本文選題：特發(fā)性膜性腎病 + 補(bǔ)脾益腎清熱活血法　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:膜性腎病(Membranous Nephropathy,MN)是以腎小球基底膜上皮細(xì)胞下免疫復(fù)合物沉積伴基底膜彌漫增厚為特征的一組疾病。特發(fā)性膜性腎病(Idiopathic Membranous Nephropathy,IMN)的病因及發(fā)生機(jī)制尚不明確,臨床上多表現(xiàn)為腎病綜合征。目前西醫(yī)治療包括非特異性對(duì)癥治療和應(yīng)用糖皮質(zhì)激素、免疫抑制劑等的特異性治療。長(zhǎng)期應(yīng)用糖皮質(zhì)激素、免疫抑制劑,部分患者會(huì)出現(xiàn)副作用及不良反應(yīng)。本研究采用補(bǔ)脾益腎、清熱活血中藥聯(lián)合糖皮質(zhì)激素、環(huán)磷酰胺治療IMN,通過(guò)觀察總蛋白(Total Protein,TP)、白蛋白(Albumin,ALB)、總膽固醇(Cholesterol,CHOL)、甘油三酯(Triglyceride,TG)、24小時(shí)尿蛋白定量(24 hours urinary total protein,24h-UTP)、尿素氮(Blood Urea Nitrogen,BUN)、血肌酐(Creatinine,CREA)、尿酸(Uric Acid,UA)、中醫(yī)(Traditional Chinese Medicine,TCM)證候積分等指標(biāo)的變化,探討中西醫(yī)結(jié)合治療IMN的有效性和安全性。方法:納入河北省中醫(yī)院和河北醫(yī)科大學(xué)第三醫(yī)院門(mén)診及住院的IMN患者50例,按隨機(jī)數(shù)字法分為試驗(yàn)組和對(duì)照組各25例。對(duì)照組應(yīng)用糖皮質(zhì)激素、環(huán)磷酰胺及對(duì)癥治療。試驗(yàn)組在對(duì)照組治療的基礎(chǔ)上加用補(bǔ)脾益腎、清熱活血中藥。療程6個(gè)月。觀察治療前后TP、ALB、CHOL、TG、24h-UTP、BUN、CREA、UA、中醫(yī)證候積分及血常規(guī)、肝功能、心電圖,計(jì)算總有效率以評(píng)判療效及副作用發(fā)生情況。結(jié)果:治療前,兩組中醫(yī)證候總積分、各證候積分、TP、ALB、CHOL、TG、24h-UTP等均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),具有可比性。1臨床療效:試驗(yàn)組總有效率88%,對(duì)照組總有效率60.9%,組間比較有統(tǒng)計(jì)學(xué)意義(P0.05);2中醫(yī)證候積分:兩組治療后,中醫(yī)證候總積分均顯著下降(P0.01),治療后組間比較試驗(yàn)組明顯優(yōu)于對(duì)照組(P0.01)。治療后兩組各中醫(yī)證候積分比較,試驗(yàn)組中部分證候積分與對(duì)照組比較有差異(P0.05)。3 TP、ALB:兩組治療3個(gè)月、6個(gè)月與治療前比較,TP、ALB均顯著升高(P0.01);治療3個(gè)月、6個(gè)月組間比較有統(tǒng)計(jì)學(xué)意義(P0.05,P0.01)。4 24h-UTP:兩組治療3個(gè)月、6個(gè)月與治療前比較,24h-UTP均顯著下降(P0.01),治療3個(gè)月、6個(gè)月組間比較有統(tǒng)計(jì)學(xué)意義(P0.05,P0.01)。5 CHOL、TG:兩組治療6個(gè)月與治療前比較,CHOL、TG下降有統(tǒng)計(jì)學(xué)意義(試驗(yàn)組P0.01,對(duì)照組P0.05),治療6個(gè)月組間比較試驗(yàn)組CHOL、TG均較對(duì)照組下降有統(tǒng)計(jì)學(xué)意義(P0.05)。6腎功能:兩組治療前后,BUN、CREA、UA均未見(jiàn)異常。7副作用發(fā)生情況:試驗(yàn)組5例出現(xiàn)副作用,出現(xiàn)副作用6例次;對(duì)照組11例出現(xiàn)副作用,出現(xiàn)副作用15例次。試驗(yàn)組低于對(duì)照組。結(jié)論:應(yīng)用中西醫(yī)結(jié)合較單純西醫(yī)治療IMN,能有效降低患者24h-UTP和血脂,升高血漿總蛋白和白蛋白,改善主要臨床癥狀,提高臨床療效,同時(shí)減少應(yīng)用糖皮質(zhì)激素、環(huán)磷酰胺所致的毒副作用,具有較高的臨床價(jià)值,值得進(jìn)一步研究。
[Abstract]:Aim: membranous Nephropathy (MN) is a group of diseases characterized by the deposition of subcellular immune complex in glomerular basement membrane epithelium and diffuse thickening of basement membrane. The etiology and pathogenesis of idiopathic Membranous Nephropathy are not clear, and the clinical manifestations are nephrotic syndrome. At present, western medicine treatment includes non-specific treatment and specific treatment of glucocorticoid and immunosuppressant. Long-term use of glucocorticoids, immunosuppressants, some patients will have side effects and adverse reactions. In this study, combined with glucocorticoid, Chinese herbal medicine of tonifying spleen and tonifying kidney, clearing heat and activating blood circulation, Cyclophosphamide was used to treat IMNs by observing the changes of total protein, Albumin, Cholesterolol, triglyceride-24 hours urinary total protein24h-UTPN, urea nitrogen, blood Urea, creatinine To explore the efficacy and safety of integrated traditional Chinese and western medicine in the treatment of IMN. Methods: fifty IMN patients were enrolled in the outpatient and inpatient department of Hebei traditional Chinese Medicine Hospital and the third Hospital of Hebei Medical University. According to the random number method, they were divided into two groups: the experimental group (n = 25) and the control group (n = 25). The control group was treated with glucocorticoid, cyclophosphamide and symptomatic therapy. Experimental group in the control group on the basis of the treatment plus tonifying spleen and kidney, clearing heat and activating blood Chinese medicine. The course of treatment was 6 months. The syndromes score, blood routine, liver function, electrocardiogram and total effective rate were observed before and after treatment to evaluate the curative effect and side effects. Results: before treatment, the total integral of TCM syndromes in the two groups, There was no statistical difference in all syndromes between the two groups (P 0.05). The clinical efficacy was comparable. 1 the total effective rate of the trial group was 880.The total effective rate of the control group was 60.9. There was statistical significance between the two groups in the score of TCM syndromes: after treatment, the total effective rate of the two groups was 60.9, and there was a significant difference between the two groups in the score of TCM syndromes: after the treatment of the two groups, the total effective rate of the two groups was higher than that of the control group. The total integral of TCM syndromes decreased significantly (P 0.01), and the comparison between the two groups was better than that in the control group (P 0.01). After treatment, the scores of TCM syndromes in the two groups were compared, The scores of some syndromes in the trial group were significantly higher than those in the control group (P 0.05), and there were significant differences between the two groups in 3 months, 6 months and 6 months, respectively, and there was significant difference between the two groups in terms of P0.05, P0.01and 24h-UTP: 3 months of treatment and 6 months of treatment. [WT5BZ] the results of the study were as follows: (1) there was a significant difference between the two groups in the scores of syndromes and syndromes in the test group (P 0.05). Compared with before treatment, 24 h-UTP decreased significantly in month, 6 months and 3 months after treatment. There was significant difference between the two groups in terms of P0.05, P0.01, and 5 Choll TG: there was a significant decrease in TG of CHOLG in the two groups after 6 months of treatment (P0.01 in the experimental group, P0.05in the control group, in the treatment group, in the control group, in the treatment group, in the control group, and in the treatment group. Compared with the control group, CHOLTG in the test group was significantly lower than that in the control group in 6 months. The renal function was significantly lower than that in the control group. There were no abnormal 7. 7 side effects in both groups before and after treatment: 5 cases in the trial group had side effects. There were 6 side effects in the control group and 15 side effects in the control group. The experimental group was lower than the control group. Conclusion: the combination of traditional Chinese and western medicine can effectively reduce 24h-UTP and blood lipid, increase plasma total protein and albumin, improve main clinical symptoms, improve clinical efficacy, and reduce glucocorticoid use. The toxic side effects of cyclophosphamide have high clinical value and are worthy of further study.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R277.5

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