比较差别有统计学意义(P0.05)。两组Scr比较差别无统计学意义(P0.05)。治疗前后两组血脂(TC、TG、LDL-C)差别均有统计学意义(P0.05),治疗组TG较对照组改善更明显,差异有统计学意义(P0.05)。⑥症状积分：治疗后两组中医症状总积分均有下降,治疗组下降更明显,组内及组间比较差异均有统计学意义(P0.01)；治疗组患者水肿、腰酸腰痛、食少纳呆、疲乏症状积分较治疗前下降,与对照组相比,组内及组间比较差异均有统计学意义(P0.01)。⑦安全性指标：两组患者安全性指标(WBC、ALT、AST)、总体不良反应差异均无统计学意义(P0.05)。结论：在西医常规及中医辨证的基础上,金芪膜肾方联合TW在降低蛋白尿、稳定肾功能方面与CTX疗效相当,在中医证候方面优于CTX,不良反应少。
[Abstract]:Objective: to observe the clinical effect of Jinqi membrane-kidney prescription combined with tripterygium polyglycoside (TW) in the treatment of idiopathic membranous nephropathy (IMN) with cyclophosphamide (CTX) as the control group, and to explore the means and mechanism of TCM treatment of IMN. Methods: from March 2014 to December 2015, a total of 40 outpatients and inpatients in Jiangsu Provincial Hospital of traditional Chinese Medicine were divided into treatment group (n = 20) and control group (n = 20). On the basis of glucocorticoid, ACEI/ARB, to control blood pressure and regulate lipid, etc. The average observation time of CTX, was 6 months in the treatment group treated with Jin Qi Mian Shen Fang and TW, control group. The changes and adverse reactions of the two groups were observed before and after treatment. Results: 1 Comprehensive curative effect: 2 cases (10%) with complete remission, 14 cases (70%) with partial remission and 4 cases (20%) with no remission in the treatment group. The total effective rate was 80%. In the control group, there were 4 cases (20%) with complete remission, 13 cases (65%) with partial remission and 3 cases (15%) with no remission. The total effective rate was 85%. 2 the curative effect of TCM syndrome: the total effective rate of treatment group and control group were 90 and 60, respectively, the difference was statistically significant (P0.01). The curative effect of the treatment group was better than that of the control group. 3. The 24hUTP of the two groups was significantly lower than that of the control group (P0.01) after 3 months and 6 months of treatment (P0.01). There was no significant difference between the two groups (P0.05). 4Scr4: the difference of Scr in the treatment group was statistically significant (P0.05). The difference of Scr in the control group was not statistically significant (P0.05). 5 other laboratory indicators: the two groups of blood Alb were significantly improved (P0.01); The improvement of treatment group was more obvious, the difference between groups was statistically significant (P0.05). There was no significant difference in Scr between the two groups (P0.05). There were significant differences in blood lipid (TC,TG,LDL-C) between the two groups before and after treatment (P0.05). TG in the treatment group was significantly improved than that in the control group. The difference was statistically significant (P0.05). 6 symptom score: after treatment, the total score of TCM symptoms in the two groups were all decreased, the decrease in the treatment group was more obvious, and the difference between the groups was statistically significant (P0.01). In the treatment group, the scores of edema, low back pain, low appetite and fatigue symptoms were lower than those before treatment, compared with those in the control group. There were significant differences within and between groups (P0.01). 7 Safety indicators: the two groups of patients with safety indicators (WBC,ALT,AST), the overall adverse reactions were not statistically significant (P0.05). Conclusion: on the basis of western medicine routine and TCM syndrome differentiation, Jinqi membrane-kidney prescription combined with TW can reduce proteinuria and stabilize renal function as well as CTX, and has less adverse reactions than CTX, in TCM syndromes.
【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
[Abstract]:Objective: to observe the clinical effect of Jinqi membrane-kidney prescription combined with tripterygium polyglycoside (TW) in the treatment of idiopathic membranous nephropathy (IMN) with cyclophosphamide (CTX) as the control group, and to explore the means and mechanism of TCM treatment of IMN. Methods: from March 2014 to December 2015, a total of 40 outpatients and inpatients in Jiangsu Provincial Hospital of traditional Chinese Medicine were divided into treatment group (n = 20) and control group (n = 20). On the basis of glucocorticoid, ACEI/ARB, to control blood pressure and regulate lipid, etc. The average observation time of CTX, was 6 months in the treatment group treated with Jin Qi Mian Shen Fang and TW, control group. The changes and adverse reactions of the two groups were observed before and after treatment. Results: 1 Comprehensive curative effect: 2 cases (10%) with complete remission, 14 cases (70%) with partial remission and 4 cases (20%) with no remission in the treatment group. The total effective rate was 80%. In the control group, there were 4 cases (20%) with complete remission, 13 cases (65%) with partial remission and 3 cases (15%) with no remission. The total effective rate was 85%. 2 the curative effect of TCM syndrome: the total effective rate of treatment group and control group were 90 and 60, respectively, the difference was statistically significant (P0.01). The curative effect of the treatment group was better than that of the control group. 3. The 24hUTP of the two groups was significantly lower than that of the control group (P0.01) after 3 months and 6 months of treatment (P0.01). There was no significant difference between the two groups (P0.05). 4Scr4: the difference of Scr in the treatment group was statistically significant (P0.05). The difference of Scr in the control group was not statistically significant (P0.05). 5 other laboratory indicators: the two groups of blood Alb were significantly improved (P0.01); The improvement of treatment group was more obvious, the difference between groups was statistically significant (P0.05). There was no significant difference in Scr between the two groups (P0.05). There were significant differences in blood lipid (TC,TG,LDL-C) between the two groups before and after treatment (P0.05). TG in the treatment group was significantly improved than that in the control group. The difference was statistically significant (P0.05). 6 symptom score: after treatment, the total score of TCM symptoms in the two groups were all decreased, the decrease in the treatment group was more obvious, and the difference between the groups was statistically significant (P0.01). In the treatment group, the scores of edema, low back pain, low appetite and fatigue symptoms were lower than those before treatment, compared with those in the control group. There were significant differences within and between groups (P0.01). 7 Safety indicators: the two groups of patients with safety indicators (WBC,ALT,AST), the overall adverse reactions were not statistically significant (P0.05). Conclusion: on the basis of western medicine routine and TCM syndrome differentiation, Jinqi membrane-kidney prescription combined with TW can reduce proteinuria and stabilize renal function as well as CTX, and has less adverse reactions than CTX, in TCM syndromes.
【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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