本文選題：局灶節(jié)段性腎小球硬化 + 加減參芪地黃湯　； 參考：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:局灶節(jié)段硬化性腎小球腎炎(Focal segmental glomurular sclerosis,FSGS)是臨床上常見的腎小球疾病中的一種病理類型,是以足細(xì)胞變性,腎小球毛細(xì)血管襻閉塞和細(xì)胞外基質(zhì)增多共見、內(nèi)皮細(xì)胞和系膜細(xì)胞節(jié)段性增生、腎間質(zhì)纖維化等一系列病變?yōu)樘卣?以血尿、蛋白尿和腎病綜合征為主要臨床表現(xiàn),并朝著終末期腎病發(fā)展的疾病。該病常見于兒童的腎小球疾病,成人的發(fā)病率占所有原發(fā)性腎小球疾病的8%左右。西醫(yī)治療以降壓、抗凝、控制蛋白尿和阻止硬化發(fā)展為主,腎上腺皮質(zhì)激素的使用也是治療該病的有效手段之一,但有近半數(shù)患者經(jīng)激素治療后效果不明顯且副作用較大。國(guó)內(nèi)已有相關(guān)研究表明,中醫(yī)中藥治療在改善FSGS患者各項(xiàng)癥狀、體征、延緩病情發(fā)展、提高患者生活質(zhì)量等方面有很好的效果,尤其是在控制本病的蛋白尿方面有其獨(dú)特的優(yōu)勢(shì)。研究對(duì)象和方法:收集了2012年9月至2016年11月來自湖北省中醫(yī)院腎病�？频淖≡翰亢烷T診的病歷資料,患者均于外院已行腎臟穿刺活檢確診為FSGS,并對(duì)繼發(fā)性因素排除后,年齡≥18周歲,經(jīng)中醫(yī)四診合參辨證后認(rèn)為屬于以氣陰兩虛為主要證候者,進(jìn)行口服加減參芪地黃湯煎劑或(和)中西醫(yī)結(jié)合基礎(chǔ)治療的病例共40份,其中使用中西醫(yī)結(jié)合基礎(chǔ)治療共17例,使用中西醫(yī)結(jié)合基礎(chǔ)治療合并加減參芪地黃湯煎劑治療共23例。監(jiān)測(cè)患者尿常規(guī)、24小時(shí)尿蛋白量及安全性指標(biāo)(血脂、血白蛋白、血肌酐等)情況,記錄患者的癥狀體征變化,進(jìn)行中醫(yī)證候量化評(píng)分,各項(xiàng)檢查指標(biāo)通過統(tǒng)計(jì)學(xué)分析比較,采用SPSS 21.0版本統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)統(tǒng)計(jì),評(píng)價(jià)該方對(duì)FSGS引發(fā)的蛋白尿的治療效果。本研究旨在觀察加減參芪地黃湯對(duì)pFSGS蛋白尿的臨床療效。結(jié)果:采用自我對(duì)照的方法,采納用藥前后及用藥期間的各項(xiàng)檢查指標(biāo)作出對(duì)比。根據(jù)局灶節(jié)段硬化性腎小球腎炎氣陰兩虛型中醫(yī)量化評(píng)分得出:總有效率67.5%,對(duì)照組有效率47.06%,治療組有效率78.26%,兩組比較有統(tǒng)計(jì)學(xué)意義(p小于0.05)。兩組用中藥治療后積分均與治療前積分相比具有統(tǒng)計(jì)學(xué)意義(p小于0.05);兩組治療前后的24小時(shí)尿蛋白定量、血脂、血白蛋白經(jīng)自我對(duì)照后差異有統(tǒng)計(jì)學(xué)意義(p小于0.05)。結(jié)論:加減參芪地黃湯配合中西醫(yī)結(jié)合基礎(chǔ)治療FSGS能顯著改善患者臨床癥狀,療效高于對(duì)照組,并可調(diào)節(jié)脂質(zhì)代謝、降低尿蛋白、升高血漿白蛋白、提高患者的生活質(zhì)量,是一種比較安全的治療手段,從而顯示了中西醫(yī)結(jié)合治療FSGS的優(yōu)勢(shì)。
[Abstract]:Objective: focal segmental glomurular glomerulonephritis (FSGS) is a common pathological type of glomerular disease, which is characterized by podocyte degeneration, glomerular capillary loop occlusion and increase of extracellular matrix. A series of pathological changes, such as segmental proliferation of endothelial cells and Mesangial cells and renal interstitial fibrosis, are characterized by hematuria, proteinuria and nephrotic syndrome. The disease is common in children with glomerular disease, and the incidence of adult glomerular disease is about 8% of all primary glomerular diseases. Western medicine is mainly used to reduce blood pressure, anticoagulant, control proteinuria and prevent the development of sclerosis. The use of adrenocortical hormone is also one of the effective methods for the treatment of the disease. Relevant studies in China have shown that traditional Chinese medicine treatment has a good effect in improving the symptoms and signs of patients with FSGS, delaying the development of the disease, improving the quality of life of patients, and so on. Especially in the control of proteinuria has its unique advantages. Subjects and methods: from September 2012 to November 2016, we collected the medical records of hospitalized and outpatient patients of nephropathy in Hubei traditional Chinese Medicine Hospital. All patients were diagnosed as FSGSby renal biopsy in other hospitals, and the secondary factors were excluded. The age 鈮，

本文編號(hào)：1795029