【作者】 张慧兰；

【导师】 孙伟；

【作者基本信息】 南京中医药大学 ， 中西医结合临床， 2010， 博士

【摘要】 目的：探讨益肾法治疗慢性肾脏病的理论基础,研究益肾法为主中药治疗慢性肾衰竭的临床疗效及安全性。方法：理论研究：通过收集、整理文献,总结肾虚在慢性肾脏病中的病因病机认识。系统整理益肾法的意义、具体分类及现代医学基础。临床研究：系统总结导师孙伟教授常用益肾法药对及治疗慢性肾脏病的经验。将50例慢性肾衰竭患者随机分为治疗组、对照组各25例,比较益肾法中药联合基础治疗较单纯基础治疗的临床疗效,观察3个月内患者的症候积分、中医危险因素、临床疗效、尿蛋白定量、血肌酐、血红蛋白、血浆白蛋白、血脂等指标的变化。结果：理论研究：肾虚的本质是肾的精气不足。现代中医学对”肾虚”本质的研究涉及到免疫缺陷、神经内分泌失常、肾脏局部血流变异常等。中医之肾是神经、内分泌、免疫、物质代谢等生理功能和病理变化的概括。肾虚的形成与内外二因均有关。肾虚病机有肾失封藏、开阖失职、殃及他脏等。肾虚可分为肾气虚、肾阳虚、肾阴虚、肾精亏虚。益肾法是补益肾中阴阳精气,补益肾脏虚损为主要目的的治疗方法,是治疗肾虚的大法。临床研究：所有患者本证以脾肾气虚及气阴两虚为主(P<0.05),标证分布无统计学意义(P>0.05),水湿、湿热是CRF患者肾损害加重的危险因素(P<0.05)。经治疗两组有效率分别为76%和60%,2组疗效差异有统计学意义(P<0.05)。治疗组症状积分明显下降(P<0.05),而对照组症状积分下降无统计学差异(P>0.05)。经治疗治疗组尿蛋白定量稳定,而对照组有上升趋势(P<0.05)。治疗3个月后治疗组SCr较基线水平明显下降(P<0.05),而对照组SCr上升较治疗前明显升高(P<0.05)。两组治疗后血红蛋白水平变化均无统计学意义(P>0.05),但治疗3个月后治疗组上升较对照组明显(P<0.05)。治疗组血白蛋白较治疗前明显升高(P<0.05),而对照组无变化(P>0.05)。治疗组总胆固醇较治疗前升高(P<0.05),而对照组治疗前后TCH变化无统计学意义(P>0.05),两组TG变化均无统计学意义(P>0.05)。结论：肾虚是慢性肾脏病的主要病机之一,益肾法是治疗慢性肾脏病的基本大法。基础治疗联合益肾法加减综合治疗慢性肾衰竭患者,可以缓解患者的不适症状、提高生活质量,提高血浆白蛋白、血红蛋白水平,稳定蛋白尿、降低观察期内的SCr水平,从而改善肾功能。更多还原

【Abstract】 Objective:To establish the theory of treatment of tonifying kidney (TK) on chronic kidney disease (CKD). Then, to investigate the effect and safety of TK treatment on Chronic renal failure (CRF).Methods:Theory study and clinical investigation were involed in this study. Selecting and analyzing classic and morden articles were the main methods of theory study. In clinical investigation, professor Sun’s experience on the treatment of CKD was summarized first. Then 50 CRF (25 treatment group,25 conrol group) patients who were mainly treated by tonifying kidney were involved. During 3 months’treatment, their changes of syndrome pattern, rick factor of TCM, urinary protein, serum creatine, hemoglobin, serum albumin, and serum lipid were recorded and analyzed.Results:The essence of kidney insufficiency was essential qi insufficiency. Morden TCM kidney insufficiency refer to immunodeficiency, nerve-incretion disorder, turbulence of kidney focal blood stream. The exogenous and endogenous factors were the main cause of kidney insufficiency. The mechanisms of kidney insufficiency were dysfunction in essence-storing, disturbance in bladder, other organ disorder. Insufficiency included kidney qi, yin, yang, essence insufficiency. So tonifying kidney was the main treatment on CKD. Clinical study:The efficiencies were 76% (TK) vs 60% (contol) (P<0.05). In treatment group, patients’symptom scores were reduced significantly compared with initial level (P<0.05). There was no significant change in proteinuria in treatment group (P>0.05). But the proteinnuria was increased compared with initial level in control (P<0.05). After 3 months, there was decrease in Scr in TK group but increase in control group (P<0.05). There was no changes in hemoglobin compared with initial datas (P>0.05). After treatment, the level of Albumin was increased whereas that of control group was no change. TCH was increase in TK group but decrease in control (P<0.05). There was no changes in TG compared with initial level (P>0.05).Conclusion:Kidney insufficiency was the main mechanisms of CKD. Tonifying kidney was the main methods on treatment of CKD. TK treatment could relieve the discomfortable symptoms, improve quality of life, improve hemoglobin and serum albumin, stablize proteinuria, decrease SCr during 3 monthes. So it could improve the renal function.更多还原