摘要
目的分析中医“健脾补肾、活血解毒”法治疗特发性膜性肾病(idiopathic membranons nephropath,IMN)的临床疗效及影响疗效的相关因素,探讨该治疗方案的有效性和安全性。方法采用单中心回顾性研究方法,严格按照纳排标准搜集、整理分析2014年1月—2019年1月于上海中医药大学附属龙华医院肾病科病房和门诊就诊的IMN患者临床病例资料。结果该研究纳入244例IMN患者,中医辨证分型本虚证属脾肾气虚证,标实证以血瘀证(28.69%,70/244)、热毒证(26.23%,64/244)为主;中药组缓解率81.63%(80/98),中西结合组缓解率71.25%(57/80),西药无效组缓解率66.67%(44/66),整体缓解率74.18%(181/244)、复发率2.87%(7/244);性别、高血压病、疗程、蛋白尿、血清白蛋白是各治疗组预后的影响因素,合并用药是单纯中药组预后的影响因素,血肌酐水平是西药无效组预后的影响因素。多因素Logistic回归分析提示蛋白尿、血清白蛋白、高血压病可能是该方案治疗IMN疗效的独立影响因素。结论中医“健脾补肾、活血解毒”法治疗IMN疗效确切,复发率低,且治疗时间越长、疗效越好、缓解率越高;蛋白尿、高血压病、血清白蛋白是影响“健脾补肾,活血解毒”方案治疗IMN的相关因素。
Objective To analyze the clinical efficacy of“strengthening spleen and kidney,activating blood circulation and detoxification”method in the treatment of idiopathic membranous nephropathy(IMN)and the related factors affecting the curative effect,and explore the effectiveness and safety of the treatment scheme.Methods A single-center retrospective research method was used to collect,organize and analyze clinical case data of IMN patients who visited the nephrology ward and outpatient clinic of Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2014 to January 2019.Results In this study,244 patients with IMN were enrolled.Deficiency syndrome of TCM differentiation is spleen and kidney Qi deficiency syndrome.The main evidence is blood stasis syndrome(28.69%,70/244)and heat toxin syndrome(26.23%,64/244).The remission rate of the traditional Chinese medicine group was 81.63%(80/98),71.25%(57/80)of the combined traditional Chinese and Western medicine group and 66.67%(44/66)of the Western medicine ineffective group.The overall remission rate was 74.18%(181/244)and the recurrence rate was 2.87%(7/244).Gender,hypertension,course of treatment,proteinuria and serum albumin were the influencing factors of the prognosis of each treatment group.The combined medication was the influencing factor of the prognosis of the simple traditional Chinese medicine group,and the level of serum creatinine was the influencing factor of the prognosis of the ineffective Western medicine group.Multivariate logistic regression analysis suggested that proteinuria,serum albumin and hypertension may be independent factors affecting the efficacy of this regimen in the treatment of IMN.Conclusion The method of“strengthening spleen and kidney,activating blood circulation and detoxification”in the treatment of IMN has a definite curative effect.The recurrence rate is low,and the longer the treatment time,the better the curative effect and the higher the remission rate.Proteinuria,hypertension and serum albumin are the related factors affecting the treatment of IMN by“strengthening spleen and kidney,activating blood circulation and detoxification”.
作者
向玲
陈万佳
刘旺意
鲁珍珍
李芳
邓跃毅
XIANG Ling;CHEN Wanjia;LIU Wangyi;LU Zhenzhen;LI Fang;DENG Yueyi(Longhua Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)
出处
《辽宁中医杂志》
CAS
2022年第3期96-101,共6页
Liaoning Journal of Traditional Chinese Medicine
基金
国家重点研发计划-中医药现代化研究重点专项(2019YFC1709403)
上海市卫计委加快中医药事业发展三年行动计划项目(16CR2033B)
关键词
特发性膜性肾病
健脾补肾
活血解毒
临床疗效
idiopathic membranous nephropathy
invigorating spleen and kidney
promoting blood circulation and detoxifying toxicity
clinical efficacy
作者简介
向玲(1991-),女,湖北人,住院医师,硕士,研究方向:中医药防治慢性肾脏病;通讯作者:邓跃毅(1965-),男,浙江人,主任医师、教授,博士研究生导师,博士,研究方向:中医药防治慢性肾脏病,E-mail:sh_dengyueyi@163.com。
