本文選題：慢性尿酸性腎病 + 脾腎氣虛　； 參考：《福建中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：通過臨床觀察以益腎健脾為治法的方劑(包括自擬方、時方、常用方)加減對慢性尿酸性腎病脾腎氣虛型患者血尿酸的影響,并初步探討降尿酸治療對腎小球濾過率、24小時尿蛋白定量、血肌酐、血尿素氮等的影響。方法：將92例入選的脾腎氣虛型的慢性尿酸性腎病患者隨機分為中藥組46例,西藥組46例,西藥組給予慢性尿酸性腎病健康教育、飲食控制、多飲水、碳酸氫鈉堿化尿液,第二個月給予別嘌醇0.05g起始,每天1次,若無不良反應(yīng),2天后增量至O.1g每天1次控制血尿酸,保持飲水量每天不小于1.5L,并保持尿液PH值在6.0-7.0之間,血尿酸在男性及絕經(jīng)女性控制在408umol/l以下、未絕經(jīng)女性控制在360umol/l以下,后給予最低劑量維持；中藥組慢性尿酸性腎病教育、飲食控制、飲水、堿化尿液要求同西藥組,實驗組第二個月起再給予以補益脾腎為治法方劑,常用中藥如黃芪15g、黨參15g、茯苓15g、白術(shù)6g、太子參15g、生地15g、山茱萸15g、山藥15g、土茯苓15g、車前子15g、鹽膚木15g等加減煎湯服用,中藥水煎煮至200m1,分早晚服用,并定期復(fù)查血尿酸、血肌酐、血尿素氮、腎小球濾過率、24小時尿蛋白定量等變化,及治療前后脾腎氣虛患者中醫(yī)證候的變化。結(jié)果：(1)中藥組的治療總有效率為84.78%,西藥組為76.09%,兩組有顯著性差異(χ2=11.554,P=0.009,P0.01),中藥組的療效優(yōu)于西藥組；并且在改善臨床證候方面,但中藥組優(yōu)于西藥組(Z=-2.829,P=0.005,P0.01)。(2)單純的給予嚴格控制飲食、多飲水及堿化尿液的除了在降低尿酸有顯著的統(tǒng)計學(xué)意義(P0.05),在減低患者肌酐、尿素氮,提高eGFR,改善患者腎功能無明顯效果(P0.05)。(3)無論是中藥組還是西藥組均有降低尿酸的作用(P0.01),并且兩者降低尿酸的程度無差異(P--0.092,P0.05)。(4)中藥組與西藥組在血肌酐、尿素氮、eGFR、24h尿蛋白定量、24h尿酸排泄率、血β2微球蛋白、尿β2微球蛋白、尿RBC(個/HP)、尿RBC(個/u1)、尿蛋白定性、尿紅細胞定性均有顯著差異(P0.05),中藥組的效果優(yōu)于西藥組。結(jié)論：(1)單純的給予嚴格控制飲食、多飲水及堿化尿液的可顯著的降低血尿酸的水平,但在降低患者肌酐、尿素氮,提高eGFR,改善患者腎功能無明顯效果。(2)益腎健脾法對脾腎氣虛的慢性高尿酸患者降低血尿酸的效果與別嘌醇無顯著差異,其機制可能為促進尿酸的排泄。(3)益腎健脾法對脾腎氣虛的慢性高尿酸患者可降低其血肌酐、血尿素氮、24h尿蛋白定量、血β2微球蛋白、尿β2微球蛋白、蛋白尿、血尿水平,提高患者腎小球濾過率,改善患者腎小球、腎小管功能的效果優(yōu)于別嘌醇組。(4)益腎健脾法對脾腎氣虛的慢性高尿酸患者改善臨床癥狀方面優(yōu)于別嘌醇組。
[Abstract]:Objective: to observe the effect of the prescription of tonifying kidney and invigorating spleen (including self-made prescription, Shi prescription, common prescription) on blood uric acid in patients with chronic uric acid nephropathy with deficiency of spleen and kidney qi through clinical observation.The effects of lowering uric acid on 24 hour urinary protein, serum creatinine and blood urea nitrogen were studied.Methods: 92 patients with chronic uric acid nephropathy with deficiency of spleen and kidney qi were randomly divided into Chinese medicine group (n = 46) and western medicine group (n = 46).The second month was given allopurinol 0.05g, once a day, if there was no adverse reaction 2 days later, increase to 0.1 g per day to control blood uric acid, keep drinking water not less than 1.5 L per day, and keep urine PH value between 6.0-7.0.Serum uric acid was controlled below 408umol/l in male and menopausal women, and below 360umol/l in premenopausal women, and then maintained at the lowest dose. Education of chronic uric acid nephropathy, diet control, drinking water and alkaline urine in Chinese medicine group were similar to those in western medicine group.From the second month, the experimental group was given with tonifying the spleen and kidney as the treatment prescription, commonly used Chinese medicine such as astragalus 15g, Codonopsis 15g, Poria cocos 15g, Atractylodes macrocephalae 6g, Radix princeliae 15g, raw land 15g, Cornus officinalis 15g, Chinese yam 15g, Thelia cocos 15g, Chenanzi 15g, Yanfumu 15g decoction, etc.The Chinese medicine decoction was boiled to 200ml and was taken in the morning and evening. The changes of serum uric acid, serum creatinine, blood urea nitrogen, glomerular filtration rate (GFR) and 24 hours urine protein were reviewed regularly, and the changes of TCM syndromes of patients with deficiency of spleen and kidney qi before and after treatment.Results the total effective rate of the Chinese medicine group was 84.78 and that of the western medicine group was 76.09. There was a significant difference between the two groups (蠂 ~ 2 / 11.554 / P ~ (0.009) P _ (0.01)). The curative effect of the Chinese medicine group was better than that of the western medicine group, and in improving the clinical symptoms, the traditional Chinese medicine group was better than the western medicine group (Z-2.829P _ (0.005) P _ (0.005) P _ (0.01) P _ (0.01)).In addition to reducing uric acid, there is a statistically significant difference between drinking water and alkaline urine (P 0.05), and in reducing creatinine and urea nitrogen in patients.Increasing eGFR, improving the renal function of patients had no obvious effect (P 0.05. 0. 0. 3) both the Chinese medicine group and the western medicine group had the effect of reducing uric acid (P 0. 01), and there was no difference in the degree of reducing uric acid between the two groups (P-0. 092, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, respectively).Serum 尾 2 microglobulin, urine 尾 2 microglobulin, urine 尾 2 microglobulin, urinary RBC (/ HPN), urine RBC (r / u 1), urine protein quality and urine erythrocyte quality were significantly different (P 0.05). The effect of Chinese medicine group was better than that of western medicine group.Conclusion (1) simple strictly controlled diet, drinking more water and alkaline urine can significantly reduce the level of serum uric acid, but in patients with creatinine, urea nitrogen,Improving eGFR and improving renal function. (2) there was no significant difference between tonifying kidney and invigorating spleen in reducing serum uric acid in chronic hyperuricemia patients with deficiency of spleen and kidney qi, and allopurinol.The mechanism may be to promote the excretion of uric acid.) tonifying the kidney and invigorating the spleen can reduce the serum creatinine, blood urea nitrogen 24h urinary protein, serum 尾 2 microglobulin, urine 尾 2 microglobulin, proteinuria, blood urine level in chronic hyperuricemia patients with deficiency of spleen and kidney qi.The effect of improving glomerular filtration rate and renal tubular function was better than that of allopurinol group.) the method of tonifying kidney and invigorating spleen was superior to allopurinol group in improving clinical symptoms of chronic hyperuricemia patients with deficiency of spleen and kidney qi.
【學(xué)位授予單位】：福建中醫(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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