本文選題：痛風(fēng) + 尿酸　； 參考：《黑龍江中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:導(dǎo)師在治療痛風(fēng)性關(guān)節(jié)炎的臨床研究的課題中發(fā)現(xiàn),許多痛風(fēng)性關(guān)節(jié)炎患者除有關(guān)節(jié)炎的改變外,尿酸鹽對腎臟也有程度不同的損壞,通過對中藥復(fù)方痹寧湯治療早期痛風(fēng)性腎病患者的觀察,研究該方劑對痛風(fēng)性關(guān)節(jié)炎早期的腎損害的防治作用及其可能的作用機(jī)制。方法:該課題通過搜集2015年9月～2017年3月期間黑龍江中醫(yī)藥大學(xué)附屬第一醫(yī)院風(fēng)濕科門診,診斷為痛風(fēng)性腎病的患者,共30例。按隨機(jī)的原則分為治療組(復(fù)方痹寧湯+西藥別嘌醇片)和對照組(西藥別嘌醇片),各組分別15例患者,1月為1個療程,共2療程;分別對兩組病人的一般情況、尿蛋白、尿潛血、尿白細(xì)胞、尿紅細(xì)胞;C-反應(yīng)蛋白、紅細(xì)胞沉降率;血尿酸、血β2-微球蛋白、尿β2-微球蛋白等相關(guān)指標(biāo)結(jié)果經(jīng)統(tǒng)計(jì)學(xué)處理、分析。結(jié)果:1.治療組組治療痛風(fēng)性腎病總有效率為93.3%,對照組的總有效率為66.67%,治療組的治療效果改善明顯(P0.05)。2.中醫(yī)證候積分:治療前,治療組與對照組比較,P0.05,具有可比性。治療后,治療組、對照組的兩個時間點(diǎn)的組內(nèi)分別比較,P0.01,差異顯著。治療后,兩組組間的兩個時間點(diǎn)的療效各自比較,P0.05,有明顯差異,治療組的中醫(yī)證候積分改善優(yōu)于對照組。3.觀察指標(biāo):(1)治療前,血尿酸組間比較,P0.05,無差異;血尿酸各組的治療前、治療1月后組間、組內(nèi)相比,P0.05,有差異,有統(tǒng)計(jì)學(xué)意義;血尿酸各組的治療前、治療2月后組內(nèi)、組間相比,P0.01,有顯著的差異,有統(tǒng)計(jì)學(xué)意義。(2)血β2-MG、尿β2-MG:血β2-MG、尿β2-MG治療前各組組間相較,P0.05,結(jié)果無差異;治療后,血β2-MG、尿β2-MG治療組內(nèi)相較,P0.01,有顯著性差異;血β2-MG、尿β2-MG對照組內(nèi)相較,P0.05,有明顯差異;血β2-MG、尿β2-MG兩組組間相較,P0.05,效果有差異性,說明治療組的治療效果優(yōu)于對照組。(3)尿蛋白、尿潛血兩組間治療前后比較,P0.05,對照組結(jié)果差于治療組,有統(tǒng)計(jì)學(xué)意義;對尿蛋白、尿潛血的治療組、對照組的組內(nèi)分別進(jìn)行對比,P0.05,說明治療后較治療前癥狀減輕,有統(tǒng)計(jì)學(xué)意義;紅細(xì)胞、白細(xì)胞的治療前兩組分別進(jìn)行相比,P0.05,無差異;紅細(xì)胞、白細(xì)胞的治療組與對照分別對比,P0.05,有差異性,有統(tǒng)計(jì)學(xué)意義;紅細(xì)胞、白細(xì)胞的治療后分別于其相應(yīng)組的治療前對比,P0.01,有顯著差異。(4)C-反應(yīng)蛋白、血沉治療前各組組間相較,P0.05,具有統(tǒng)計(jì)學(xué)意義;各組治療后與治療前相較,P0.05,有差異性;各組治療后組間相較,P0.05,無統(tǒng)計(jì)學(xué)意義。結(jié)論:痛風(fēng)性關(guān)節(jié)炎反復(fù)發(fā)作可引起腎功能的損傷;中藥復(fù)方痹寧湯可使痛風(fēng)病人的臨床表現(xiàn)和體征得到有效改善;使病人的BUA水平下降,減少尿潛血、蛋白尿和尿中白細(xì)胞,降低血β2-MG、尿β2-MG。在降低血沉、C-反應(yīng)蛋白方面治療效果不明顯。中藥復(fù)方痹寧湯對痛風(fēng)患者早期性腎損害有確切的臨床療效,在預(yù)防痛風(fēng)性腎病的進(jìn)一步發(fā)展有療效,可對痹寧湯行進(jìn)一步深入的研究,可在臨床廣泛應(yīng)用。
[Abstract]:Objective: in the course of clinical research on the treatment of gouty arthritis, our tutor found that many patients with gouty arthritis have different degrees of kidney damage in addition to the changes of arthritis.By observing the treatment of early gouty nephropathy with compound Bining decoction, the preventive and therapeutic effects of the prescription on early renal damage in gouty arthritis and its possible mechanism were studied.Methods: from September 2015 to March 2017, 30 patients with gouty nephropathy were collected from the Department of Rheumatology of the first affiliated Hospital of Heilongjiang University of traditional Chinese Medicine.According to the random principle, they were divided into treatment group (compound binning decoction and western medicine allopurinol tablet) and control group (western medicine allopurinol tablet).Urine occult blood, urine leukocyte, urine erythrocyte C-reactive protein, erythrocyte sedimentation rate, blood uric acid, blood 尾 _ 2-microglobulin, urine 尾 _ 2-microglobulin were analyzed by statistical analysis.The result is 1: 1.The total effective rate of gouty nephropathy was 93.3in the treatment group and 66.67 in the control group.TCM syndrome score: before treatment, the treatment group compared with the control group P 0.05, comparable.After treatment, the two time points in the treatment group and the control group were significantly higher than that in the control group (P 0.01).After treatment, the curative effect of two time points in the two groups was significantly different (P 0.05), and the improvement of TCM syndrome integral in the treatment group was better than that in the control group. 3.Observation measure: 1) before treatment, there was no difference in serum uric acid group (P 0.05); before treatment, after 1 month treatment, there was significant difference in blood uric acid group (P 0.05), and there was significant difference in blood uric acid group (P 0.05) before and after treatment for 2 months (P 0.05), and there was significant difference in blood uric acid group (P 0.05) before and after treatment for 2 months (P 0.05).There was significant difference in blood 尾 2-MG, urine 尾 2-MG: blood 尾 2-MG: urine 尾 -MG: urine 尾 -MG: compared with P0.05 before and after treatment, there was no significant difference in blood 尾 2-MGG, urine 尾 -MGG, urine 尾 -MGG, urine 尾 -MGG and urine 尾 -MGG, and there was significant difference in blood 尾 2-MGG, urine 尾 -MGG and urine 尾 -MGG, compared with P0.01 after treatment, there was no significant difference between the two groups before and after treatment.Serum 尾 2-MG and urine 尾 2-MG were significantly different in control group compared with control group P0.05, blood 尾 2-MG and urine 尾 2-MG were significantly higher than that of control group P0.05, indicating that the therapeutic effect of the treatment group was better than that of the control group (P 0.05), and the effect of urine protein in the treatment group was better than that in the control group.The results of the control group were worse than that of the treatment group (P 0.05), the urine protein, urine occult blood treatment group and the control group were compared with each other before and after treatment (P0.05), which indicated that the symptoms were alleviated after treatment.Before the treatment of red blood cells and white blood cells, there was no difference between the two groups; the treatment group of red blood cells and white blood cells were compared with the control group (P 0.05), there was difference, there was statistical significance; red blood cells, red blood cells, red blood cells, red blood cells, red blood cells, white blood cells, red blood cells,The leukocytes were compared with P0.01 before and after treatment in the corresponding group. There was a significant difference in C- reactive protein between the two groups, there was significant difference between the two groups before and after ESR treatment (P 0.05), there was significant difference between the two groups after treatment and before treatment, and there was a significant difference between the two groups before and after treatment, and there was no significant difference between the two groups before and after treatment.There was no significant difference between groups after treatment (P 0.05).Conclusion: repeated attack of gouty arthritis can cause damage to renal function, compound Chinese medicine Bining decoction can effectively improve the clinical manifestations and signs of gout patients, decrease the level of BUA in patients, and reduce urine occult blood, proteinuria and white blood cells in urine.Serum 尾 2-MG and urine 尾 2-MG were decreased.The effect of treatment on reducing ESR C-reactive protein was not obvious.Compound Bining decoction has definite clinical effect on early renal damage in gout patients, has curative effect in preventing the further development of gouty nephropathy, and can be further studied on Bining decoction, which can be widely used in clinic.
【學(xué)位授予單位】：黑龍江中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R589.7;R692

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