活血解毒汤联合西药治疗活动性狼疮性肾炎临床观察

【作者】 彭碧波；

【导师】 薛莎；

【作者基本信息】 湖北中医学院 ， 中医内科学， 2008， 硕士

【摘要】 目的:通过应用活血解毒方加味联合西药治疗活动性狼疮性肾炎临床研究,观察中西药结合的临床疗效,分析活血解毒方的作用机理,探寻中西医结合治疗活动性狼疮性肾炎的有效途径。方法:1临床资料:将2006年3月-2008年2月在我院肾内科住院或门诊就诊,已确诊为活动性狼疮性肾炎的40例患者,其中男2例,女38例,年龄18-54岁,平均(25.4±0.4)岁,随机分为中西药组(治疗组)和西药组(对照组),每组各20例,两组患者在性别、年龄、病程上经统计学处理,差异无显著性(P＞0.05),具有可比性。观察方法为随机对照,观察时间为3个月。2治疗方法:西药组采用激素标准疗程;有明显活动时,加用环磷酰胺(CTX)冲击疗法;以及对症、支持等治疗.中西药组在西医治疗基础上,使用活血解毒方:丹参、生地、益母草、川芎、赤芍、白花蛇舌草、半枝莲、半边莲、全蝎.并在此方基础上辨证加减。3疗效观察及安全性观察3.1临床主要相关症状:临床症状如发热、乏力、红斑、关节肿痛、浮肿、饮食情况等临床表现,体征及舌象、脉象。根据病情变化随时记录.3.2临床主要相关副作用:激素和细胞毒药物治疗后引起的柯氏症(痤疮)、神经系统症状(兴奋失眠)、感染、上消化道出血、血糖升高等副作用。根据病情变化随时记录。3.3实验室相关检查:血生化(BUN、Scr、ALT、AST、TP、ALB);血常规,尿常规,24 h upq;ESR、抗ds-DNA抗体水平、c 3水平;并计算狼疮活动指数,作出疗效评价。3.4采用SPSS12.0统计分析软件计算。所有计量资料用(?)±s(均数±标准差)表示,采用t检验;计数资料采用X~2检验;等级资料采用Ridit分析。结果:1中西药组总有效率90.00%;西药组总有效率50.00%。两组相比有显著性差异(P＜0.05)。2中西药组在改善患者临床症状,降低症状积分,活动积分,明显优于西药组,两组比较有显著性差异(P＜0.05或0.01)。3中西药组在防止激素和细胞毒药引起的柯氏症、兴奋失眠、白细胞下降等副作用方面,与治疗前比较有显著性差异(P＜0.05)。4中西药组在控制蛋白尿方面,明显优于西药组,两组比较有显著性差异(P＜0.05).5两组在控制实验室检查指标的时间比较方面,治疗组具有显著性差异(P＜0.01或0.05)。结论:活血解毒方加味联合西药治疗活动性狼疮性肾炎临床疗效确切,可显著缓解活动性狼疮性肾炎患者的各种临床症状和体征,减少西药的毒副作用,缩短疾病病程控制时间,从而有效延缓狼疮性肾炎的进展达到持续缓解的目的。为治疗狼疮性肾炎的有效的方剂和方法之一。更多还原

【Abstract】 Objective:To investigate the clinical effect and anti-influence of western medicine of the basic prescription on treatment of active lupus nephritis,try to find out the mechanism of Huo Xue Jie Du prescriptionthrough clinical experiment.Methods:40 patients with active lupus nephritis were selected and randomly divided into two groups:the united Chinese and western medicine treatment group（A）and western medicine control group（B）,20 patients for each group.Group B were given criterion prednisone orally taking and cyclophamide impact therapy in injection.Group A were given Huo Xue Jie Du prescription with dialectically adding other herbs on the base of group B.We observed on the/their symptoms and signs pre-treatment and post-treatment.Blood-routine,urine-routine,stool-routine+OB,BS, ALB,AST,BUN,Scr,C₃,ESR,ANA,anti-ds-DNA,24hupq,active degree of lupus were measured to evaluate the effect of the united Chinese and western medicine therapy.Result:Result of the study could be summarized as:1.Group A total effective rates were 90.00%;while group B was 50.00%;the total therapeutic effect of group A was better than that of group B（P＜0.05）2.Group A could improve the patients’ clinical symptoms and signs,the effects was better than group B（P＜0.05 or 0.01）3.Group A have better effect than group B in anti-side-effect of prednisone and cyclophamide（CTX）such as Cushing syndrome,excitement,insomnia or descent of white blood cell（WBC）（P＜0.05）4.Compared with group B,group A has differential effect in decreasing urine protein（P＜0.05） 5.The time of controlling the clinical symptoms,signs,experimental index has remarkable less in group A than that of group B（P＜0.01 or＜0.05）Conclusion:Group A were better than group B in symptoms and signs of the patients,western medicine anti-influence and experiment index after the treatment.Therefore,the united treatment could markedly keep long-relieve in the patient of lupus nephritis.更多还原