【摘要】：目的：觀察溫陽活血法對陽虛血瘀型3-4期慢性腎臟病(CKD)患者臨床療效及其對血清不對稱二甲基精氨酸(ADMA)的影響,運(yùn)用《傷寒論》經(jīng)方真武湯合桃核承氣湯為基礎(chǔ)方治療,以血清ADMA為觀察指標(biāo),運(yùn)用氧化應(yīng)激反應(yīng)理論闡明陽虛血瘀型3-4期慢性腎臟病患者的發(fā)病機(jī)制,進(jìn)一步探討中藥干預(yù)治療慢性腎臟病的可能途徑,為中醫(yī)藥延緩腎功能進(jìn)展的治療奠定基礎(chǔ)。方法：①將確診為3-4期慢性腎臟病同時(shí)中醫(yī)辨證為陽虛血瘀證型的80例患者,運(yùn)用簡單隨機(jī)劃分法分為治療組、對照組；②對照組予單純西藥進(jìn)行治療,治療組在對照組的基礎(chǔ)上予以溫陽活血方治療,療程均為3個(gè)月；③檢測治療前后其腎小球?yàn)V過率(eGFR)、血清尿素氮(BUN)、血清肌酐(Scr)、血清ADMA的數(shù)值變化。結(jié)果：①兩組經(jīng)治療后,在臨床療效比較上,兩者有統(tǒng)計(jì)學(xué)差異(P0.05),表明溫陽活血法結(jié)合西藥治療慢性腎臟病的臨床療效優(yōu)于單用西藥治療。②兩組經(jīng)治療后,在臨床證候療效比較上,兩者有統(tǒng)計(jì)學(xué)差異(P0.05),表明溫陽活血法結(jié)合西藥治療慢性腎臟病的臨床證候療效優(yōu)于單用西藥治療。③經(jīng)統(tǒng)計(jì)學(xué)處理后,比較兩組同組治療前后癥狀變化,表明對照組除惡心、大便不實(shí)無明顯改善外,其余癥狀均有明顯改善作用(P0.05或P0.01)；治療組除大便不實(shí)無明顯改善外,其余臨床癥狀均有明顯改善作用(P0.01)。治療組和對照組進(jìn)行組間比較,治療組在腰膝酸軟、畏寒肢冷、惡心、夜尿清長等癥狀的改善明顯優(yōu)于對照組,有顯著性統(tǒng)計(jì)學(xué)意義(P0.05或P0.01)；其余各癥狀均有一定改善,但兩組組間比較不具有顯著性統(tǒng)計(jì)學(xué)意義(P0.05)。④治療后,同組比較,兩組較治療前均能降低Scr、BUN、血清ADMA水平,升高eGFR,均具有統(tǒng)計(jì)學(xué)意義(P0.05),其中治療組對降低血清ADMA水平具有高度統(tǒng)計(jì)學(xué)意義(P0.01)；⑤治療后,治療組血肌酐、血清ADMA水平低于對照組,治療組eGFR高于對照組,有統(tǒng)計(jì)學(xué)意義(P0.05),而治療組與對照組比較,血尿素氮水平兩組相比無統(tǒng)計(jì)學(xué)意義(P0.05)。⑥相關(guān)性分析：患者血清ADMA與Scr呈正相關(guān)(P0.01),與BUN亦呈正相關(guān)(P0.01),與eGFR呈負(fù)相關(guān)(P0.01)。結(jié)論：①溫陽活血法治療3-4期慢性腎臟病陽虛血瘀證型療效確切。②入組的3-4期陽虛血瘀型CKD患者血清ADMA水平與健康組相比,可見顯著升高。③溫陽活血法能顯著改善3-4期陽虛血瘀型CKD患者的臨床癥狀,其療效高于單純西藥治療。④溫陽活血法可顯著降低3-4期陽虛血瘀型CKD患者血清ADMA水平,提示其在抗氧化反應(yīng)方面有明顯的優(yōu)勢。⑤溫陽活血法可使3-4期陽虛血瘀型CKD患者血肌酐水平降低并提高eGFR水平,療效高于單純西藥治療,表明其對腎功能具有改善作用,從而使腎小球?yàn)V過率得以提高,進(jìn)一步延緩慢性腎臟病病情進(jìn)展,達(dá)到臨床癥狀的改善及療效的提高。
[Abstract]:Objective: to observe the clinical effect of warming yang and activating blood circulation method on chronic kidney disease (CKD) of phase 3-4 of Yang deficiency and blood stasis type and its effect on serum asymmetric dimethyl arginine (ADMA). Taking serum ADMA as the observation index, using the theory of oxidative stress reaction to elucidate the pathogenesis of chronic kidney disease in phase 3-4 of Yang-deficiency and blood-stasis type, and to further explore the possible ways of Chinese medicine intervention in the treatment of chronic kidney disease. It lays a foundation for the treatment of delaying the progress of renal function with traditional Chinese medicine. Methods 80 cases of chronic kidney disease with syndrome differentiation of yang deficiency and blood stasis were divided into treatment group and control group by simple randomized method. Control group was treated with western medicine. The treatment group was treated with Wenyang Huoxue recipe on the basis of the control group. The course of treatment was 3 months to detect the changes of glomerular filtration rate (eGFR), serum urea nitrogen (bun), serum creatinine (SCR) and serum ADMA before and after treatment. Results there was a significant difference between the two groups in clinical efficacy after treatment (P0.05). The results showed that the therapeutic effect of warming yang and activating blood circulation method combined with western medicine in treating chronic kidney disease was better than that of western medicine alone in the treatment of chronic kidney disease. There was statistical difference between the two groups (P0.05), which indicated that the therapeutic effect of warming Yang and activating Blood Circulation combined with Western Medicine in treating chronic Kidney Disease was better than that in treating chronic Kidney Disease with only Western Medicine (P 0.05), and the curative effect of warming Yang and activating Blood Circulation combined with Western Medicine was better than that of western medicine alone. The changes of symptoms before and after treatment in the two groups were compared. The results showed that the control group had significant improvement except nausea, stool unreality, and other symptoms (P0.05 or P0.01), while the treatment group had no significant improvement except defecation. The other clinical symptoms were obviously improved (P0.01). Compared with the control group, the improvement of symptoms in the treatment group was significantly better than that in the control group (P0.05 or P0.01), and the other symptoms were improved to some extent. However, there was no significant statistical significance between the two groups (P0.05) after treatment, compared with the same group, both groups could reduce the levels of Scr-BUNand serum ADMA. After treatment, the serum creatinine and serum ADMA levels in the treatment group were lower than those in the control group, and the eGFR in the treatment group was higher than that in the control group. Compared with the control group, there was no significant correlation between the two groups (P0.05). The serum ADMA was positively correlated with SCR (P0.01), bun was positively correlated (P0.01), and negatively correlated with eGFR (P0.01). Conclusion the therapeutic effect of the method of warming Yang and activating Blood Circulation at stage 3 to 4 in treating chronic kidney disease with yang deficiency and blood stasis syndrome is exact .2 the serum ADMA level of CKD patients with CKD of 3 to 4 stages of yang deficiency and blood stasis is higher than that of healthy group. It can be seen that the treatment of warming yang and activating blood circulation can significantly improve the clinical symptoms of CKD patients with Yang deficiency and blood stasis syndrome in phase 3-4, and its curative effect is higher than that of western medicine alone. The treatment of warming yang and activating blood circulation method can significantly reduce the level of serum ADMA in patients with CKD with Yang deficiency and blood stasis type in phase 3-4. It is suggested that the method of warming yang and activating blood circulation can decrease the level of creatinine and increase the level of eGFR in CKD patients with Yang deficiency and blood stasis syndrome in 3-4 stages, and the curative effect is higher than that of western medicine alone, which indicates that it can improve renal function. Thus, the glomerular filtration rate can be increased, and the progress of chronic kidney disease can be further delayed, and the clinical symptoms and curative effects can be improved.
【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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