【摘要】：目的：本試驗(yàn)通過分別對試驗(yàn)組與對照組患者進(jìn)行臨床用藥、觀察并比較，兩種不同治療方案在膜性腎病合并血脂異�；颊哒{(diào)脂治療后的臨床療效、不良反應(yīng)、及各項(xiàng)臨床檢測指標(biāo)的變化差異，為膜性腎病合并血脂異�；颊咴谂R床調(diào)脂治療方面，提供新思想、新策略，更好地進(jìn)行臨床調(diào)脂治療和預(yù)防血脂異常并發(fā)癥的發(fā)生。 方法：研究對象為2012年1月至2013年12月期間，在延安大學(xué)附屬醫(yī)院住院的患者共60例，診斷均符合原發(fā)性腎病綜合征，同時(shí)符合病理診斷均為膜性腎病，且治療前4周均未接受過調(diào)脂治療，肝功能及腎功能指標(biāo)均正常。將研究對象隨機(jī)分為兩組：①試驗(yàn)組（30例），給予口服辛伐他汀10mg，1次/日，聯(lián)合依折麥布10mg，1次/日；②對照組（30例），給予口服辛伐他汀20mg，1次/日。其余膜性腎病�？浦委熅嗤Ｓ诜幥�、服藥2周末、4周末、8周末時(shí)，分別檢測患者血清各項(xiàng)血脂、轉(zhuǎn)氨酶、肌酸激酶、24小時(shí)尿蛋白定量指標(biāo)水平，隨后觀察并記錄各組患者臨床用藥不良反應(yīng)情況。采用SPSS16.0軟件包處理數(shù)據(jù)，組間比較用兩獨(dú)立樣本t檢驗(yàn)，計(jì)數(shù)資料及兩樣本率比較用卡方檢驗(yàn)。P 0.05有統(tǒng)計(jì)學(xué)差異。 結(jié)果：①服藥2周末、4周末時(shí)試驗(yàn)組與對照組患者，各項(xiàng)血脂指標(biāo)水平比較，無統(tǒng)計(jì)學(xué)差異，轉(zhuǎn)氨酶、肌酸激酶及24小時(shí)尿蛋白定量水平的變化比較，均無統(tǒng)計(jì)學(xué)差異(P0.05)。②服藥8周末，試驗(yàn)組較對照組患者血清膽固醇水平有統(tǒng)計(jì)學(xué)差異（P0.05），余各項(xiàng)血脂指標(biāo)及其他指標(biāo)比較，，均無統(tǒng)計(jì)學(xué)差異(P0.05)。③服藥8周末，試驗(yàn)組較對照組患者，不良反應(yīng)發(fā)生率及調(diào)脂治療有效率，無統(tǒng)計(jì)學(xué)差異(P0.05)。 結(jié)論：①本試驗(yàn)中依折麥布聯(lián)合辛伐他汀較單獨(dú)應(yīng)用辛伐他汀在原發(fā)性膜性腎病患者的臨床調(diào)脂治療中可以減少膽固醇的吸收，進(jìn)一步降低血漿中的膽固醇水平，更好地做到血脂達(dá)標(biāo)，避免血脂異常引起的并發(fā)癥。②本試驗(yàn)中聯(lián)合用藥組較單獨(dú)用藥組并未增加肝功能異常的風(fēng)險(xiǎn)率，在消化道等不良反應(yīng)發(fā)生率上無統(tǒng)計(jì)學(xué)差異，同時(shí)兩組患者均無肌溶解等嚴(yán)重不良反應(yīng)發(fā)生。
[Abstract]:Objective: to observe and compare the clinical efficacy and adverse reactions of the two different treatment schemes in patients with membranous nephropathy complicated with dyslipidemia after lipid regulation treatment, and to observe and compare the clinical efficacy and side effects of the two different treatments in patients with membranous nephropathy complicated with dyslipidemia. The changes of clinical detection indexes provided new ideas and strategies for patients with membranous nephropathy complicated with dyslipidemia in clinical lipid regulation treatment, so as to better carry out clinical lipid regulation treatment and prevent the occurrence of dyslipidemia complications. Methods: from January 2012 to December 2013, a total of 60 patients were hospitalized in the affiliated Hospital of Yan'an University. The diagnosis was in accordance with primary nephrotic syndrome and the pathological diagnosis was membranous nephropathy. No lipid regulating therapy was received 4 weeks before treatment, and the indexes of liver function and renal function were normal. The subjects were randomly divided into two groups: (1) the experimental group (n = 30) was given simvastatin 10 mg once a day, and the control group (30 cases) was given simvastatin 20 mg once a day. The other specialist treatments for membranous kidney disease were the same. Before taking medicine, at the end of 2nd, 4th and 8th week, the levels of serum lipid, transaminase, creatine kinase and 24-hour urinary protein were measured, and then the adverse reactions of clinical medication were observed and recorded. SPSS16.0 software package was used to process the data, two independent samples t test, counting data and chi-square test were used to compare the two sample rates. There was significant difference between the two groups. Results: 1 at the end of 2 weeks and 4 weeks, there was no significant difference in the levels of blood lipids between the experimental group and the control group, and the quantitative levels of transaminase, creatine kinase and 24-hour urinary protein were compared. There was no significant difference (P 0.05). 2 at the end of 8 weeks, the serum cholesterol level of the experimental group was significantly different from that of the control group (P 0.05), and the rest of the blood lipid indexes and other indexes were compared. There was no significant difference (P 0.05). 3 at the end of 8 weeks, the incidence of adverse reactions and the effective rate of lipid regulation in the experimental group were not significantly different from those in the control group (P 0.05). Conclusion: 1 in this study, etumab combined with simvastatin alone can reduce the absorption of cholesterol and further reduce the level of cholesterol in patients with primary membranous kidney disease in the clinical treatment of lipid regulation in patients with primary membranous kidney disease (PNS). The results show that simastatin alone can reduce the absorption of cholesterol and further decrease the level of cholesterol in plasma of patients with primary membranous nephropathy. In this experiment, the combined drug group did not increase the risk rate of abnormal liver function, and there was no significant difference in the incidence of adverse reactions such as digestive tract. At the same time, there were no serious adverse reactions such as myolysis in both groups.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692

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