下瘀血汤治疗高血压性肾损害患者夜尿增多临床研究

【作者】 蔡倩；

【导师】 王暴魁；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2011， 硕士

【摘要】 背景高血压性肾损害是指根据高血压的程度和持续时间,引起轻重不等的肾损害。高血压性肾损害由于各种原因导致血管活性物质平衡失调、肾小动脉硬化等,使肾血流动力学发生异常,肾小管缺血,其浓缩稀释功能发生障碍。早期主要表现为夜尿增多,低比重尿、低渗透压尿。肾小球内持续高压则会引起肾小球脏层上皮细胞损伤,基底膜通透性增加,引起持续性蛋白尿。中医认为高血压性肾损害病机为本虚标实,本虚主要为脾肾亏虚,标实主要为血瘀、痰湿等,其中肾脏局部脉络瘀阻为重要病机。高血压导致的肾损害病程较长,久病入络,肾脉局部瘀血阻滞,瘀血不利则水液不循常道,发为夜尿增多。下瘀血汤由大黄、桃仁、蛰虫三味药物组成,具有活血化瘀,通络散结功效。该研究通过下瘀血汤对高血压性肾损害患者夜尿增多的疗效观察,评价下瘀血汤治疗高血压性肾损害患者夜尿增多的作用,为高血压性肾损害夜尿增多患者提供更有效的治疗方法。目的证实下瘀血汤对高血压性肾损害患者夜尿增多具有减少作用,同时对中医症候具有缓解作用。方法及结果收集高血压性肾损害患者60例,随机分为两组,对照组给予西药降压及对症治疗,治疗组在此基础上给予下瘀血汤进行治疗。分析治疗前后夜尿次数,夜尿尿量,实验室指标(血肌酐、尿素氮、尿酸、肾早损、24小时尿蛋白定量)的变化,对治疗结果采用统计描述的方法分析。结果显示：治疗组与对照组的尿NAG酶及尿微量白蛋白均有明显的下降,组间无显著性差异。治疗组夜尿次数及夜尿增多有明显改善。治疗组中医证候学积分治疗前后也有显著性差异。结论高血压性肾损害患者早期主要临床表现为夜尿增多,中医辨证为肾络血瘀,下瘀血汤具有活血化瘀的作用,临床可缓解夜尿增多,改善实验室指标,对减轻肾脏损害,延缓慢性肾功能不全的发展有重要作用。更多还原

【Abstract】 BackgroundHypertensive renal damage is based on the extent and duration of hypertension, renal damage caused by varying severity. Hypertensive renal damage due to various causes imbalance of vasoactive substances, renal arteriosclerosis, so that the abnormal renal hemodynamics, renal ischemia, functional disorder in its concentrated dilution. Mainly for the early increase in nocturia, low specific gravity of urine, low urinary osmolality. Continued pressure caused by renal glomerular visceral epithelial cell injury, the basement membrane permeability, causing persistent proteinuria. Chinese medicine pathogenesis of hypertensive renal injury based virtual standard and chronic illness into the network, the local blood stasis renal vein, marking the most important fact is blood stasis. Congestion Liquid disadvantage is the unusual road, hair nocturia increased. Xiayuxue soup from the rhubarb, peach, Thoroughfare shamisen drug composition, with blood circulation effect. The clinical research study under the bleeding through the soup of the nocturnal hypertension in patients with renal impairment increased the efficacy, bleeding under evaluation in the treatment of hypertensive renal damage soup caused by nocturia increased the role of those who, for the increase in nocturnal blood pressure in patients with renal impairment to provide more effective treatment.ObjectiveTom confirmed that under the congestion on hypertensive renal damage in patients with nocturia increased with mitigation.Methods and ResultsHypertensive patients with renal impairment to collect 60 cases were randomly divided into two groups, blood pressure and symptomatic treatment given to western medicine, the treatment group was given based on the decoction for treatment under the congestion. Analysis of indicators before and after treatment in each group changes, the survey method described by statistical analysis. The results showed that:the treatment group and control group, urinaryβ2-microglobulin were significantly decreased, more meaningful decline in the treatment group, treatment group, a significant improvement in nocturia increased.ConclusionsHypertensive renal damage in patients with early clinical manifestations of primary nocturnal increase in TCM as blood stasis, promoting blood circulation under the congestion has the role of Tom, can alleviate nocturia increased clinical, laboratory parameters improved, and reduce kidney damage, chronic delays the development of renal dysfunction plays an important role.更多还原