和解聚散法治疗慢性肾小球肾炎的临床研究

【作者】 王晓楠；

【导师】 王耀献；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2012， 硕士

【摘要】 慢性肾小球肾炎(慢性肾炎)是肾脏内科常见病,在各类肾脏疾病中发病率最高,目前在我国导致终末期肾病(ESRD)最常见的原因。慢性肾炎的病理发展经历了细胞外基质在肾内不断沉积,完整肾单位进行性减少,肾小球滤过率下降,最终形成肾纤维化(肾功能衰竭)的病理生理过程。细胞外基质(ECM)过度积聚,为慢性肾炎发展至终末期肾脏病的唯一的病理改变。这个过程与肾络(?)瘕的形成和发展过程相符合的。肾络(?)瘕理论不仅阐述了对慢性肾炎的病理生理过程,也将肾脏超微结构形态学改变与中医的病因病机相关的关系进行了探讨。在此理论指导下我们提出和解聚散法,研究其对防治慢性肾炎向终末期肾病进展的临床意义。论文包括文献综述和临床研究两部分。文献综述分两篇。第一篇“慢性肾炎的中医病因病机研究进展”,结合近年来的中医药研究,从肾小球肾炎及其蛋白尿、血尿、水肿等角度对其病因病机进行了概述。第二篇“和解聚散法治疗慢性肾炎的理论探讨”,结合肾小球疾病发病机制及病理改变,对肾络微型瘤瘕理论的病因病机简要论述,并对和解聚散法进行了简要探讨。第二部分为临床研究。目的：和解聚散方治疗慢性肾炎的疗效及安全性,验证其正确性。方法：纳入慢性肾炎患者68例,以分为治疗组与对照组,其中治疗组38例,对照组30例。两组患者在给予相同西药基础上,治疗组给予和解聚散方中药汤剂口服治疗,对照组给予肾炎康复片治疗,疗程两个月。对照观察两组治疗前后临床症状及尿蛋白定量、红细胞、肾功能的情况。结果：治疗组病例24小时尿蛋白定量减少非常显著(P<0.01),对照组病例24小时尿蛋白定量减少显著(P<0.05),治疗组优于对照组(P<0.05)。治疗组治疗前后尿沉渣镜检红细胞个数非常显著下降(P<0.01),治疗组治疗后与对照组相比,有显著性差异(P<0.05)。两组病例治疗前后BUN和Scr无明显改善(P>0.05)。在改善患者临床主要症状、体征方面,两组病例治疗后中医证候总积分都显著下降,但治疗组较对照组作用更为显著(P<0.01)。和解聚散汤组临床总有效率为84.2%,对照组为53.3%,治疗组优于对照组(P<0.01)。结论：和解聚散法治疗慢性肾炎是安全有效的,从临床疗效上初步证实肾络(?)瘕理论具有较高理论意义和临床价值。其方能有效改善慢性肾炎患者的临床症状、体征及减少蛋白尿,可能有效延缓慢性肾炎病程的进展。更多还原

【Abstract】 Chronic glomerulonephi tis (CGN) is a kind of common disease in the Department of Nephrology and have the highest incidence in the various kinds of kidney in China.It led to the most common cause of end-stage renal disease (ESRD). Pathological development of chronic nephitis experience the continuous deposition of extracellular matrix in the kidney, conplete nephron reduction and glomerular filtration rate decreased and uiltmately the formation of the pathophysiological process of renal fibrosis (renal failure). Excessive extra-cellular matix (ECM) accumulation was considered to only pathological changes from chronic nephritis to end-stage renal disease. This process is consistent with the formation and development of shenluozhengjia. The theory not only explain the pathophysiological changes, but have a preliminary study in the relationship between pathological changes of the nephropathy and the etiology, pathogenesis in TCM. We proposed hejiejusan formula to study the clinical significance of the prevention of chronic nephritis progress to ESRD, which is under the guidance of pathogenesis of shenluozhengjia theory.The thesis divided into two parts:literature review and clinical study.The first part is the literature study including two papes.The first one was about the research progress of Pathogenesis of CGN. It was stated combined with several years of research in TCM from the point of view of its proteinuria hematuria edama in TCM. The second one states the discussion of shenluozhengjia theory, that it is a brief discourse about the etiology and pathogenesis of kidney based on pathogenesis and pathological changes of the Nephritis. The hejiejusan formula was briefly discussed.The second part is clinical study. Objective:In the clinical study, we verify the correctness efficacy and safety of the treatment of CGN. Methods: We selected68patients of CGN, and divided them into groups randomly and comparably,38cases were in treatment group,30in control group. Both of groups were treated by Chinese herb. The control group was just treated by nephritis rehabilitation tablets. We observed the urine protein in24hours, red blood cells of Urine Sediment, scores of Chinese medicine symptom and curative effect after two months. Results:In treatment group, the urine protein in24hours decreased very shapely (P<0.01), while in control group, it also deceased sharply (P<0.05). However, the effect is much better in treatment group. Red blood cell of urinary sediment had significant deviation comparing before treatment in the treat group (P<0.05). After the treatment, compared with the control group, the red blood cell of urinary sediment was significantly decreased (P<0.05). After treatment in two groups, serum creatinine and blood urea nitrogen has no significant decrease. The syndroms total score about clinical symptoms and signs was significantly decreased, but the effect of improving symptom of treatment is better than the control group. The effective rate of is84.2%in treatment, while it is53.4%in control group.Conclusion:It suggests that hejiejusan method is safe and effective in treatment of chronic nephritis and preliminarily confirms shenluozhengjia theory has higher theoretical significance and clinical studyin inclinical efficacy. The hejiequsan formula can improve the clinical symptoms of chronic nephritis, signs and reduce proteinuria and may slow down the progession of chronic nephritis.更多还原