發(fā)布時(shí)間：2018-02-27 16:27

  本文關(guān)鍵詞： 中西醫(yī)結(jié)合 來(lái)氟米特 狼瘡性腎炎 回顧性分析 文獻(xiàn)分析　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：本研究分析在我院腎病中心采用中藥聯(lián)合激素及來(lái)氟米特治療活動(dòng)性狼瘡性腎炎的療效性和安全性,并以近10年的中西醫(yī)結(jié)合治療狼瘡性腎炎的臨床研究文獻(xiàn)為對(duì)象,通過(guò)文獻(xiàn)分析的方法,了解中西醫(yī)結(jié)合治療狼瘡性腎炎的臨床研究的現(xiàn)狀。方法:采用回顧性分析的方法分析2009年-2016年間在我院腎病中心治療的采用中藥聯(lián)合激素及來(lái)氟米特治療,療程不小于6個(gè)月的32例活動(dòng)性狼瘡性腎炎患者,記錄患者的性別、年齡、病程、病理、病史、用藥情況、中醫(yī)證候等一般資料,治療期間記錄24h尿蛋白、尿紅細(xì)胞計(jì)數(shù)、Scr、ALB、補(bǔ)體C3、抗ds-DNA、中醫(yī)證候積分、SLEDAI及不良反應(yīng),主要觀察指標(biāo)為第3、6、12個(gè)月的完全緩解率、總有效率,次要觀察指標(biāo)為復(fù)發(fā)率,觀察時(shí)間截至2016年12月。檢索2007年-2016年發(fā)表并收錄在中國(guó)知網(wǎng)期刊全文數(shù)據(jù)庫(kù)(CNKI)、維普《中文科技期刊網(wǎng)數(shù)據(jù)庫(kù)》、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM)、萬(wàn)方期刊數(shù)據(jù)庫(kù)上的中西醫(yī)結(jié)合治療狼瘡性腎炎的臨床研究文獻(xiàn),對(duì)納入文獻(xiàn)的樣本量、治療方案、療效、證型進(jìn)行描述性分析。結(jié)果:1.回顧性分析符合納入標(biāo)準(zhǔn)共32例患者,其中女性26例,男性6例,平均年齡33.97± 12.41歲,中位病程46.1(11-68.7)月,既往高血壓病史6例,曾用CTX或MMF無(wú)效或復(fù)發(fā)14例,病理類(lèi)型方面,Ⅳ或Ⅳ+V有18例,Ⅲ型5例,Ⅱ型3例,未行腎穿6例;疾病療效評(píng)價(jià)方面,治療第3、6、12月后,完全緩解率為3.13%、21.88%、34.48%,總有效率分別為50%、90.63%、93.1%;中醫(yī)證候療效方面,第3、6、12月總有效率分別為84.38%、93.75%、96.55%;實(shí)驗(yàn)室指標(biāo)方面,24h尿蛋白、尿紅細(xì)胞計(jì)數(shù)、Scr、ALB、C3、抗ds-DNA、中醫(yī)癥候積分、SLEDAI與治療前比較,均有顯著差異(P0.05);觀察時(shí)間6-56個(gè)月[平均(21.53±13.75)個(gè)月],2例腎臟復(fù)發(fā),1例腎外復(fù)發(fā),復(fù)發(fā)率10.34%,復(fù)發(fā)時(shí)間為緩解后第9-14個(gè)月[平均(12±2.65)個(gè)月];觀察期間不良反應(yīng)有感染(25%),肝酶升高(3.13%),白細(xì)胞下降(3.13%)、帶狀皰疹(3.13%)、腹瀉(3.13%),月經(jīng)不調(diào)(3.13%),其中感染以上呼吸道感染(15.63%)為主,所有不良反應(yīng)較輕微,經(jīng)治療后消失或好轉(zhuǎn),不影響治療;中醫(yī)證型方藥方面,以脾腎氣/陽(yáng)虛證最常見(jiàn),兼證以血瘀證最常見(jiàn),其次為濕熱證,中藥有補(bǔ)益藥、活血藥、祛濕藥使用最多。2.文獻(xiàn)分析符合納入標(biāo)準(zhǔn)的臨床研究文獻(xiàn)共93篇,其中無(wú)對(duì)照組11篇(11.83%),非隨機(jī)對(duì)照文獻(xiàn)8篇(8.6%),假隨機(jī)對(duì)照文獻(xiàn)3篇(3.23%),隨機(jī)對(duì)照文獻(xiàn)71篇(76.34%),其中隨機(jī)對(duì)照文獻(xiàn)中,12篇描述具體隨機(jī)方法,僅有1篇實(shí)施盲法,隨機(jī)化隱藏和樣本量估算情況不清楚;樣本量方面,3篇(3.23%)大于100例,56篇(60.22%)為59-99例,34篇(36.53%)小于50例;治療方面,西醫(yī)治療方案以激素+CTX為主,占56.99%,其余還有單用激素、單用免疫抑制劑、激素+/免疫抑制劑等,中西醫(yī)結(jié)合治療方案,91篇(97.85%)在西醫(yī)治療基礎(chǔ)上加中成藥或中藥湯劑,用自擬方治療有35篇(37.63%);治療療程在0.5-24個(gè)月,平均5.86個(gè)月;療效方面,文獻(xiàn)療效評(píng)價(jià)標(biāo)準(zhǔn)來(lái)源不一,80篇(86.02%)文獻(xiàn)報(bào)道了總有效率,總有效率在74%-100%,隨機(jī)對(duì)照文獻(xiàn)中,92.96%文獻(xiàn)的中西醫(yī)結(jié)合治療組療效顯著優(yōu)于對(duì)照組,總體而言,中西醫(yī)結(jié)合治療狼瘡性腎炎的療效優(yōu)于單用西藥,但納入文獻(xiàn)方法學(xué)質(zhì)量不高。結(jié)論:回顧性分析表明中藥聯(lián)合來(lái)氟米特、激素治療活動(dòng)性狼瘡性腎炎療效良好,且能延長(zhǎng)維持緩解時(shí)間,復(fù)發(fā)率低,不良反應(yīng)較少。文獻(xiàn)分析提示中西醫(yī)結(jié)合治療狼瘡性腎炎有優(yōu)勢(shì),但文獻(xiàn)質(zhì)量低,證據(jù)不強(qiáng)。
[Abstract]:Objective: This study was used to analyze the efficacy and safety of traditional Chinese medicine combined with hormone and leflunomide in the treatment of lupus nephritis in our hospital nephrology center, and nearly 10 years of combined traditional Chinese and Western medicine clinical studies on the treatment of lupus nephritis as the object, by means of document analysis, understand the treatment of lupus nephritis clinical research the status quo of combining traditional Chinese and Western medicine. Methods: using the method of analysis during the period of 2009 -2016 in our hospital nephrology center with Chinese medicine combined with hormone and leflunomide in the treatment of treatment review, not less than 32 of patients with active lupus nephritis patients 6 months, record the patient's gender, age, course of disease, pathology, medical history general information, medicine, TCM syndrome, recorded during the treatment of 24h urine protein, urine red blood cell count, Scr, ALB, complement C3, anti ds-DNA, TCM syndrome score, SLEDAI and adverse reaction, we observed for the article The complete remission rate of 3,6,12 months, the total efficiency, secondary index for the recurrence rate of the observation time as of December 2016. Retrieved 2007 -2016 published and included in the China CNKI Journal Full-text Database (CNKI), VIP Journals Database > < Chinese net, Chinese biological medicine database (CBM), the clinical research and treatment lupus nephritis with Wanfang periodical database of traditional Chinese medicine and Western medicine, included in the sample, the treatment effect, the descriptive analysis of syndromes were analyzed retrospectively. Results: 1. met the inclusion criteria of a total of 32 cases of patients, 26 cases were female and 6 males, mean age 33.97 + 12.41 years old, in a duration of 46.1 months (11-68.7), 6 cases had history of hypertension, CTX or MMF is invalid or recurrence in 14 cases, pathological type, IV or IV +V in 18 cases, 5 cases of type III, 3 cases of type II, 6 cases without renal biopsy; clinical evaluation of diseases, treatment of 3,6,12 鏈堝悗,瀹屽叏緙撹В鐜囦負(fù)3.13%,21.88%,34.48%,鎬繪湁鏁堢巼鍒嗗埆涓，

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