摘要
目的 观察基于“培土制水”理论自拟健脾益肾方联合西医治疗特发性膜性肾病的临床疗效。方法 选取2019年8月—2021年8月陕西省中医医院肾病科诊治的Ⅰ~Ⅱ期脾肾两虚兼血瘀型特发性膜性肾病患者97例,依据是否采用“培土制水”法辨证施治将患者分为2组,对照组给予糖皮质激素+环磷酰胺一线方案治疗,治疗组加用“培土制水”法为理论基础的自拟健脾益肾方加减治疗,2组疗程均为24周,观察比较2组患者治疗前后24 h尿蛋白(24 h-UTP)、血肌酐(SCr)、血清白蛋白(ALB)、三酰甘油(TG)、总胆固醇(TC)水平变化,比较2组中医证候疗效、西医临床疗效及不良反应发生率。结果 2组治疗12周及24周时24 h-UTP水平均明显降低(P均<0.05),且治疗组24h-UTP水平均明显低于对照组(P均<0.05)。2组患者治疗前后SCr水平比较差异均无统计学意义(P均>0.05)。2组治疗12周及24周时,血清ALB水平均明显升高(P均<0.05),且治疗组均明显高于对照组(P均<0.05)。2组治疗12周时TC、TG水平均明显降低(P均<0.05),但2组比较差异无统计学意义(P均>0.05);2组治疗24周时TC、TG水平均明显低于治疗12周时(P均<0.05),且治疗组明显低于对照组(P均<0.05)。治疗组治疗12周及24周时中医证候疗效总有效率及西医临床缓解率均明显高于对照组(P均<0.05);治疗组治疗12周时不良反应发生率明显低于对照组(P<0.05)。结论 基于“培土制水”理论自拟健脾益肾方联合西医治疗特发性膜性肾病的临床疗效优于单纯西医治疗,并且随着治疗周期延长疗效更好。
Objective It is to observe the clinical effect of Jianpi Yishen decoction made based on the theory of“cultivating soil to control water”combined with western medicine on idiopathic membranous nephropathy(IMN).Methods A total of 97 patients with IMN at stage I to II with syndrome of spleen and kidney deficiency and blood stasis diagnosed and treated at the Nephrology Department of Shaanxi Provincial Hospital of Traditional Chinese Medicine from August 2019 to August 2021 were selected.The patients were divided into two groups according to whether the method of“cultivating soil to control water”was used for treatment based on syndrome differentiation.The control group was treated with the first-line scheme of glucocorticoid+cyclophosphamide,and the treatment group was additionally treated with self-made Jianpi Yishen decoction.The course of treatment of both groups was 24 weeks,The levels of 24 hour urinary protein(24 h-UTP),serum creatinine(SCr),serum albumin(ALB),triacylglycerol(TG)and total cholesterol(TC)were observed and compared between the two groups before and after treatment,and the curative effect of traditional Chinese medicine,the clinical efficacy of western medicine and the incidence of adverse reactions were compared between the two groups.Results The levels of 24h-UTP in both groups were significantly decreased after 12 and 24 weeks of treatment(all P<0.05),and the levels of 24h-UTP in the treatment group were significantly lower than those in the control group(all P<0.05).There was no significant difference in the level of SCr between the two groups before and after treatment(all P>0.05).After 12 and 24 weeks of treatment,the levels of serum ALB in both groups were significantly increased(all P<0.05),and the treatment group was significantly higher than the control group(P<0.05).The levels of TC and TG in the two groups were significantly decreased after 12 weeks of treatment(all P<0.05),but there was no significant difference between the two groups(P>0.05);The levels of TC and TG in both groups after 24 weeks of treatment were significantly lower than those after 12 weeks of treatment(all P<0.05),and those in the treatment group were significantly lower than those in the control group(all P<0.05).The total effective rate of TCM syndrome and the clinical remission rate of western medicine in the treatment group after 12 and 24 weeks of treatment were significantly higher than those in the control group(P<0.05);The incidence of adverse reactions in the treatment group was significantly lower than that in the control group after 12 weeks of treatment(P<0.05).Conclusion The self-made Jianpi Yishen decoction made based on the theory of“cultivating soil to control water”combined with western medicine is more effective than western medicine alone in the treatment of IMN,and the effect is better with the prolongation of the treatment cycle.
作者
张晓蓉
宛欣
程小红
ZHANG Xiaorong;WAN Xin;CHENG Xiaohong(Shaanxi University of Traditional Chinese Medicine,Xianyang 712000,Shaanxi,China;Xi’an Ninth Hospital,Xi’an 710000,Shaanxi,China;XD Group Hospital,Xi’an 710082,Shaanxi,China;Shaanxi Provincial Hospital of Traditional Chinese Medicine,Xi’an 710082,Shaanxi,China)
出处
《现代中西医结合杂志》
CAS
2022年第19期2657-2662,共6页
Modern Journal of Integrated Traditional Chinese and Western Medicine
基金
国家重点研发计划项目(2019YFC1709404)。
关键词
培土制水
健脾益肾方
特发性膜性肾病
24
h尿蛋白
白蛋白
血脂
cultivating soil to control water
Jianpi Yishen decoction
idiopathic membranous nephropathy
24 one hour urine protein
albumin
blood fat
作者简介
张晓蓉,女,研究方向为肾脏疾病的中西医结合治疗;通信作者:程小红,E-mail:sxzyyy2007@126.com。
