本文選題：原發(fā)性腎性水腫 + 血瘀證�。� 參考：《青島大學》2017年碩士論文

【摘要】：目的:研究活血利水法對原發(fā)性腎性水腫血瘀證的臨床療效觀察,探討其作用機制。方法:隨機選取菏澤市中醫(yī)醫(yī)院在2016年3月份—2016年8月份接受治療的70例原發(fā)性腎性水腫血瘀證型的患者(急性腎小球腎炎、腎病綜合征、慢性腎功能衰竭)進行了臨床研究。將患者隨機分為兩組,治療組35例,對照組35例。在對患者進行治療時,治療組和對照組所有的患者均進行常規(guī)西醫(yī)治療,治療方式主要是應用糖皮質(zhì)激素、降壓、降脂、免疫抑制劑以及對癥支持治療等,治療組患者在西醫(yī)治療的基礎上進行中醫(yī)辯證應用丹芪活血利水湯治療,患者的治療周期為8個周。在治療過程中要對患者的中醫(yī)癥候變化情況、24小時內(nèi)尿蛋白定量、尿紅細胞、腎小球濾過率、血肌酐、尿素氮、凝血酶原時間、ANP等進行實時監(jiān)測,并進行記錄。服藥期間兩組均予以同樣的飲食指導。結(jié)果:1.總體療效比較:治療組有效率為93.33%,對照組患者71.42%(P0.05),總體療效顯著優(yōu)于對照組,差異具有統(tǒng)計學意義。2.兩組治療前后24小時尿蛋白定量比較:兩組治療前后都有明顯的降低,在降低蛋白尿水平上有統(tǒng)計學差異(P0.05或0.01),治療組優(yōu)于對照組。3.兩組治療前后血漿白蛋白比較:血漿白蛋白都有所升高,差值有統(tǒng)計學差異(P0.05或0.01),治療組療效明顯優(yōu)于對照組。4.兩組治療前后心鈉素(ANP)比較:兩組水平都有明顯升高前后的比較統(tǒng)計(P0.01),具有明顯差異。治療組對升高患者ANP的作用明顯優(yōu)于對照組。5.兩組治療前后尿紅細胞計數(shù)比較:患者尿紅細胞記數(shù)水平都有明顯降低,組間比較,經(jīng)用藥前后統(tǒng)計檢驗,具有明顯差異(P0.01)。治療組降低患者尿紅細胞水平療效明顯優(yōu)于對照組。6.兩組治療前后血肌酐、尿素氮比較:治療前后都有所降低,同組間比較,經(jīng)用藥前后的比較統(tǒng)計檢驗(P0.05),具有顯著差異。治療組和對照組組間對比無統(tǒng)計學差異。結(jié)論:活血利水藥物能有效改善原發(fā)性腎性水腫血瘀證患者癥狀,顯著降低尿蛋白排泄量,減少尿紅細胞,降低患者血肌酐、尿素氮水平,改善患者的腎功能。
[Abstract]:Objective: to study the clinical effect of activating blood circulation and promoting water therapy on primary renal edema and blood stasis syndrome and to explore its mechanism. Methods: 70 patients with primary renal edema and blood stasis syndrome (acute glomerulonephritis, nephrotic syndrome) were randomly selected from Heze traditional Chinese Medicine Hospital from March 2016 to August 2016. Chronic renal failure (CRF) is a clinical study. The patients were randomly divided into two groups: treatment group (n = 35) and control group (n = 35). When the patients were treated, all the patients in the treatment group and the control group were treated with routine western medicine. The main methods of treatment were glucocorticoid, hypotension, lipid-lowering, immunosuppressant and symptomatic support therapy. The patients in the treatment group were treated with Danqi Huoxue Lishui decoction on the basis of western medicine treatment. The treatment period was 8 weeks. In the course of treatment, the changes of TCM symptoms should be monitored in real time, such as urine protein quantity, urine red blood cell, glomerular filtration rate, blood creatinine, urea nitrogen, prothrombin time and ANP. Both groups were given the same dietary guidance during medication. The result is 1: 1. Comparison of overall efficacy: the effective rate of the treatment group was 93.33 and that of the control group was 71.42 and P0.05.The overall curative effect was significantly better than that of the control group, and the difference was statistically significant. Two groups before and after treatment 24 hours urine protein quantitative comparison: two groups before and after treatment have the obvious reduction, in the reduction albuminuria level has the statistical difference P05 or 0.01, the treatment group is superior to the control group. 3. Comparison of plasma albumin between the two groups before and after treatment: plasma albumin increased, the difference was statistically significant (P0.05 or 0.01), the therapeutic effect of the treatment group was significantly better than that of the control group. 4. Comparison of atrial natriuretic peptide (ANPs) before and after treatment: there were significant differences between the two groups before and after treatment. The effect of ANP in treatment group was better than that in control group. Comparison of urine erythrocyte count before and after treatment in two groups: the count level of urine red blood cell in patients was significantly decreased, and there was a significant difference between the two groups by statistical test before and after treatment (P 0.01). The therapeutic effect of reducing urine erythrocyte level in the treatment group was significantly better than that in the control group. 6. 6. Comparison of serum creatinine and urea nitrogen between the two groups before and after treatment: before and after treatment, there was a significant difference between the two groups. There was no statistical difference between the treatment group and the control group. Conclusion: the drugs of promoting blood circulation and promoting water can effectively improve the symptoms of patients with primary renal edema and blood stasis syndrome, reduce urine protein excretion, reduce urine red blood cells, reduce the levels of serum creatinine and urea nitrogen, and improve the renal function of the patients.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R256.51

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