本文關鍵詞： 特發(fā)性膜性腎病 宣通三焦、活血通絡 中西醫(yī)結合 臨床研究 臨床療效　出處：《河北醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:本課題通過對特發(fā)性膜性腎病的臨床研究,以觀察宣通三焦、活血通絡方治療特發(fā)性膜性腎病的療效及安全性,為臨床推廣應用提供數(shù)據(jù)支持及科學依據(jù),并論證和探討特發(fā)膜性腎病所存在的脾腎陽虛、水濕血瘀、三焦氣化不利的基本病機,從而為中醫(yī)辨證論治提供新思路。方法:將符合入選標準的62例特發(fā)性膜性腎病患者,采用隨機數(shù)字表法分為試驗組32例和對照組30例。對照組予激素聯(lián)合環(huán)磷酰胺治療,同時予以常規(guī)對癥治療,囑患者休息、低鹽低脂優(yōu)質蛋白飲食以及利尿、降脂、降壓、抗凝等對癥治療。試驗組在對照組治療基礎上,加服宣通三焦、活血通絡方,并隨證加減。觀察對比兩組治療前、治療3個月、治療6個月的各項療效指標。結果:共有59例患者完成6個月觀察,其中試驗組30例,對照組29例。兩組患者治療前24小時尿蛋白定量比較無統(tǒng)計學差異(P(29)0.05),具有可比性,治療3個月與治療前比較,兩組患者24小時尿蛋白均顯著減少(P(27)0.01),且試驗組療效優(yōu)于對照組(P(27)0.05),治療6個月與治療前比較,兩組患者24小時尿蛋白均顯著減少(P(27)0.01),且試驗組療效優(yōu)于對照組(P(27)0.01);兩組患者治療前總蛋白、白蛋白比較無統(tǒng)計學差異(P(29)0.05),具有可比性,治療3個月與治療前比較,兩組患者總蛋白、白蛋白均顯著升高(P(27)0.01),兩組比較無明顯差異(P(29)0.05),治療6個月與治療前比較,兩組患者總蛋白、白蛋白均明顯升高(P(27)0.01),且試驗組療效優(yōu)于對照組(P(27)0.01);兩組患者治療前總膽固醇、甘油三酯、低密度脂蛋白膽固醇比較無統(tǒng)計學差異(P(29)0.05),具有可比性,治療3個月與治療前比較,試驗組總膽固醇顯著降低(P(27)0.01),甘油三酯、低密度脂蛋白膽固醇無顯著變化(P(29)0.05),對照組總膽固醇、甘油三酯、低密度脂蛋白膽固醇無顯著變化(P(29)0.05),且兩組比較無明顯差異(P(29)0.05),治療6個月與治療前比較,兩組患者總膽固醇、甘油三酯、低密度脂蛋白膽固醇均顯著降低(P(27)0.01),且試驗組療效優(yōu)于對照組(P(27)0.05,P(27)0.01);兩組患者治療前、治療3個月、治療6個月血肌酐、尿素氮、尿酸均無明顯差異(P(29)0.05);治療后兩組患者生命體征及血、尿、便常規(guī)加潛血、肝功能、ECG及膽、脾、胰B超均未發(fā)現(xiàn)明顯異常、治療過程中無不良反應發(fā)生;試驗組中醫(yī)癥候療效及西醫(yī)綜合療效優(yōu)于對照組(P0.05,P(27)0.01)。結論:宣通三焦、活血通絡方治療特發(fā)性膜性腎病有較好的療效,具有降低尿蛋白、升高血漿蛋白、調節(jié)血脂的作用,且有一定的保護腎功能作用,安全可靠,中醫(yī)癥候療效及西醫(yī)綜合療效突出,且隨療程延長療效逐漸明顯。
[Abstract]:Objective: to observe the efficacy and safety of Xuantong Sanjiao and Huoxue Tongluo decoction in the treatment of idiopathic membranous nephropathy through the clinical study of idiopathic membranous nephropathy, and to provide data support and scientific basis for clinical application. The basic pathogenesis of idiopathic membranous nephropathy such as deficiency of spleen and kidney yang, water dampness and blood stasis, and unfavorable gasification of three Jiao were demonstrated and discussed. Methods: 62 patients with idiopathic membranous nephropathy who met the inclusion criteria were selected. The control group was treated with hormone combined with cyclophosphamide, the control group was treated with routine therapy, the patients were told to rest, low-salt and low-fat high quality protein diet, diuretic, lipid-lowering, hypotensive, diuretic, lipid-lowering and hypotensive diet. The experimental group was treated with Xuantong Sanjiao, Huoxue Tongluo recipe, and the syndrome was added and subtracted. Before the treatment, the two groups were treated for 3 months. Results: a total of 59 patients were observed for 6 months, 30 in the experimental group and 29 in the control group. There was no significant difference in urinary protein between the two groups at 24 hours before treatment. After 3 months of treatment, the urine protein of 24 hours in both groups was significantly decreased compared with that before treatment, and the curative effect of the trial group was better than that of the control group, and compared with that of the control group at 6 months. The 24 hour urine protein of the two groups was significantly reduced, and the curative effect of the experimental group was better than that of the control group. There was no significant difference in the total protein and albumin between the two groups before treatment, and there was no statistical difference between the two groups. The total protein of the two groups was comparable after 3 months of treatment compared with that before treatment, and the total protein of the two groups was higher than that of the control group. There was no significant difference between the two groups. The total protein and albumin of the two groups were significantly higher than those of the control group after 6 months of treatment, and the curative effect of the test group was better than that of the control group. The total cholesterol and triglyceride of the two groups before treatment were higher than those of the control group, and there was no significant difference between the two groups in total cholesterol and triglyceride before treatment, and the effect of the test group was better than that of the control group, and the effect of the two groups was better than that of the control group. There was no significant difference in low density lipoprotein cholesterol (LDL-C). There was no significant difference in low density lipoprotein cholesterol (LDL-C). Compared with before treatment for 3 months, the total cholesterol of the trial group was significantly lower than that of the control group, and the total cholesterol of the trial group was significantly lower than that of the control group. There was no significant change in the level of triglyceride and low density lipoprotein cholesterol. There was no significant change in triglyceride, low density lipoprotein cholesterol, and there was no significant difference between the two groups. After 6 months of treatment, total cholesterol, triglyceride and triglyceride were compared between the two groups. Low density lipoprotein cholesterol (LDL-C) was significantly decreased in both groups, and the curative effect of the trial group was better than that of the control group. There was no significant difference in serum creatinine, urea nitrogen and uric acid between the two groups before and after treatment for 3 months and 6 months, and there was no significant difference in vital signs and blood between the two groups after treatment. Urine, routine addition of occult blood, liver function, ECG, bile, spleen, pancreas B ultrasound did not find any obvious abnormalities, no adverse reactions occurred in the course of treatment, the effect of traditional Chinese medicine and western medicine in the experimental group was better than that in the control group (P0.05P0. 05, P0. 05, P0. 27 and 0. 01). Conclusion: Xuantong Sanjiao, Xuan Tong San Jiao, is better than the control group. Huoxue Tongluo recipe has a good effect in treating idiopathic membranous nephropathy. It can reduce urine protein, increase plasma protein, regulate blood lipid, protect renal function, and is safe and reliable. The curative effect of TCM symptom and western medicine is outstanding, and the curative effect is obvious with the course of treatment.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R277.5

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