益肾活血利湿汤治疗慢性移植肾肾病的临床观察.doc

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1、益肾活血利湿汤治疗慢性移植肾肾病的临床观察作者：李夏玉,贺学林,陈江华,何强,王苏娅,黄洪锋【摘要】　　目的观察益肾活血利湿汤治疗慢性移植肾肾病（chronicallograftnephropathy，CAN）患者的疗效。方法选择CAN，且符合血肌酐（SCr）≥180μmol/L患者31例，分成治疗组（14例）与对照组（17例），对照组接受免疫抑制改良方案，治疗组接受益肾活血利湿汤联合免疫抑制改良方案，疗程均为6个月。结果治疗组治疗后6个月24h尿蛋白降低显著优于对照组（P＜0.05）；12个月随访结束后，治疗组S

2、Cr显著降低及肌酐清除率（CCr）水平显著升高；对照组SCr水平显著升高及CCr水平显著降低，两组疗程及随访结束时SCr及CCr比较差异均有显著性（P<0.05）。治疗组与对照组发生血清肌酐翻倍分别为1例与5例，对照组2例进入终末期肾病。结论与单用免疫抑制改良方案治疗比较，益肾活血利湿汤联合免疫抑制改良方案治疗CAN患者能更有效减少尿蛋白排泄，短期随访发现其似乎有更好的肾功能保护作用。【关键词】益肾活血利湿汤　免疫抑制方案　慢性移植肾肾病【Abstract】ObjectiveToobservetheeffec

3、tsoftraditionalChinesemedicine（TCM）ofYishenHuoxueLishi（YHL）decoctionintreatingpatientswithchronicallograftnephropathy（CAN）.MethodsAprospective,controlledtrialwasconductedin31patientswithCANandserumcreatinine（SCr）atleast180μmol/L,whowereassignedtotwogroups（14in

4、treatmentgroup,17incontrolgroup）treatedwithYHLdecoctioncombinedimprovedimmunosuppressiveprotocolandimprovedimmunosuppressiveprotocol.Thedurationoftherapyoftwogroupswas6months.ResultsThereweresignificantdifferencesbetweenthe2groupsindecreaseindailyproteinuriaat

5、theendof6monthsoftherapy（P＜0.05）.Attheendof12monthsfollow-up,meanSCrleveldecreasedandmeanCCrlevelincreasedintreatmentgroupandmeanSCrlevelincreasedandmeanCCrleveldecreasedincontrolgroup.ThedifferencesofmeanCCrlevelbetweenthe2groupsattheendoftherapyandfollow-upw

6、eresignificant.Doublingofbaselineserumcreatininewereseen1intreatmentgroupand5incontrolgroup.2patientsincontrolgroupcametoESRD.ConclusionTherapywithYHLdecoctioncombinedimprovedimmunosuppressiveprotocolseemstobemoreeffectivebyreducingexcretionofurinaryproteininp

7、atientswithchronicallograftnephropathy,andmorefavorablerenalfunctionpreservedincomparisonwithimprovedimmunosuppressiveprotocolbasedonshort-termfollow-up.4【Keywords】YishenHuoxueLishidecoction;immunosuppressivetreatmentprotocol;chronicallograftnephropathy慢性移植肾肾病

8、（chronicallograftnephropathy，CAN）是影响移植肾长期存活的重要因素，但是至今尚无有效的治疗方法，调整免疫抑制方案可能对慢性移植肾肾病有益，但由于CAN肾脏病变的慢性化突出，更应寻找能减少免疫抑制剂剂量而维持良好的移植肾功能的有效低毒措施，是当代器官移植界的热点和难点。许多学者试图寻求能防治CAN或减少免疫抑制药物用量的中医药疗法