【作者】 杨婧梅；

【导师】 巴元明；

【作者基本信息】 湖北中医药大学 ， 中医内科学， 2011， 硕士

【摘要】 目的：本研究通过观察玄梗地黄汤对气阴两虚型IgA肾病(IgAnephropathy, IgAN)的中医症状积分及尿红细胞计数、24小时尿蛋白定量、血清免疫球蛋白(IgA、IgG、IgM)等实验室指标水平的影响,客观评价玄梗地黄汤对气阴两虚型IgA肾病的治疗作用,并探讨其作用机制。方法：将肾穿刺确诊为IgA肾病的患者按就诊顺序随机分为试验组(30例)和对照组(30例),试验组给予口服玄梗地黄汤每日1剂,对照组用单纯西医治疗(双嘧达莫),两组均治疗3个月。观察两组患者中医证候积分及尿红细胞计数、24小时尿蛋白定量、血清免疫球蛋白(IgG,IgM,IgA)等实验室指标水平的变化,并对比两组疗效。结果：1.两组疾病疗效比较：试验组总有效率86.6%,对照组总有效率63.3%,两组总有效率有显著性差异(u=2.24,P<0.05)。试验组的疾病疗效优于对照组。2.两组证候疗效比较：试验组总有效率83.3%,对照组总有效率53.3%,两组总有效率有非常显著性差异(u=2.91,P<0.01)。试验组证候疗效明显优于对照组。3.两组中医症状总积分比较：治疗后两组中医症状总积分组间比较,有非常显著性差异(P<0.01),试验组优于对照组。4.两组单项症状积分比较：治疗后两组单项症状积分组间比较,在少气乏力,手足心热,易感冒症状改善方面,有非常显著性差异(P<0.01),在口干咽燥,浮肿的改善方面,有显著性差异(P<0.05),试验组明显优于对照组。5.两组尿红细胞计数(/μL)比较：治疗后组间比较,有非常显著性差异(P<0.01),试验组改善血尿明显优于对照组。6.两组24小时尿蛋白定量比较：治疗后组间比较,有显著性差异(P<0.05),试验组改善蛋白尿优于对照组。7.两组血清免疫球蛋白比较：治疗后组间比较,仅血清IgA有显著性差异(P<0.05),试验组改善血清IgA优于对照组。结论：试验组能有效改善气阴两虚型IgA肾病患者的临床症状,尤其在少气乏力,手足心热,易感冒,口干咽燥,浮肿的症状改善方面,明显优于对照组,亦能有效减少血尿和蛋白尿,稳定肾功能,提高患者的生存质量,表明玄梗地黄汤是治疗气阴两虚型IgA肾病的有效方剂,为临床治疗气阴两虚型IgA肾病提供了新的、安全的治疗方法。更多还原

【Abstract】 Objective:To examine the effects of Xuangengdihuang Decoction on IgA nephropathy (IgA nephropathy, IgAN) of Qi and Yin Deficiency type,to calendar the syndrome integral and urinary red blood cell count,24-hour urinary protein, serum immunoglobulin (IgA, IgG, IgM),to evaluate the treatment of Xuangengdihuang Decoction on IgA nephropathy of Qi and Yin Deficiency type, and to explore the mechanisms.Methods:The patients diagnosed of IgAN were randomly divided into experimental group (30 cases) and control group (30 cases), experimental group were given daily Xuangengdihuang Decoction, The control group were treated with Western medicine alone (dipyridamole), two groups were treated for 3 months. TCM syndrome score and urinary red blood cell count,24-hour urinary protein, serum immunoglobulin (IgG, IgM, IgA), renal function (Ccr, Scr, BUN) levels and other changes in laboratory parameters were observed and compared in two groups.Results:1 Comparative efficacy of diseases:in experimental group, the total efficiency was 86.6%,in the control group, the total efficiency was 63.3%.Total effective rate was significantly different (u=2.24,P<0.05). The experimental group was better than the control group in the effect of disease.2 Comparison of syndromes:the rate of experimental group was 83.3%,in the control group the rate was 53.3%, total effective rate was significantly different (u=2.91,P<0.01). The experimental group was better than the control group in syndromes.3 Comparison of total score of clinical symptoms:After treatment, the total score of clinical symptoms between the two groups there was a significant difference (P<0.01), experimental group was better than the control group.4 Comparison of individual symptom scores:After treatment, the individual symptom scores between the two groups in shortness of breath, lassitude, feverish sensations in the chest,palms and soles, vulnerable to cold, there was a significant difference(P<0.01),the scores in dryness in the mouth and throat,edema,there was a significant difference (P<0.05),experimental group was better than the control group.5 Urinary red blood cell count (/μL) comparison:between the two groups after treatment, there was a significant difference (P<0.01), experimental group was better than the control group in the reducement of urinary red blood cell count.624-hour urine protein comparison:between the two groups after treatment, there was a significant difference (P<0.05), the experimental group reduced 24-hour urinary protein better than the control group.7 Serum immunoglobulin comparison:between the two groups after treatment, only a significant difference in IgA (P<0.05), experimental group reduced IgA better than the control group.Conclution:Experimental group can effectively improve the clinical symptoms of patients with type Qi and Yin Deficiency, especially in shortness of breath, lassitude, feverish sensations in the chest,palms and soles, vulnerable to cold, dryness in the mouth and throat, edema, and it is significantly better than the control group. Experimental group is also effective in reducing urine and proteinuria, stable renal function and improve quality of life of patients, indicating that Xuangengdihuang Decoction is an effective prescription for clinical treatment of IgA nephropathy of Qi and Yin Deficiency type and it may become a new, safe treatment.更多还原