【摘要】：目的：運用加減翹荷湯對慢性腎臟病(CKD)1-3a期患者的外感邪熱證進行治療,觀察患者外感邪熱癥狀的轉歸過程,評估其臨床療效；同時觀察加減翹荷湯對慢性腎臟病患者腎功能的影響。方法：收集CKD1-3a期合并外感邪熱證的患者66名,分為對照組(33名)和治療組(33名)。對66名患者的慢性腎臟病均采用的現代西醫(yī)對慢性腎臟病的治療方法作為常規(guī)治療。在常規(guī)治療前提下,對照組用常規(guī)西藥治療對患者的外感邪熱證進行治療,治療組用每日一劑加減翹荷湯對患者的外感邪熱進行治療,兩組均以14天為治療觀察期。治療過程中,對照組和治療組各有2名患者被剔除。治療3天后對患者的外感邪熱臨床癥狀進行判定；治療7天后對患者的C反應蛋白(CRP)進行檢測；治療14天后對患者的外感癥候病程和血肌酐(Scr)、腎小球濾過率(eGFR)、尿蛋白定量、尿紅細胞、尿轉鐵蛋白、尿免疫球蛋白的指標變化進行對比。結果：①治療3天后,兩組在外感臨床癥候療效比較上,有統(tǒng)計學差異(P0.01)。②治療7天后,兩組組內比較,患者CRP均較治療前下降(P0.05),但組間比較無差異(P0.05)。③治療14天后,兩組患者外感邪熱癥候病程的比較有差異(P0.05)。④治療14天后,同組比較,對照組,尿蛋白定量、尿紅細胞、尿轉鐵蛋白較治療前升高(P0.05),血肌酐、eGFR、尿免疫球蛋白無明顯差異(P0.05)。⑤治療14天后,同組比較,治療組血肌酐、尿紅細胞、尿轉鐵蛋白均有下降(P0.05),eGFR升高(P0.05),尿蛋白定量、尿免疫球蛋白無明顯差異(P0.05)。⑥治療14天后,組間比較,兩組患者的尿免疫球蛋白無明顯差異,治療組對血肌酐、eGFR、尿蛋白定量、尿紅細胞、尿轉鐵蛋白的療效均優(yōu)于對照組(P0.05)。結論：①加減翹荷湯對CKD1-3a期患者的外感邪熱證的臨床療效優(yōu)于單純西藥治療。②兩種治療方法對慢性腎臟病患者CRP的作用無差異。③單純西藥治療外感邪熱證后可觀察到CKD1-3a期患者的腎臟損傷加重,可能是由于邪熱由表循經下傳,以及部分西藥對腎臟具有一定的損害引起的。④應用加減翹荷湯療外感邪熱證后可觀察到CKD1-3a期患者的腎臟損傷減輕。⑤外感邪熱犯肺對CKD1-3a期患者的尿免疫球蛋白無顯著影響,對腎小管損傷未見明顯影響。
[Abstract]:Objective: to treat the patients with exogenous pathogenic heat syndrome of chronic kidney disease (CKD) stage 1-3a by adding and reducing Qiao-he decoction, observe the process of the outcome of the patients' symptoms of exogenous pathogenic heat, and evaluate its clinical efficacy. At the same time, the effect of Jiajianqiahe decoction on renal function of patients with chronic kidney disease was observed. Methods: 66 CKD1-3a patients with exogenous heat syndrome were divided into control group (33 cases) and treatment group (33 cases). All 66 patients with chronic kidney disease were treated with modern western medicine as routine therapy. On the premise of routine treatment, the control group was treated with routine western medicine for the syndrome of exogenetic pathogenic heat, and the treatment group was treated with one dose per day plus Xianqiahe decoction. The two groups were treated with 14 days of treatment. During the course of treatment, 2 patients in the control group and 2 patients in the treatment group were excluded. After 3 days of treatment, the clinical symptoms of exogenous fever were determined, and the C-reactive protein (CRP) was detected after 7 days of treatment. After 14 days of treatment, the course of external symptoms and serum creatinine (Scr),) glomerular filtration rate (eGFR), urinary protein quantity, urine erythrocyte, urinary transferrin and urinary immunoglobulin were compared. Results: 1 after 3 days of treatment, there was a significant difference in the curative effect of external symptoms between the two groups (P0.01). After 7 days of treatment, the CRP of the two groups was lower than that before treatment (P0.05). However, there was no difference between the two groups (P0.05). 3 after 14 days of treatment, there was a difference between the two groups in the course of exogenous heat syndrome (P0.05). After 14 days of treatment, the control group, the urine protein quantitative, the urine red blood cell, the control group, the urine protein quantity, the urine red blood cell, the urine protein quantity, the urine red blood cell, Urinary transferrin was higher than that before treatment (P0.05), but there was no significant difference in serum creatinine and eGFR, urine immunoglobulin (P0.05). Urinary transferrin decreased (P0.05), eGFR increased (P0.05), urine protein quantitative, urinary immunoglobulin no significant difference (P0.05). After 14 days of treatment, there was no significant difference between the two groups of urine immunoglobulin. The therapeutic effect of the treatment group on serum creatinine, eGFR, urine protein, urine erythrocyte, urinary transferrin was better than that of the control group (P0.05). Conclusion: 1 the clinical effect of Jiajiaohe decoction on exogenous heat syndrome in CKD1-3a patients is better than that of western medicine alone. 2 there is no difference between the two treatment methods on CRP in patients with chronic kidney disease. 3 the treatment of exogenous heat with western medicine alone is not different. The severity of renal injury in patients with CKD1-3a can be observed after the syndrome. It may be that the evil heat is transmitted down the meridian. And some western medicine have certain damage to the kidney. 4 after the treatment of exogenous heat syndrome by adding and reducing Qiao-he decoction, it can be observed that renal damage can be alleviated in patients with CKD1-3a stage. 5 the urine immunity of patients with CKD1-3a stage caused by exogenous pathogenic fever invading the lung can be observed. There was no significant effect on immunoglobulin, There was no obvious effect on renal tubular injury.
【學位授予單位】：福建中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R277.5

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