益气活血,通络消癥法治疗原发性膜性肾病的临床研究

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1、提要目的：观察以益气活血、通络消癥为原则，用经验组方益气通络饮治疗原发性膜性肾病（IMN）的临床疗效，进一步探讨IMN从“肾络癥瘕”论治，寻找一种适合大多数IMN患者的系列方药。方法：将符合标准的56例患者（经肾活检并结合临床诊断为原发性膜性肾病的患者，尿蛋白定量＞3.5g/d）按就诊顺序分为对照组（单数）28例、试验组（双数）28例。对照组以雷公藤多苷片治疗；试验组在上述治疗基础上加用经验组方益气通络饮，观察比较两组治疗3个月、6个月后的各疗效指标。结果：共有49例患者完成6个月观察，其中对照组25例，试验组24例。（1）疗效指标组内比较：治疗3个月、6

2、个月后两组24小时尿蛋白定量、胆固醇、甘油三酯均较前下降(P<0.05)，血浆白蛋白较前升高(P<0.05)，其中两组6个月后的疗效均较3个月时显著(P<0.05)。血清肌酐治疗3个月、6个月后均保持稳定，与治疗前比较无明显变化(P>0.05)。（2）疗效指标组间比较：治疗3个月、6个月后试验组24小时尿蛋白定量、胆固醇、甘油三酯、血浆白蛋白等指标明显优于对照组(P<0.05)，血清肌酐两组间无明显差异(P>0.05)。（3）总有效率比较：治疗3个月，对照组总有效率64%，试验组总有效率75%；治疗6个月对照组总有效率72%，试验组总有效率87.5%。试验

3、组均明显高于对照组(P<0.05)。结论：益气通络饮可以显著降低患者的尿蛋白，提高患者血浆白蛋白水平，可降低血胆固醇、甘油三酯，能保持肾功能的稳定，且患者耐受好，无明显不良反应，值得临床推广。关键词原发性膜性肾病；益气通络饮；肾络；癥瘕ClinicalStudyontreatingidiopathicmembranousnephropathywithmethodsoftonifyingqiinvigoratethecirculationofblood,dredgecollateralsanddissipationagglomerateSpeciality:

4、ThestudyofKidneyDiseases.InternalMedicineofTCMAuther:GaoZhiqiangTutor:ProfessorGuoZhaoanAbstractObjective:Toobservetheclinicaleffectoftreatingidiopathicmembranousnephr-opathy(IMN)withthemethodsoftonifyingqiinvigoratethecirculationofblood,dredgecollateralsanddissipationagglomerate,

5、anddisscussthenextcureofIMNfromkidneycollateralandabdominalmass,lookingforoneprescriptionsuitableformostpeople.Methods:Fifty-sixcasesofbiopsy-provenIMNwereenrolledinthistrial,withproteinuria＞3.5g/d.Theyweredividedintwogroupsinchronological：experimentalgroupandcontrolgroup.Thecontr

6、olgroupweretreatedwithtripterygiumwilfordiwhiletheexperimentalgroupweretreatedwithtripterygiumwilfordiandYi-qi-tong-luodecoction.Theywouldhaveacomparebetweenthetwogroupsfor3months,6monthsaftertheeffectoftheindicators.Results:Forty-ninepatientscompleted6monthsobservation,including2

7、5casesofcontrolgroupand24casesofexperimentalgroup.(1)Comparebytwogroupsofoneselves:After3and6months,24hoururinaryproteinquantityandtotalcholesterolandtriglyceridedecreasedandalbuminincreasedinthetwogroups(P＜0.05).Thecurativeeffectaftersixmonthswerebetterthanthethreemonths(P＞0.05),

8、andtherewasnodifferenceincreatini