消白方治疗脾肾气虚、湿热瘀阻型慢性肾小球肾炎（CKD1～2期）的临床研究
Clinical research on Xiaobai Decoction in the treatment of chronic glomerulonephritis (CKD at stages 1-2) with syndrome of spleen and kidney qi deficiency and stagnant dampness-heat
- 上海中医药大学学报 2021年35卷第6期 页码：17-21
- 作者机构：
1.上海中医药大学附属曙光医院肾病科，上海中医药大学中医肾病研究所，肝肾疾病病证教育部重点实验室（上海 201203）
- 作者简介：
钱祎玲，女，硕士，主治医师，主要从事中医药防治慢性肾脏病的临床研究
王琛，主任医师，博士生导师；E-mail：chenwang42@163.com
- 基金信息：上海市进一步加快中医药事业发展三年行动计划项目(ZY-（2018-2020）-FWTX-7005);上海市浦东新区卫生系统重点学科群建设项目(PWZxq2017-07);上海中医药大学附属曙光医院四明青年基金资助项目(SGKJ-201902)
DOI：10.16306/j.1008-861x.2021.06.003
中图分类号：
扫 描 看 全 文
钱祎玲, 周圆, 兰天鹰, 等. 消白方治疗脾肾气虚、湿热瘀阻型慢性肾小球肾炎（CKD1～2期）的临床研究[J]. 上海中医药大学学报, 2021,35(6):17-21.
QIAN Yiling, ZHOU Yuan, LAN Tianying, et al. Clinical research on Xiaobai Decoction in the treatment of chronic glomerulonephritis (CKD at stages 1-2) with syndrome of spleen and kidney qi deficiency and stagnant dampness-heat[J]. Academic Journal of Shanghai University of Traditional Chinese Medicine, 2021,35(6):17-21.
钱祎玲, 周圆, 兰天鹰, 等. 消白方治疗脾肾气虚、湿热瘀阻型慢性肾小球肾炎（CKD1～2期）的临床研究[J]. 上海中医药大学学报, 2021,35(6):17-21. DOI： 10.16306/j.1008-861x.2021.06.003.
QIAN Yiling, ZHOU Yuan, LAN Tianying, et al. Clinical research on Xiaobai Decoction in the treatment of chronic glomerulonephritis (CKD at stages 1-2) with syndrome of spleen and kidney qi deficiency and stagnant dampness-heat[J]. Academic Journal of Shanghai University of Traditional Chinese Medicine, 2021,35(6):17-21. DOI： 10.16306/j.1008-861x.2021.06.003.
摘要
目的：,2,观察消白方结合西医常规疗法治疗脾肾气虚、湿热瘀阻型慢性肾小球肾炎（CGN）患者的临床疗效。,方法：,2,纳入120例脾肾气虚、湿热瘀阻型CGN患者[慢性肾脏病（CKD）1～2期]，随机分为对照组和治疗组，每组各60例。对照组患者给予西医开放性方案治疗，治疗组患者在此基础上加用消白方口服，两组疗程均为6个月。评价两组患者的临床疗效及中医证候疗效，治疗前后检测所有患者的24 h尿蛋白定量（24 h UPro）、尿微量白蛋白/尿肌酐比值（UACR）、尿N-乙酰-β-D-葡萄糖苷酶（NAG）、尿视黄醇结合蛋白（RBP）、尿α1-微球蛋白（α1-MG）、尿β2-微球蛋白（β2-MG）及血清肌酐（Scr）和尿素氮（BUN）、肾小球滤过率估计值（eGFR）水平。,结果：,2,研究过程中，治疗组4例患者剔除或脱落，对照组5例患者剔除或脱落，最终治疗组56例、对照组55例患者纳入统计分析。①临床疗效：治疗后，治疗组患者的临床总有效率为92.9%，对照组为87.3%，治疗组的疗效优于对照组（,P,<,0.05）。②中医证候疗效：治疗后，治疗组患者的中医证候疗效总有效率为89.3%，对照组为54.5%，治疗组的疗效优于对照组（,P,<,0.01）。③实验室指标：治疗后，两组患者的24 h UPro、UACR、NAG、RBP水平较治疗前均明显降低（,P,<,0.05），治疗组患者的α1-MG、β2-MG水平亦明显降低（,P,<,0.05），且治疗组患者的24 h UPro、NAG、RBP、α1-MG、β2-MG水平低于对照组（,P,<,0.05）。治疗后，治疗组患者的eGFR水平较治疗前明显升高（,P,<,0.05）、Scr水平较治疗前明显降低（,P,<,0.05），且治疗组患者的Scr水平低于对照组（,P,<,0.05）。④相关性分析：eGFR与24 h UPro、UACR、NAG、RBP呈负相关。,结论：,2,消白方结合西医常规疗法治疗脾肾气虚、湿热瘀阻型CGN（CKD1～2期）患者，能有效改善患者的临床症状，降低尿蛋白水平，改善肾小管损伤相关指标，延缓肾功能进展。
Abstract
Objective:,2,To observe the clinical efficacy of Xiaobai Decoction combined with conventional western medicine in the treatment of chronic glomerulonephritis(CGN) with syndrome of spleen and kidney qi deficiency and stagnant dampness-heat.,Methods:,2,A total of 120 CGN patients[chronic kidney disease(CKD) at stages 1-2] with syndrome of spleen and kidney qi deficiency and stagnant dampness-heat were included and randomly divided into the control group and treatment group, 60 cases in each group. The patients in the control group were treated with the open scheme of western medicine, and the patients in the treatment group were orally treated with Xiaobai Decoction based on above.The treatment course of both groups was 6 months.The clinical efficacy and Chinese medical syndrome efficacy of the two groups were evaluated.Before and after treatment, the levels of 24-hour urinary protein quantity(24 h UPro), ratio of urinary microalbumin to urinary creatinine(UACR), urinary N-acetyl-β-D-glucosidase(NAG), urinary retinol binding protein(RBP), urinary α1-microglobulin(α1-MG), urinary β2-microglobulin(β2-MG), serum creatinine(Scr), blood urea nitrogen(BUN) and estimated glomerular filtration rate(eGFR) were detected.,Results:,2,During the study, 4 patients in the treatment group were removed or shed off and 5 patients in the control group were removed or shed off, finally 56 patients in the treatment group and 55 patients in the control group were included for the statistical analysis.①Clinical efficacy: After treatment, the total clinical effective rate was 92.9% in the treatment group and 87.3% in the control group, and the efficacy of the treatment group was better than that of the control group(,P,<,0.05) .②Chinese medical syndrome efficacy: After treatment, the total effective rate on Chinese medical syndrome was 89.3% in the treatment group and 54.5% in the control group, and the efficacy of the treatment group was better than that of the control group(,P,<,0.01) .③Laboratory indexes: After treatment, the levels of 24 h UPro, UACR, NAG and RBP in both groups were significantly decreased compared with those before treatment(,P,<,0.05), the levels of α1-MG and β2-MG in the treatment group were also significantly decreased(,P,<,0.05), and the levels of 24 h UPro, NAG, RBP, α1-MG and β2-MG in the treatment group were lower than those in the control group(,P,<,0.05) .After treatment, the level of eGFR in the treatment group was significantly increased compared with that before treatment(,P,<,0.05), the level of Scr was significantly decreased compared with that before treatment(,P,<,0.05), and the level of Scr in the treatment group was lower than that in the control group(,P,<,0.05) .④Correlation analysis: The eGFR was negatively correlated with 24 h UPro, UACR, NAG and RBP.,Conclusion:,2,Xiaobai Decoction combined with conventional western medicine can effectively improve the clinical symptoms, reduce the level of urinary protein, improve the related indexes of renal tubular injury and delay the progress of renal function in treating CGN patients(CKD at stages 1-2) with syndrome of spleen and kidney qi deficiency and stagnant dampness-heat.
关键词
慢性肾小球肾炎消白方脾肾气虚、湿热瘀阻型蛋白尿中西医结合
Keywords
chronic glomerulonephritisXiaobai Decoctionsyndrome of spleen and kidney qi deficiency and stagnant dampness-heatproteinuriaintegrated traditional Chinese and western medicine
references
HRICIK D E，CHUNG-PARK M，SEDOR J R.Glomerulonephritis[J].N Engl J Med，1998，339(13)：888-899.
中国中西医结合学会肾脏疾病专业委员会.慢性肾衰竭中西医结合诊疗指南[J].中国中西医结合杂志，2015，35(9)：1029-1033.
CORESH J，HEERSPINK H J，SANG Y, et al.Change in albuminuria and subsequent risk of end-stage kidney disease: an individual participant-level consortium meta-analysis of observational studies[J].Lancet Diabetes Endocrinol，2019，7(2)：115-127.
王琛，郑平东，何立群.消白冲剂治疗气虚湿瘀型慢性肾炎60例[J].上海中医药杂志，2004，38(12)：8-10.
王海燕.肾脏病学[M].3版.北京：人民卫生出版社, 2008:937.
KDOQI.KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease[J].Am J Kidney Dis，2007，49(2 Suppl 2)：S12-S154.
郑筱萸.中药新药临床研究指导原则（试行）[M].北京：中国医药科技出版社, 2002:156-162.
刘俊，陈香美.蛋白尿加速肾小管损伤的作用机制[J].中华肾病研究电子杂志，2014，3(2)：38-42.
AMANO H，KOIKE K，HARUHARA K, et al.Time-averaged proteinuria during follow-up and renal prognosis in patients with biopsy-proven benign nephrosclerosis[J].Clin Exp Nephrol，2020，24(8)：688-695.
CARNEY E F.Endocytosis in the proximal tubule[J].Nat Rev Nephrol，2019，15(1)：2.
CHALMERS S A，GARCIA S J，REYNOLDS J A, et al.NF-κB signaling in myeloid cells mediates the pathogenesis of immune-mediated nephritis[J].J Autoimmun，2019，98：33-43.
TESCH G H，MA F Y，NIKOLIC-PATERSON D J.Targeting apoptosis signal-regulating kinase 1 in acute and chronic kidney disease[J].Anat Rec（Hoboken），2020，303(10)：2553-2560.
MOTOYOSHI Y，MATSUSAKA T，SAITO A, et al.Megalin contributes to the early injury of proximal tubule cells during nonselective proteinuria[J].Kidney Int，2008，74(10)：1262-1269.
叶进.叶景华辨治泌尿系病症经验采撷[J].上海中医药杂志，2018，52(11)：2-5.
焦剑.国医大师张大宁教授治疗慢性肾炎的经验[J].天津中医药，2016，33(6)：321-324.
刘辉，孙懿，姚英.肾小管损伤标志物检测对慢性肾脏病高危人群的意义及影响因素研究[J].临床肾脏病杂志，2019，19(9)：672-676.
0
浏览量
275
下载量
0
CSCD
6
CNKI被引量
- 网络PDF下载
- BibTeX下载
- Endnote下载
- RefMan 下载
- NoteExpress下载
- NoteFirst下载
关联资源
相关文章
相关作者
相关机构
- 技术支持由北京北大方正电子有限公司提供 京ICP备09064830号-19
京公网安备11010802024621 - 本系统建议在Chrome、 IE9+ 以上版本浏览器阅读本站内容，360浏览器请切换至极速模式
- Cookies帮助我们提供服务并提供个性化体验。使用本网站，即表示您同意我们使用Cookies
- 总访问量：10152 今日访问量：15