本文選題：狼瘡性腎炎 + 黃芪��； 參考：《廣西中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過觀察以黃芪為主的中藥制劑二步序貫法配合西藥治療狼瘡性腎炎的臨床療效,探討以黃芪為主的中藥制劑二步序貫法配合西藥治療狼瘡性腎炎的有效性及安全性,為中西醫(yī)結(jié)合治療狼瘡性腎炎提供一種簡便、安全、有效的方法。方法:選取在廣西中醫(yī)藥大學(xué)附屬瑞康醫(yī)院就診的60例IV型狼瘡性腎炎患者,用隨機(jī)數(shù)字表法隨機(jī)分為對照組(A組)、黃芪方藥組(B組)、二步序貫組(C組)各20例,A組采用西醫(yī)常規(guī)治療,即強(qiáng)的松加環(huán)磷酰胺(CTX);B組在A組治療的基礎(chǔ)上,予CTX沖擊時(shí)當(dāng)天即予加服復(fù)方黃芪顆粒至12周;C組同樣在A組治療基礎(chǔ)上,予CTX沖擊時(shí),先用黃芪注射液50ml加入5%葡萄糖注射液250ml中靜脈滴注,連用1周后序貫每天服用復(fù)方黃芪顆粒至第4周,反復(fù)使用3次。3組共同療程均為12周。通過觀察三組患者治療前后白細(xì)胞(WBC)、血紅蛋白(HGB)、24h尿蛋白定量、血肌酐(Scr)、血清白蛋白(ALB)、T細(xì)胞亞群(CD4+、CD8+、CD4+/CD8+)、補(bǔ)體C3與C4、血沉(ESR)、雌二醇(E2)、促卵泡刺激素(FSH)、促黃體生成素(LH)、睪酮(T)、泌乳素(PRL)、孕酮(P)、谷丙轉(zhuǎn)氨酶(ALT)、谷草轉(zhuǎn)氨酶(AST)等療效指標(biāo),同時(shí)觀察患者臨床癥狀、體征的改善狀況,并進(jìn)行療效及安全性評價(jià)。結(jié)果:在治療過程中,有2例患者脫落,其中A組與B組各1例,脫落的2例病例不參與數(shù)據(jù)分析。結(jié)果如下:1、治療后三組患者疾病療效總有效率分別為:73.68%、78.95%、90.00%,中醫(yī)證候療效總有效率分別為:78.95%、84.21%、95.00%,結(jié)果表明C組療效總有效率優(yōu)于A組與B組(P0.05),而B組與A組相比無明顯差異(P0.05)。2、三組患者SLEDAI積分、中醫(yī)癥候積分經(jīng)治療后均較治療前下降(P0.05),C組較A組及B組下降更為明顯(P0.05),而B組與A組相比無明顯差異(P0.05)。3、三組經(jīng)CTX沖擊后WBC均較前下降(P0.05),而C組WBC較A組與B組恢復(fù)快(P0.05),B組與A組相比無明顯差異(P0.05);A組及B組治療后HGB改變不明顯(P0.05),而C組HGB明顯升高(P0.05)。4、三組治療后24h尿蛋白定量、Scr均較前下降(P0.05),C組、B組24h尿蛋白定量均較A組下降明顯(P0.05),但C組優(yōu)于B組(P0.05),B組Scr與A組比較無明顯差異(P0.05);A組及B組治療后ALB改變不明顯(P0.05),而C組ALB明顯升高(P0.05)。5、三組治療后CD4+、CD4+/CD8+比值均較前升高(P0.05),而C組升高更明顯(P0.05),B組與A組相比無明顯差異(P0.05);三組治療后CD8+與治療前無明顯差異(P0.05)。6、三組治療后C3、C4均升高(P0.05),但C組較A組及B組升高明顯(P0.05),B組與A組相比無明顯差異(P0.05);三組治療后ESR均較前下降(P0.05),C組和B組ESR均較A組下降明顯(P0.05),而C組ESR下降幅度較B組更大(P0.05)。7、治療后三組E2均較前下降(P0.05),而C組下降幅度較A組和B組小(P0.05);三組治療后FSH、LH均較前上升(P0.05),而C組上升幅度較A組和B組小(P0.05),B組E2、FSH、LH與A組相比無明顯差異(P0.05);三組治療后T、PRL、P較治療前均無明顯差異(P0.05)。8、治療后C組在感染、肝功能異常、痤瘡、血糖升高、上消化道出血等不良反應(yīng)的發(fā)生率均低于A組和B組(P0.05),B組與A組相比無明顯差異(P0.05)。結(jié)論:1、以黃芪為主的中藥制劑二步序貫法配合西藥治療狼瘡性腎炎療效確切,可增強(qiáng)機(jī)體免疫功能,改善腎功能,減少激素及免疫抑制劑所引起的不良反應(yīng),提高患者整體生活質(zhì)量。2、中西醫(yī)結(jié)合治療狼瘡性腎炎具有協(xié)同作用,療效優(yōu)于單獨(dú)運(yùn)用西醫(yī)治療。
[Abstract]:Objective: To observe the clinical efficacy of the two step sequential method of traditional Chinese medicine with Astragalus and Western medicine in the treatment of lupus nephritis, and to explore the efficacy and safety of the two step sequential method of traditional Chinese medicine with Astragalus and Western medicine in the treatment of lupus nephritis, and provide a simple, safe and effective prescription for the combination of Chinese and Western medicine in the treatment of lupus nephritis. Methods: 60 patients with type IV lupus nephritis were randomly divided into the control group (group A), the Astragalus prescription group (group B), the two step sequential group (group C) 20 cases, and the A group using western medicine routine treatment, namely, prednisone plus cyclophosphamide (CTX), and B group on the basis of A group treatment, and B group were given CTX. In the same day, the Compound Huangqi granule was added to 12 weeks, and the C group was also treated with the A group on the basis of the treatment of group A, and the astragalus injection 50ml was first added to the intravenous drip of Glucose Injection 250ml. After 1 weeks, the Compound Huangqi granule was taken for fourth weeks, and the common course of the 3.3 group was repeated for 12 weeks. Three groups were observed. WBC, HGB, 24h urine protein, serum creatinine (Scr), serum albumin (ALB), T cell subgroup (CD4+, CD8+, CD4+/CD8+), complement C3 and C4, erythrocyte sedimentation (ESR), follicle stimulating hormone, progesterone, prolactin, prolactin, prolactin, glutamic pyruvine aminotransferase, glutamic pyruvic transaminase, and serum albumin (ALB), T cell subgroup (CD4+, CD8+, CD4+/CD8+), (AST) and other therapeutic indicators, at the same time, the clinical symptoms and signs of the patients were observed, and the efficacy and safety were evaluated. Results: during the treatment, 2 cases were dropped, including 1 cases in group A and B, and 2 cases were not involved in data analysis. The results were as follows: 1, the total effective rate of the three groups of patients after treatment was 73.68%, 78, respectively. .95%, 90%, the total effective efficiency of TCM syndrome was 78.95%, 84.21%, 95%. The results showed that the total effective efficiency of group C was better than that of group A and group B (P0.05), but there was no significant difference between group B and A group (P0.05).2, and the three group of SLEDAI integral, after treatment, the TCM syndrome score decreased more obviously than that before treatment (P0.05), and the decrease of C group was more obvious than that of group and group. There was no significant difference (P0.05) between group B and A group (P0.05).3, and WBC decreased after CTX shock (P0.05), and C group WBC was faster than A group and B group (P0.05). The 24h urine protein in C group and B group decreased significantly (P0.05), but the C group was superior to that of the A group (P0.05), but the C group was better than the B group (P0.05), and the Scr in the B group was not significantly different from that of the A group, while the three groups were significantly higher than those in the A group. There was no significant difference (P0.05) between group B and group A (P0.05), and there was no significant difference between the three groups after treatment (P0.05).6, C3, C4 increased (P0.05) in the three groups after treatment, but there was no significant difference between the C group and the A group and the group. The three groups were all lower than those in the previous group. The decrease of ESR in group C was larger than that in group B (P0.05).7, and the E2 in the three groups after treatment was lower than that in the former (P0.05), but the decrease in the C group was smaller than that in the A group and B group (P0.05). L, P had no significant difference (P0.05).8 before treatment. After treatment, the incidence of adverse reactions such as infection, abnormal liver function, acne, hyperglycemia, upper gastrointestinal bleeding were lower than that of group A and B group (P0.05), and there was no significant difference between the B group and the A group (P0.05). Conclusion: 1, the two step sequential method of traditional Chinese medicine with Astragalus was combined with western medicine to treat lupus kidney. The effect of inflammation is accurate. It can enhance the immune function of the body, improve the function of the kidney, reduce the adverse reactions caused by the hormone and immunosuppressant, and improve the overall quality of life of the patients with.2. The combination of traditional Chinese and Western medicine has a synergistic effect on the treatment of lupus nephritis. The curative effect is better than the treatment of Western medicine alone.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R593.242

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