本文選題：原發(fā)性腎病綜合征 + 糖皮質(zhì)激素�。� 參考：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過觀察加味清心蓮子飲對原發(fā)性腎病綜合征氣陰兩虛型患者的臨床療效,探討其可能的作用機(jī)制,為中醫(yī)藥治療原發(fā)性腎病綜合征提供一個新的思路。方法:病例來源于2015年07月至2016年12月在福建中醫(yī)藥大學(xué)附屬人民醫(yī)院腎病科及南京軍區(qū)福州總醫(yī)院腎內(nèi)科住院及門診已采用標(biāo)準(zhǔn)激素方案為主治療6-8周的PNS患者74例,按隨機(jī)數(shù)字表法分為對照組38例,試驗(yàn)組36例。對照組(38例)按標(biāo)準(zhǔn)激素治療方案,按首量足,維持時間長,減藥緩慢為原則,即潑尼松起始劑量為1.Omg/(Kg· d),最大用量不超過80mg/d,每日晨起頓服,對嚴(yán)重消化道水腫或肝功能異常者改用相同劑量的甲潑尼龍靜脈滴注,癥狀改善后改為口服給藥。對于病理類型診斷為膜性腎病(Membranous nephropathy,MN)或局灶節(jié)段性腎小球硬化(Focal segmental glomerulosclerosis,FSGS)等的患者,聯(lián)合使用其他免疫抑制劑,具體用法按照中國成人腎病綜合征免疫抑制治療專家共識(2014)執(zhí)行。試驗(yàn)組(36例)在對照組治療基礎(chǔ)上,加用加味清心蓮子飲口服治療,每日一劑。兩組療程為2個月。觀察兩組治療前后24小時尿蛋白定量、清晨8點(diǎn)血清皮質(zhì)酵、上呼吸道感染發(fā)生次數(shù)情況,并觀察治療前后兩組氣陰兩虛證候積分、血清白蛋白、甘油三酯、總膽固醇、血肌酐等的變化情況,并進(jìn)行相關(guān)統(tǒng)計分析。結(jié)果:1.兩組患者治療前性別、年齡、氣陰兩虛證候積分、相關(guān)實(shí)驗(yàn)室檢測指標(biāo)比較無統(tǒng)計學(xué)意義(P0.05),有可比性。2.治療后兩組患者中醫(yī)氣陰兩虛證候積分均有明顯降低,且試驗(yàn)組顯著優(yōu)于對照組(P0.01)。3.治療后兩組患者ALB、SC較治療前均有升高,TG、24hUV、TC、LDL-C均有所降低,差異具有統(tǒng)計學(xué)意義(P0.05),治療后兩組Scr差異無統(tǒng)計學(xué)意義(P0.05)。4.治療后試驗(yàn)組ALB、TG、24hUV、SC、臨床轉(zhuǎn)歸判定優(yōu)于對照組(P＜0.05),其中ALB顯著優(yōu)于對照組(P0.01)。5.試驗(yàn)組在觀察期內(nèi)上呼吸道感染的發(fā)生率明顯少于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1.加味清心蓮子飲聯(lián)合標(biāo)準(zhǔn)激素方案為主的治療可以從整體上改善PNS激素撤減期氣陰兩虛證候積分,改善患者的臨床癥狀,且中醫(yī)臨床證候療效改善程度顯著高于標(biāo)準(zhǔn)激素方案。2.加味清心蓮子飲能夠顯著改善PNS激素撤減期氣陰兩虛型患者的ALB、TG、24hUV、SC水平,表現(xiàn)為更好的促進(jìn)血清白蛋白的合成,調(diào)節(jié)脂代謝紊亂,減少蛋白尿,改善HPA系統(tǒng)的功能紊亂,更好的促進(jìn)腎上腺皮質(zhì)功能的恢復(fù)。3.加味清心蓮子飲能夠更好的減少原發(fā)性腎病綜合征激素撤減期上呼吸道感染的發(fā)生,更好的改善患者的臨床轉(zhuǎn)歸。4.加味清心蓮子飲在改善PNS激素撤減期氣陰兩虛型患者的TC、LDL-C、Scr與標(biāo)準(zhǔn)激素方案為主的治療差異不顯著。
[Abstract]:Objective: to observe the clinical effect of Jiawei Qingxinlianzi decoction on patients with deficiency of Qi and Yin in primary nephrotic syndrome and to explore its possible mechanism so as to provide a new idea for the treatment of primary nephrotic syndrome with traditional Chinese medicine.Methods: from July 2015 to December 2016, 74 PNS patients were treated with standard hormone regimen in Renal Department of Renal Hospital affiliated to Fujian University of traditional Chinese Medicine and Department of Renal Medicine of Fuzhou General Hospital of Nanjing military region.According to the random digital table method, 38 cases in control group and 36 cases in test group were divided into two groups.The control group (n = 38) was treated with standard hormone regimen, according to the principle of first dose, long maintenance time and slow drug reduction. The initial dose of prednisone was 1.Omg/(Kg DX, the maximum dose was not more than 80 mg / d, and the dosage was taken daily from morning to morning.The patients with severe digestive tract edema or abnormal liver function were given the same dose of methylprednisolone, and the symptoms were improved by oral administration.Patients with membranous nephropathy (MNs) or focal segmental glomerulosclerosis (FSGSs) were treated with other immunosuppressants in accordance with the consensus of immunosuppressive therapy for adult nephrotic syndrome in China (2014).The trial group (36 cases) was treated with modified Qingxinlianzi decoction once a day on the basis of control group.The course of treatment was 2 months.Before and after treatment, 24 hours urine protein quantification, 8 am serum cortical leaven and the frequency of upper respiratory tract infection were observed. The syndromes of qi and yin deficiency, serum albumin, triglyceride, total cholesterol were observed before and after treatment.The changes of serum creatinine were analyzed.The result is 1: 1.Two groups of patients before treatment gender, age, Qi and Yin deficiency syndrome score, related laboratory indicators were not statistically significant (P 0.05), comparable. 2.After treatment, the scores of Qi and Yin deficiency syndrome in both groups were significantly decreased, and the experimental group was significantly better than the control group (P 0.01). 3.After treatment, the Scr of the two groups was significantly lower than that of the control group (P 0.05). There was no significant difference in Scr between the two groups after treatment.After treatment, the clinical outcome of the experimental group was better than that of the control group (P < 0.05), and the ALB was significantly better than that of the control group (P < 0.01).The incidence of upper respiratory tract infection in the experimental group was significantly lower than that in the control group (P 0.05).Conclusion 1.The treatment of modified Qingxinlianzi decoction combined with standard hormone regimen can improve the integral of Qi and Yin deficiency syndrome in the period of withdrawal of PNS hormone, improve the clinical symptoms of patients, and improve the curative effect of TCM clinical syndrome significantly higher than that of standard hormone regimen. 2.Jiawei Qingxinlianzi decoction could significantly improve the level of PNS TGG in patients with deficiency of both qi and yin in the period of withdrawal of PNS hormone, which could promote the synthesis of serum albumin, regulate lipid metabolism disorder, reduce proteinuria, and improve the functional disorder of HPA system.Better promote the recovery of adrenocortical function. 3.Jiawei Qingxin Lianzi decoction can better reduce the incidence of primary nephrotic syndrome hormone withdrawal of upper respiratory tract infection, better improve the clinical outcome of patients. 4.There was no significant difference between modified Qingxinlianzi decoction and standard hormone regimen in the treatment of patients with deficiency of qi and yin in the period of withdrawal of PNS hormone.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R277.5

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