【作者】 钱蕾蕾；

【导师】 孙伟；

【作者基本信息】 南京中医药大学 ， 中医学， 2012， 硕士

【摘要】 目的：评价中医“益肾清利活血”法治疗慢性原发性肾小球肾炎的临床疗效。方法：本论文采用回顾性与前瞻性相结合的方法,观察经“益肾清利活血”法治疗后实验室指标的变化。首先回顾性研究了60例在江苏省中医院肾内科诊治的确诊为慢性原发性肾小球肾炎的患者,治疗时间为1年,分别收集患者治疗前后24小时尿蛋白定量(UTP)、尿蛋白定性、尿红细胞计数(URBC)等数据以及中医临床症状变化进行回顾性研究分析。再随机选取24例慢性原发性肾小球肾炎的患者,治疗时间为1个月,收集患者治疗前后24小时尿蛋白定量(UTP)、尿蛋白定性、尿隐血(BLD)、尿红细胞计数(URBC)等数据进行分析。结果：1.回顾性研究表明：1)临床总疗效：经“益肾清利活血”法配合基础治疗后,60例慢性肾小球肾炎患者的总有效率为85.6%。2)对中医临床症状的影响：60例慢性肾小球肾炎患者经治疗1年(12月)后中医临床症状除面色晦暗或黧黑外,如腰脊酸痛、疲倦乏力、浮肿、食少纳呆、胃脘胀满、口干咽燥、夜尿多等明显改善,中医症状临床积分差异具有显著统计学意义(P<0.01)。3)对实验室检查指标的影响：60例慢慢性肾小球肾炎患者经治疗后UTP、尿蛋白定性呈明显好转趋势,随着治疗时间的延长,UTP持续下降,各时间点与治疗前相比差异有高度统计学意义(P<0.01)。安全性指标ALT、Scr、Plt、WBC治疗前后比较无明显统计学意义(P>0.05)。2.前瞻性研究表明：1)临床总疗效：经“益肾清利活血法”配合基础治疗后,24例慢性原发性肾小球肾炎患者的总有效率为83.3%2)对实验室指标的影响：经4周治疗后患者Pro治疗前后比较有高度统计学意义(P<0.01)；患者经治疗后4周UTP明显下降,较治疗前相比组内差异有高度统计学意义(P<0.01),说明UTP于治疗第四周即出现明显下降,其中加用雷公藤多苷片治疗的患者UTP下降更明显,组间差异有统计学意义(P<0.05),另外正常血压组与高血压组间患者UTP变化的组间比较,差异无统计学意义(P>0.05)；经4周的治疗URBC、BLD改善不明显,较治疗前组内相比差异无统计学意义(P>0.05)。安全性指标血常规及肝肾功能治疗前后比较均无明显统计学意义(P>0.05)。结论：1.“益肾清利活血法”配合基础治疗慢性原发性肾小球肾炎是有效的,可降低患者的Pro及UTP,从而延缓疾病进展。2. UTP>1.5g/24h患者加用雷公藤可以提高降蛋白的疗效；高血压患者控制血压达标后不影响治疗后蛋白尿的变化。3.“益肾清利活血法”可以改善患者临床症状,如腰脊酸痛、疲倦乏力、浮肿、食少纳呆、胃脘胀满、口干咽燥、夜尿多等,提高患者生活质量。4.“益肾清利活血”法无明显副作用,对血常规及肝肾功能无明显影响,疗效安全。更多还原

【Abstract】 Objective:To evaluate the therapeutic effect of tonifying kidney, clearing away the damp-heat, and moving blood treatment on chronic primary glomerulonephrit.Methods:The integration of retrospective and prospective studies was carried out to observe the laboratory examination results of the patients treated by onifying kidney, clearing away the damp-heat, and moving blood. In the first place,60cases diagnosed as chronic glomerulonephritis in Nephropathy Department of Jiangsu Provincial Hospital of TCM were treated for1year to detect their quantitative and qualitative tests for urinary protein24h before and after treatment, urinary red blood cells (URBC) to undertake analysis in consideration with the changes of TCM clinical symptoms. Afterwards,24cases were randomly selected to collect and analyze the above indexes after1month treatment.Results:1. The retrospective study showed:1) Overall therapeutic effect:the total effective rate of the60cases with chronic primary glomerulonephritis was85.6%after treated by tonifying kidney, clearing away the damp-heat, and moving blood accompanied by basic therapy.2) The changes of TCM clinical symptoms:there were improvements of symptoms like aching pain along spinal column, weariness, hypodynamia, edema, poor appetite. tumescence in stomach, dry mouth and throat, frequent nocturia except dark and gloomy complexion. with statistic significance in clinical grading difference (P<0.01).3) The effect on laboratory examination results:there was a improving trend of quantitative and qualitative tests for urinary protein of the60cases after treatment, and their UTP kept going downward as treatment prolonged, with an obvious statistic significance (P<0.01). Compared with the indexes before treatment, ALT, Scr, Plt and WBC did not show a significant difference.2. The prospective study showed:1) Overall therapeutic effect:the total effective rate of the24cases with chronic primary glomerulonephritis was83.3%after treated by tonifying kidney, clearing away the damp-heat, and moving blood accompanied by basic therapy.2) The effect on laboratory examination results:there was statistic obvious significance in Pro of patients after4weeks treatment (P<0.01). UTP greatly decreased, showing significant difference if compared with before treatment (P<0.01); moreover, the decrease of UTP of the patients given Tripterysium Glucosides tablets was more apparent, with statistic significance (P<0.05). But, no statistic significance was exhibited between the UTP of patients in hypertension group and normal blood pressure group (P>0.05). Also, compared with before treatment, there was no great improvement in URBC and BLD, without statistic significance(p>0.05).Conclusion:1. The therapy of tonifying kidney, clearing away the damp-heat, and moving blood accompanied by basic treatment is effective on chronic primary glomerulonephritis by lowering Pro and UTP to postpone the development of this disease.2. The therapeutic effect of protein decrease can be enhanced by adding Tripterysium Glucosides according to the specific condition of each patient; and the urinary protein of patients with hypertension will not be influenced after treatment if their blood pressure is under control.3. The therapy of tonifying kidney, clearing away the damp-heat, and moving blood can improve clinical symptoms like aching pain along spinal column, weariness, hypodynamia, edema, poor appetite, tumescence in stomach, dry mouth and throat, dark and gloomy complexion, frequent nocturia to improve patients’life quality.4. There is not side effect of this therapy without clear effect on blood routine examination and the function of liver and kidney, showing therapeutic safety.更多还原