【摘要】：目的：觀察加味升陽(yáng)益胃湯對(duì)慢性腎臟病3-4期脾腎虧虛、濕濁內(nèi)蘊(yùn)證患者的血肌酐(Serum creatinine,Scr)、尿素氮(Blood urea nitrogen,BUN)、24小時(shí)尿蛋白定量(24 hours urinary protein quantitative,PRO)、尿紅細(xì)胞(Red blood cell in urine,BLD)、尿酸(Uric acid, UA)、腎小球?yàn)V過率(estimated Glomerular filtration rate,eGFR)、總膽固醇(Total cholesterol, TC)、甘油三酯(Triglyceride,TG)、高密度脂蛋白(high density lipoprotein,HDL)、低密度脂蛋白(low density lipoprotein,LDL)、載脂蛋白al(Apoprotein-al,Apo-al)、載脂蛋白b(Apoprotein-b,Apo-b)等的影響；從而進(jìn)一步評(píng)價(jià)加味升陽(yáng)益胃湯對(duì)治療慢性腎臟病3-4期脾腎虧虛、濕濁內(nèi)蘊(yùn)證患者的臨床應(yīng)用價(jià)值。方法：本研究選取了I晦床辨證為慢性腎臟病3-4期脾腎虧虛、濕濁內(nèi)蘊(yùn)證的住院及門診患者60例,隨機(jī)分成治療組和對(duì)照組,每組各30例。對(duì)照組予以西醫(yī)常規(guī)治療,治療組在對(duì)照組基礎(chǔ)之上,加用加味升陽(yáng)益胃湯,日一劑,早晚分服各一劑,持續(xù)療程為3個(gè)月。觀察兩組患者治療前后臨床總療效、中醫(yī)癥狀改善情況,腎功能(血肌酐、尿素氮、尿酸、腎小球?yàn)V過率),腎損害指標(biāo)(尿蛋白、尿紅細(xì)胞),血脂代謝(總膽固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、載脂蛋白a1、載脂蛋白b)水平的變化情況。結(jié)果： (1)治療組臨床總療效有效率為86.21%,對(duì)照組為63.30%,治療組優(yōu)于對(duì)照組(P0.05)；且治療組在改善中醫(yī)癥狀倦怠乏力、食少納呆、腰膝酸軟、肢體困重、大便不實(shí)等方面優(yōu)于對(duì)照組(P0.05)； (2)經(jīng)3個(gè)月治療后,治療組在降低Scr、BUN水平,改善eGFR方面優(yōu)于對(duì)照組,兩組差值比較具有統(tǒng)計(jì)學(xué)意義(P0.05)； (3)治療組與對(duì)照組相比,在降低24小時(shí)尿蛋白定量方面具有顯著統(tǒng)計(jì)學(xué)差異(P0.01),治療組優(yōu)于對(duì)照組； (4)經(jīng)3個(gè)月治療后,兩組患者治療后血脂代謝水平較治療前差異均有統(tǒng)計(jì)學(xué)意義(P0.05),其中治療組TC、TG、LDL、Apo-b下降更為顯著(P0.01)且優(yōu)于對(duì)照組(P0.05)。結(jié)論：加味升陽(yáng)益胃湯可改善慢性腎臟病3-4期脾腎虧虛、濕濁內(nèi)蘊(yùn)證患者的臨床癥狀；降低患者血肌酐、尿素氮水平,改善腎小球?yàn)V過率；降低24小時(shí)尿蛋白定量水平；加味升陽(yáng)益胃湯可改善慢性腎臟病3-4期脾腎虧虛、濕濁內(nèi)蘊(yùn)證患者血脂代謝水平。
[Abstract]:Objective: to observe the effect of Jiawei Shengyang Yiwei decoction on deficiency of spleen and kidney in the period of 3-4 chronic kidney disease. Serum creatinine (Serum creatinine,Scr), urea nitrogen (Blood urea nitrogen,BUN), 24 hours urine protein (24 hours urinary protein quantitative,PRO), urine red blood cell (Red blood cell in urine,BLD), uric acid (Uric acid, UA), glomerular filtration rate (estimated Glomerular filtration rate,eGFR), total cholesterol (Total cholesterol, TC), triglyceride (Triglyceride,TG), high density in patients with dampness accumulation syndrome Lipoprotein (high density lipoprotein,HDL), low density lipoprotein (low density lipoprotein,LDL), apolipoprotein al (Apoprotein-al,Apo-al), apolipoprotein b (Apoprotein-b,Apo-b) and so on; Further evaluate the clinical application value of Jiawei Shengyang Yiwei decoction in treating the patients with deficiency of spleen and kidney and dampness accumulation in 3-4 period of chronic kidney disease. Methods: in this study, 60 inpatients and outpatients with the syndrome of deficiency of spleen and kidney and dampness and accumulation of dampness were randomly divided into treatment group and control group with 30 cases in each group. The control group was treated with routine western medicine, and the treatment group was treated with modified Shengyang Yiwei decoction on the basis of the control group, one dose per day, one dose in the morning and evening, and one dose in the morning and evening. The course of treatment lasted for 3 months. To observe the total clinical curative effect, the improvement of TCM symptoms, renal function (serum creatinine, urea nitrogen, uric acid, glomerular filtration rate), renal damage index (urine protein, urine red blood cell), blood lipid metabolism (total cholesterol, triglyceride), and observe the two groups before and after treatment. Changes in high density lipoprotein, low density lipoprotein, apolipoprotein a 1 and apolipoprotein b. Results: (1) the total effective rate was 86.21 in the treatment group, 63.30 in the control group, which was superior to that in the control group (P0.05); After 3 months of treatment, the treatment group was superior to the control group in lowering the level of Scr,BUN and improving eGFR. The difference between the two groups was statistically significant (P0.05); (3). There was significant difference in reducing 24 hour urine protein quantity (P0.01), the treatment group was better than the control group, (4) after 3 months treatment, There were significant differences in blood lipid metabolism between the two groups after treatment (P0.05), in which the TC,TG,LDL,Apo-b in the treatment group was significantly decreased (P0.01) and better than that in the control group (P0.05). Conclusion: modified Shengyang Yiwei decoction can improve the clinical symptoms of the patients with deficiency of spleen and kidney and dampness and accumulation of kidney in the period of 3-4 chronic kidney disease, decrease the level of serum creatinine, urea nitrogen, improve glomerular filtration rate, decrease the quantitative level of urinary protein in 24 hours. Jiawei Shengyang Yiwei decoction can improve the level of blood lipid metabolism in patients with deficiency of spleen and kidney and dampness in 3-4 stages of chronic kidney disease.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R277.5

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