本文選題：原發(fā)性腎病綜合征 + 加味真武湯　； 參考：《天津醫(yī)科大學》2017年碩士論文

【摘要】：目的:本文的主要研究目的是通過觀察加味真武湯聯(lián)合激素治療原發(fā)性腎病綜合征的臨床治療效果,探討中西醫(yī)結合治療本病的新方法和治療機理。方法:將符合原發(fā)性腎病綜合征脾腎陽虛型診斷的來自天津市第三中心醫(yī)院及天津權健腫瘤醫(yī)院門診及住院病人60例,采用隨機數(shù)字表法分為治療組和對照組進行臨床觀察,每組各30例。對照組病人給予西醫(yī)糖皮質(zhì)激素治療,藥物選用醋酸潑尼松按1mg/kg.d晨起頓服。治療組在對照組激素治療基礎上給予加味真武湯水煎劑150ml一日二次口服,療程30天。觀察比較兩組病人在中醫(yī)癥狀積分、中醫(yī)癥狀(水腫、畏寒肢冷、腰膝酸軟等)、24小時尿蛋白定量、血漿白蛋白、血總膽固醇、血甘油三脂等臨床實驗室指標的改變情況,對兩組患者治療后的臨床療效進行對比,評估藥物的安全性及不良反應情況。結果:(1)臨床綜合療效:經(jīng)過臨床觀察治療組病人中完全緩解有8例,基本解11例,有效6例,無效5例,總有效率為83.33%;對照組病人完全緩解6例,基本緩解8例,顯效5例,無效11例,總有效率為63.3%,總有效率明顯高于對照組,兩組間臨床治療效果具有明顯差異(p0.05)。(2)兩組病人治療后中醫(yī)癥狀與治療前相比較都有明顯減輕,中醫(yī)癥狀總積分下降(p0.05),中醫(yī)證候的總有效率分別為76.67%和56.7%,治療組的中醫(yī)治療效果與對照組相比更為顯著(p0.05)。(3)治療后兩組病人24小時尿蛋白定量組內(nèi)比較均較治療前下降,兩組間比較經(jīng)統(tǒng)計學分析,有統(tǒng)計學意義(p0.05),兩組間治療后24小時尿蛋白變化有顯著差異,治療組優(yōu)于對治療組。(4)兩組治療后血TC、TG組內(nèi)比較均較治療前有所下降,兩組間比較經(jīng)統(tǒng)計學統(tǒng)計分析,有統(tǒng)計學意義(p0.05),說明兩組間治療后血TC、TG變化有顯著差異,治療組優(yōu)于對照組。(5)安全性方面,兩組在治療過程中均未出現(xiàn)過敏、肝腎損害等不良反應和藥物毒副作用,說明加味真武湯在臨床較為安全有效,無不良反應。結論:經(jīng)過臨床觀察證實,加味真武湯聯(lián)合激素在腎病綜合征治療上優(yōu)于對照組,能夠明顯減輕患者臨床癥狀,能夠維持腎小球濾過膜穩(wěn)定性,提高血漿白蛋白,調(diào)節(jié)脂代謝紊亂,提高機體抗病能力。臨床用藥安全,無不良反應發(fā)生,值得臨床推廣應用。
[Abstract]:Objective: to observe the clinical effect of Jiawei Zhenwu decoction combined with hormone in the treatment of primary nephrotic syndrome and to explore the new method and treatment mechanism of integrated traditional Chinese and western medicine for the treatment of primary nephrotic syndrome. Methods: sixty outpatients and inpatients from Tianjin third Center Hospital and Tianjin Quanjian tumor Hospital were divided into treatment group and control group by random digital table. There were 30 cases in each group. The patients in the control group were treated with western glucocorticoid and prednisone acetate was taken in the morning according to 1mg/kg.d. The treatment group was treated with Jiawei Zhenwu decoction 150ml twice a day on the basis of hormone therapy in the control group for 30 days. To observe and compare the clinical laboratory indexes such as symptom score of TCM, symptoms of TCM (edema, cold limbs, tender waist and knee, etc.) 24 hours urine protein quantitative, plasma albumin, serum total cholesterol, serum triglyceride, and so on. The safety and adverse reactions of the two groups were evaluated. Results: in the clinical observation group, there were 8 cases of complete remission, 11 cases of basic release, 6 cases of effective, 5 cases of ineffectiveness, and 83.33% of total effective rate, while the control group had 6 cases of complete remission, 8 cases of basic remission and 5 cases of remarkable effect. The total effective rate was 63.3%, and the total effective rate was significantly higher than that of the control group. The total score of TCM symptoms decreased p0.05A, the total effective rate of TCM syndromes were 76.67% and 56.7%, respectively. The therapeutic effect of TCM in the treatment group was more significant than that in the control group. The difference between the two groups was statistically significant (p 0.05). There was a significant difference between the two groups in the changes of urinary protein at 24 hours after treatment, and the treatment group was superior to the treatment group. The comparison between the two groups was statistically significant (p 0.05), indicating that there was a significant difference between the two groups in the changes of blood TCU TG after treatment, and the safety of the treatment group was superior to that of the control group. There was no allergy in the two groups during the course of treatment. Adverse reactions such as liver and kidney damage and side effects of drugs showed that Jiawei Zhenwu decoction was safe and effective in clinical practice without adverse reactions. Conclusion: after clinical observation, Jiawei Zhenwu decoction combined with hormone is superior to the control group in the treatment of nephrotic syndrome, it can obviously alleviate the clinical symptoms of the patients, maintain the stability of glomerular filtration membrane, and improve the plasma albumin. Regulate the disorder of lipid metabolism and improve the disease resistance of the body. Clinical drug use is safe, no adverse reactions occur, and it is worth popularizing.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R692

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