本文選題：加味黑地黃丸　切入點(diǎn)：慢性腎臟病(CKD3-4期)　出處：《山東中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:觀察加味黑地黃丸對慢性腎臟病患者(CKD3-4期)腎性營養(yǎng)不良狀態(tài)的臨床干預(yù)效果,探討中西醫(yī)結(jié)合治療本病的優(yōu)勢和可行性,以期更好的發(fā)揮中醫(yī)藥在腎性營養(yǎng)不良治療方面的治療優(yōu)勢和潛力。方法:收集山東中醫(yī)藥大學(xué)附屬醫(yī)院66例慢性腎臟病(CKD3-4期)腎性營養(yǎng)不良患者,并將其隨機(jī)分為試驗組和對照組兩組,試驗組應(yīng)用西醫(yī)基礎(chǔ)治療,并加用加味黑地黃丸,對照組僅應(yīng)用西醫(yī)基礎(chǔ)治療的方法,2個月作為一治療療程,療程結(jié)束后并觀察兩組治療前后臨床癥狀的變化、主觀營養(yǎng)評估(SGA)積分、體重指數(shù)(BMI)和上臂肌圍(AMC),以及腎功能、白蛋白(ALB)、前白蛋白(PA)、轉(zhuǎn)鐵蛋白(TRF)、血脂的變化結(jié)果并進(jìn)行統(tǒng)計學(xué)分析及討論。結(jié)果:試驗組總有效率為86.67%,對照組有效率64.52%,兩組間統(tǒng)計差異明顯(P0.05),證明其總有效率高于對照組;中醫(yī)證侯療效上試驗組(80.00%)亦優(yōu)于對照組(54.84%),具備統(tǒng)計差異(P0.05),在中醫(yī)癥狀總積分方面試驗組優(yōu)于對照組(P0.05),單項癥狀比較方面試驗組改善納呆少食、倦怠乏力、肢體困重、腰膝酸軟、腰腹冷痛方面優(yōu)于對照組(P0.05);而在惡心嘔吐、氣短懶言、脘腹脹滿、失眠癥狀的比較無統(tǒng)計差異;試驗組SGA評分下降優(yōu)于對照組(P0.05);兩組在治療后的體重指數(shù)均升高且組間比較有差異(P0.05),而上臂肌圍的組內(nèi)及組間比較無差異;試驗組患者腎小球濾過率(GFR)升高,血肌酐(Scr)、尿素氮(BUN)水平下降,且Scr、GFR組間療效比較具統(tǒng)計學(xué)差異(P0.05),而BUN治療后的組間比較不具差異(P0.05);試驗組治療后生化指標(biāo)血清白蛋白(ALB)、前白蛋白(PA)、轉(zhuǎn)鐵蛋白(TRF)水平升高,且療效均優(yōu)于對照組(P0.05),兩組膽固醇(CHOL)水平變化無統(tǒng)計意義(P0.05)。結(jié)論:加味黑地黃丸在一定程度上保護(hù)CKD3-4期患者腎功能,改善其營養(yǎng)不良狀態(tài),并使患者的生存質(zhì)量提高。
[Abstract]:Objective: to observe the clinical intervention effect of Jiawei Heidihuang pills on chronic kidney disease (CKD 3-4) renal dystrophy, and to explore the advantages and feasibility of integrated traditional Chinese and western medicine in the treatment of this disease. Methods: 66 patients with chronic kidney disease (CKD3-4) were collected from the affiliated Hospital of Shandong University of traditional Chinese Medicine to give full play to the advantages and potential of traditional Chinese medicine in the treatment of renal malnutrition. They were randomly divided into two groups: the experimental group and the control group. The experimental group was treated with basic western medicine, and the treatment group was treated with modified Heidi Dihuang pill. The control group was treated with western medicine for 2 months as a course of treatment. After the course of treatment, the changes of clinical symptoms, subjective nutrition assessment (SGA) scores, body mass index (BMI) and arm muscle circumference (AMC), and renal function were observed before and after treatment in both groups. Results: the total effective rate of the test group was 86.677.The effective rate of the control group was 64.52. The statistical difference between the two groups was significant (P 0.05), which proved that the total effective rate of the two groups was higher than that of the control group. On the curative effect of TCM syndromes, the experimental group was also superior to the control group (54.84) and had statistical difference (P 0.05). The experimental group was superior to the control group in the total score of TCM symptoms (P 0.05). The single symptom comparison of the experimental group improved the intake of food less, fatigue and fatigue, heavy limbs, and weak waist and knee. Lumbar and abdominal cold pain was better than that of control group (P 0.05), but there was no statistical difference in nausea and vomiting, short breath and lazy speech, abdominal distention and insomnia. The SGA score in the experimental group was lower than that in the control group (P 0.05), the body mass index of the two groups was increased after treatment and there was significant difference between the two groups, but there was no difference in the muscle circumference of the upper arm between the two groups. The glomerular filtration rate (GFR) of the patients in the trial group was higher than that in the control group. The levels of serum creatinine creatinine (SCR) and bun bun (BUNA) decreased, and there was a significant difference in the curative effect of Scr-GFR group (P 0.05), but there was no significant difference between the two groups after BUN treatment (P 0.05), and the levels of serum albumin (Alb), prealbumin (PAA), transferrin (TRF) increased after treatment in the experimental group. The therapeutic effect was better than that of the control group (P 0.05). There was no statistical significance in the changes of cholesterol in the two groups. Conclusion: the modified Heidi Dihuang pill can protect renal function, improve the malnutrition and improve the quality of life of the patients with CKD3-4 to a certain extent.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R277.5

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