發(fā)布時(shí)間：2018-03-17 07:30

  本文選題：IgA腎病　切入點(diǎn)：益氣養(yǎng)陰、清熱利濕法　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:IgA腎病是指腎臟免疫病理檢查以腎小球系膜區(qū)IgA或IgA為主的免疫復(fù)合物沉積為特征的腎小球腎炎,是世界上最常見的一種腎小球疾病,于1968年由法國學(xué)者Berger與Hinglais首次描述,又稱為Berger病。臨床表現(xiàn)具有多樣性,多數(shù)患者表現(xiàn)為反復(fù)發(fā)作的肉眼血尿、無癥狀血尿及蛋白尿,部分患者可合并有水腫、高血壓、腎功能不全。本病發(fā)病率高,是一種進(jìn)展性疾病,是我國終末期腎病的首要原因。目前發(fā)病機(jī)制尚未完全闡明,臨床治療上尚無統(tǒng)一的方案及特效藥物,多采用對癥治療,視病理類型及病情發(fā)展選擇性使用糖皮質(zhì)激素和(或)免疫抑制劑,但病情容易反復(fù),同時(shí)激素及免疫抑制劑有較大的毒副作用。近年來大量的實(shí)驗(yàn)研究及臨床實(shí)踐表明,中醫(yī)藥在辨證治療IgA腎病方面取得了卓越成效。導(dǎo)師檀金川教授結(jié)合多年臨床經(jīng)驗(yàn),在辨證論治的基礎(chǔ)上,結(jié)合患者個(gè)體情況,以益氣養(yǎng)陰、清熱利濕為治療大法,自擬腎炎2號(hào)方治療該病,臨床療效顯著,為IgA腎病的中醫(yī)藥治療提供了理論依據(jù)及研究思路。方法:本研究全部病例均選自2015年7月-2017年1月就診于河北省中醫(yī)院腎內(nèi)科門診部的原發(fā)性IgA腎病患者,按照診斷標(biāo)準(zhǔn)、納入標(biāo)準(zhǔn)以及排除標(biāo)準(zhǔn)選取病例60例,采用隨機(jī)數(shù)字表法,將病例隨機(jī)分為治療組30例,對照組30例。兩組患者在治療前臨床參數(shù)無統(tǒng)計(jì)學(xué)差異,所有患者均給予相同的基礎(chǔ)治療(即一般治療和對癥治療),在此基礎(chǔ)上,治療組予以腎炎2號(hào)方加減,日一劑,水煎兩次,共取汁300毫升,分早晚兩次分服;對照組予以口服黃葵膠囊,每次5粒,每日3次。療程均為3個(gè)月。觀察患者尿紅細(xì)胞計(jì)數(shù)、24小時(shí)尿蛋白定量、血漿白蛋白(ALB)、血脂(CHOL、TG)、腎功能(BUN、Scr、UA)、血和尿β2-微球蛋白(β2-MG)及中醫(yī)癥狀積分在治療前后的變化,以評(píng)價(jià)該藥臨床療效。結(jié)果:1治療組總有效率86.67%,對照組總有效率63.33%。兩組的總有效率比較,有統(tǒng)計(jì)學(xué)差異(P0.05)。2治療組在治療1個(gè)月、3個(gè)月的癥狀積分與治療前比較,治療前為31.40±8.71,治療1個(gè)月為27.80±6.13,3個(gè)月為14.86±6.42,均有顯著性差異(P0.01);治療組與對照組治療后(21.93±7.29)比較,有顯著性差異(P0.01)。3從病理分級(jí)所占比例來看,Lee氏Ⅲ級(jí)最高,Ⅱ級(jí)次之,Ⅰ級(jí)最低。病理分級(jí)療效分析Ⅰ級(jí)與Ⅱ級(jí),Ⅰ級(jí)與Ⅲ級(jí),Ⅱ級(jí)與Ⅲ級(jí)相比均P0.05,沒有統(tǒng)計(jì)學(xué)差異,治療效果沒有明顯的差別。4治療組在減輕蛋白尿、血尿,升高血漿白蛋白,調(diào)節(jié)血脂,降低血尿酸水平、降血和尿β2-微球蛋白等方面優(yōu)于對照組,有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1以益氣養(yǎng)陰、清熱利濕為治療原則,腎炎2號(hào)方為主方治療IgA腎病,能明顯的降低患者臨床癥狀積分,改善臨床癥狀,其作用明顯優(yōu)于對照組。2腎炎2號(hào)方能減輕蛋白尿、血尿,提高血漿白蛋白含量,調(diào)節(jié)血脂,降尿酸,保護(hù)腎功能。3腎炎2號(hào)方能降低血清及尿液中β2-微球蛋白水平,逆轉(zhuǎn)早期腎損害,改善腎小管的功能,延緩IgA腎病病情進(jìn)展。
[Abstract]:Objective: IgA nephropathy refers to immune complex deposition in kidney by pathological examination in glomerular mesangial IgA or IgA glomerulonephritis characterized by glomerular disease is a most common in the world, in 1968 by the French scholar Berger and Hinglais first described, also known as Berger disease. Clinical manifestations are diversified. The majority of patients presenting with recurrent hematuria, asymptomatic hematuria and proteinuria, some patients with edema, hypertension, renal insufficiency. The high incidence of the disease, is a progressive disease, is a leading cause of end-stage renal disease in China. At present, the pathogenesis has not been fully elucidated, and special effects drug in clinical treatment and no uniform, with symptomatic treatment, pathological types and the progression of the disease as the selective use of corticosteroids and immunosuppressive agents (or), but the condition is easily repeated at the same time, hormones and immunosuppressive agents Have sideeffects. Show that a large number of experimental studies and clinical practice in recent years, Chinese medicine in the treatment of IgA nephropathy syndrome and achieved remarkable results. Professor Tan Jinchuan combined with years of clinical experience, on the basis of syndrome differentiation and treatment, combined with individual cases, with Replenishing Qi and nourishing Yin, clearing heat and removing dampness for treatment of the disease. Treatment of Shenyan No. 2, clinical curative effect, provide a theoretical basis and research method for the treatment of IgA nephropathy in traditional Chinese medicine. Methods: in this study, all cases were selected from July 2015 January -2017 year visits to the nephrology clinic department of Hebei Province Hospital of traditional Chinese medicine in patients with primary IgA nephropathy, according to diagnostic criteria, inclusion criteria and exclusion the standard selection of 60 cases, using the method of random number table, the patients were randomly divided into treatment group of 30 cases, 30 cases in the control group. Two groups of patients before treatment. There were no significant differences in clinical parameters, all patients were given 浜堢浉鍚岀殑鍩虹娌葷枟(鍗充竴鑸不鐤楀拰瀵圭棁娌葷枟),鍦ㄦ鍩虹涓，

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