益气活血法治疗特发性局灶节段性肾小球硬化的临床研究
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摘要
目的:
通过使用益气活血中药对特发性局灶节段性肾小球硬化的治疗,探讨特发性局灶节段性肾小球硬化病理类型与中医辩证之间的联系。观察治疗前后临床症状的变化、血生化的改变,评价通脉口服液是否对FSGS类型的原发性慢性肾脏病存在保护作用,同时初步观察特发性局灶节段性肾小球硬化型肾病的中医证型分布,判断气虚血瘀型在FSGS中所占的比例。
方法:
1.本研究将30例经肾穿刺活检诊断为特发性局灶节段性肾小球硬化进行中医辩证分析,填写症候调查表,再给予益气活血作用的通脉口服液1支tid口服,疗程8周。
2.观察其治疗前的中医症候,判断气虚血瘀在FSGS患者中所占比例,同时填写治疗前后患者气虚血瘀积分,通过前后比较判断通脉口服液对于FSGS气虚血瘀证候的疗效。
3.检测治疗前后24h尿蛋白定量、尿畸形红细胞计数、血白蛋白、血红蛋白、血肌酐及血尿素氮、血胆固醇、甘油三脂、高密度脂蛋白、低密度脂蛋白及凝血功能、尿PDF。
结果:
1.本研究表明通过通脉口服液治疗后患者气虚血瘀积分较治疗前明显减少(P＜0.05),提示通过使用通脉口服液治疗可减轻特发性FSGS患者气虚血瘀的症状。
2.同时临床研究提示治疗后24小时尿蛋白定量水平较治疗前均明显下降(P＜0.05),提示通脉口服液可能对特发性FSGS患者有减轻蛋白尿的作用。而通脉口服液治疗前后尿畸形红细胞水平无明显差异,无证据提示通脉口服液可能对特发性FSGS患者有减轻血尿的作用。
3.治疗前后血白蛋白比较有显著差异,治疗后血白蛋白较前明显上升,提示通脉口服液对于FSGS患者有可能促进血白蛋白合成,但其作用也可能通过减轻蛋白尿来实现,其升高血白蛋白作用机制尚待进一步阐述。血红蛋白治疗前后比较无显著性差异(P＞0.05),提示通脉口服液在短期治疗期间对血红蛋白无明显影响,但临床数据分析,研究患者中有贫血仅仅为4人,约占研究病例的13%,而且皆为轻度贫血,故其对于其是否有改善贫血作用尚未能确定。两组血尿素氮及血肌酐治疗前后比较无显著性差异(P＞0.05)。通脉口服液治疗前后血尿素氮及血肌酐无明显差异,提示通脉口服液在短期治疗期间可能有保护肾功能作用。
4.通脉口服液治疗前后总胆固醇、高密度脂蛋白、低密度脂蛋白比较有显著差异,治疗后总胆固醇、低密度脂蛋白血液浓度较前明显下降,治疗前后高密度脂蛋白较前明显上升,甘油三酯治疗前后比较无显著性差异(P＞0.05)。本研究提示通脉口服液对于FSGS患者有调整脂质代谢作用,同时通过改善患者血脂异常,可能有保护肾功能作用。
5.通脉口服液治疗血PT、APTT浓度比较无明显差异,治疗后血Fg浓度及尿FDP浓度较前明显下降,提示通脉口服液对于FSGS患者凝血功能无明显作用(P＞0.05),对于血Fg浓度及尿FDP浓度有降低作用,提示通脉口服液有改善患者血液系统及肾脏高凝状态的作用
结论:
1.气虚血瘀证型存在于绝大部分FSGS患者之中。患者病程及患者治疗前气虚血瘀证候积分的相关性分析结果提示患者治疗前气虚血瘀证候积分与患者病程呈显著正相关。通脉口服液治疗后患者气虚血瘀积分较治疗前明显减少(P＜0.05),提示通过使用通脉口服液治疗可减轻特发性FSGS患者气虚血瘀的症状。
2.研究提示通脉口服液有减少FSGS患者蛋白尿作用,升高血白蛋白作用,改善血脂异常和肾脏及血液高凝状态作用,可能具有保护肾功能作用。
Objectives:
Through the treatment by Chinese herbs of supplementing Qi and activating blood Circulation of idiopathic focal segmental glomerular sclerosis(FSGS), to investigate of the Relationship between the Syndrome Patterns in TCM Differential Diagnostics and the pathological types of FSGS。Through the analysis of Clinical symptoms before and after the treatment the changes, biochemical changes in blood,we evaluated whether the oral liquid of Tongmai exists protective effect of FSGS primary types of chronic kidney disease。At the same time we have the initial observation of distribution of TCM syndromes for idiopathic focal segmental glomerulosclerosis,and judge Qi deficiency and blood stasis type of the proportion of FSGS。
Method:
1.In this study,30 cases of renal biopsy diagnosed as idiopathic FSGS in a dialectical analysis of TCM,symptom questionnaire filled out,and then given to the role of Tongmai of supplementing Qi and activating blood circulation a tid Oral Liquid,treatment Eight weeks.
2.Observe their symptoms before treatment,and judge qi deficiency and blood stasis type in the proportion of patients with FSGS。Then filled out before and after treatment in patients with the points of qi deficiency and blood stasis.
4.Testing before and after treatment 24 h urine protein,urinary malformed red blood cell count,blood albumin,hemoglobin,serum creatinine and blood urea nitrogen,blood cholesterol and triglyceride,high-density lipoprotein, LDL and coagulation,urine PDF.
Results:
1.The points of Qi deficiency and Blood stasis after treatment in patients with Tongmai Oral Solution than before significantly reduced(P＜0.05), prompt treatment through Tongmai Oral Solution reduce idiopathic FSGS patients with symptoms of Qi deficiency and blood stasis.
2.The study suggested that the quantitative of ptoteinuria in 24 hour were significantly decreased(P＜0.05)after the treatment than before,prompted the treatment Tongmai oral solution may be reduce proteinuria of idiopathic FSGS patients.Before and after the treatment of urinary malformed red blood cell count were no significant difference,there is no evidence prompted the treatment of Tongmai oral solution may be reduce idiopathic FSGS patients to the role of hematuria.
3.Serum albumin compared before and after treatment were significantly increased,suggesting that Tongmai oral solution for patients with FSGS may promote albumin synthesis,but its role may also be achieved by reducing proteinuria,Its increased serum albumin mechanism to be further elaborated. Hemoglobin before and after the treatment showed no significant difference (P＞0.05),prompted Tongmai oral solution in the short term treatment of hemoglobin no significant impact,but clinical data analysis,research in patients with anemia only for four people(13%),But were mild anemia,is whether its for its role in improving the anemia could not be ascertained. Two groups of blood urea nitrogen and serum creatinine before and after the treatment showed no significant difference(P＞0.05),suggesting that Tongmai oral solution in the short term treatment may protect kidney function.
4.After the treatment the cholesterol,low-density lipoprotein dropped significantly,and the high-density lipoprotein marked increase. triglycerides after the treatment showed no significant difference(P＞0.05). This study suggested that Tongmai oral solution for patients to adjust FSGS lipid metabolism,and by improving patients with abnormal blood lipids,may have the protection of kidney function.
5.There were no significant difference in the concentration of the blood PT and APTT between pre- and post- treatment,but significant difference in the concentration of blood Fg and urine FDP。It prompted that Tongmai oral solution improve hypercoagulability。
Conclusion:
1.Qi deficiency and blood stasis type existed in the majority of patients with FSGS.The points of Qi deficiency and Blood stasis before treatment further integration with the course was positively correlated.The points of Qi deficiency and Blood stasis after treatment in patients with Tongmai Oral Solution than before significantly reduced.
2.The research suggested that the treatment with Tongmai Oral Solution may be reduce proteinuria in patients with FSGS,elevated blood albumin,improved lipid disorders and kidney and blood hypercoagulability,may have the protection of kidney function.
通过使用益气活血中药对特发性局灶节段性肾小球硬化的治疗,探讨特发性局灶节段性肾小球硬化病理类型与中医辩证之间的联系。观察治疗前后临床症状的变化、血生化的改变,评价通脉口服液是否对FSGS类型的原发性慢性肾脏病存在保护作用,同时初步观察特发性局灶节段性肾小球硬化型肾病的中医证型分布,判断气虚血瘀型在FSGS中所占的比例。
方法:
1.本研究将30例经肾穿刺活检诊断为特发性局灶节段性肾小球硬化进行中医辩证分析,填写症候调查表,再给予益气活血作用的通脉口服液1支tid口服,疗程8周。
2.观察其治疗前的中医症候,判断气虚血瘀在FSGS患者中所占比例,同时填写治疗前后患者气虚血瘀积分,通过前后比较判断通脉口服液对于FSGS气虚血瘀证候的疗效。
3.检测治疗前后24h尿蛋白定量、尿畸形红细胞计数、血白蛋白、血红蛋白、血肌酐及血尿素氮、血胆固醇、甘油三脂、高密度脂蛋白、低密度脂蛋白及凝血功能、尿PDF。
结果:
1.本研究表明通过通脉口服液治疗后患者气虚血瘀积分较治疗前明显减少(P＜0.05),提示通过使用通脉口服液治疗可减轻特发性FSGS患者气虚血瘀的症状。
2.同时临床研究提示治疗后24小时尿蛋白定量水平较治疗前均明显下降(P＜0.05),提示通脉口服液可能对特发性FSGS患者有减轻蛋白尿的作用。而通脉口服液治疗前后尿畸形红细胞水平无明显差异,无证据提示通脉口服液可能对特发性FSGS患者有减轻血尿的作用。
3.治疗前后血白蛋白比较有显著差异,治疗后血白蛋白较前明显上升,提示通脉口服液对于FSGS患者有可能促进血白蛋白合成,但其作用也可能通过减轻蛋白尿来实现,其升高血白蛋白作用机制尚待进一步阐述。血红蛋白治疗前后比较无显著性差异(P＞0.05),提示通脉口服液在短期治疗期间对血红蛋白无明显影响,但临床数据分析,研究患者中有贫血仅仅为4人,约占研究病例的13%,而且皆为轻度贫血,故其对于其是否有改善贫血作用尚未能确定。两组血尿素氮及血肌酐治疗前后比较无显著性差异(P＞0.05)。通脉口服液治疗前后血尿素氮及血肌酐无明显差异,提示通脉口服液在短期治疗期间可能有保护肾功能作用。
4.通脉口服液治疗前后总胆固醇、高密度脂蛋白、低密度脂蛋白比较有显著差异,治疗后总胆固醇、低密度脂蛋白血液浓度较前明显下降,治疗前后高密度脂蛋白较前明显上升,甘油三酯治疗前后比较无显著性差异(P＞0.05)。本研究提示通脉口服液对于FSGS患者有调整脂质代谢作用,同时通过改善患者血脂异常,可能有保护肾功能作用。
5.通脉口服液治疗血PT、APTT浓度比较无明显差异,治疗后血Fg浓度及尿FDP浓度较前明显下降,提示通脉口服液对于FSGS患者凝血功能无明显作用(P＞0.05),对于血Fg浓度及尿FDP浓度有降低作用,提示通脉口服液有改善患者血液系统及肾脏高凝状态的作用
结论:
1.气虚血瘀证型存在于绝大部分FSGS患者之中。患者病程及患者治疗前气虚血瘀证候积分的相关性分析结果提示患者治疗前气虚血瘀证候积分与患者病程呈显著正相关。通脉口服液治疗后患者气虚血瘀积分较治疗前明显减少(P＜0.05),提示通过使用通脉口服液治疗可减轻特发性FSGS患者气虚血瘀的症状。
2.研究提示通脉口服液有减少FSGS患者蛋白尿作用,升高血白蛋白作用,改善血脂异常和肾脏及血液高凝状态作用,可能具有保护肾功能作用。
Objectives:
Through the treatment by Chinese herbs of supplementing Qi and activating blood Circulation of idiopathic focal segmental glomerular sclerosis(FSGS), to investigate of the Relationship between the Syndrome Patterns in TCM Differential Diagnostics and the pathological types of FSGS。Through the analysis of Clinical symptoms before and after the treatment the changes, biochemical changes in blood,we evaluated whether the oral liquid of Tongmai exists protective effect of FSGS primary types of chronic kidney disease。At the same time we have the initial observation of distribution of TCM syndromes for idiopathic focal segmental glomerulosclerosis,and judge Qi deficiency and blood stasis type of the proportion of FSGS。
Method:
1.In this study,30 cases of renal biopsy diagnosed as idiopathic FSGS in a dialectical analysis of TCM,symptom questionnaire filled out,and then given to the role of Tongmai of supplementing Qi and activating blood circulation a tid Oral Liquid,treatment Eight weeks.
2.Observe their symptoms before treatment,and judge qi deficiency and blood stasis type in the proportion of patients with FSGS。Then filled out before and after treatment in patients with the points of qi deficiency and blood stasis.
4.Testing before and after treatment 24 h urine protein,urinary malformed red blood cell count,blood albumin,hemoglobin,serum creatinine and blood urea nitrogen,blood cholesterol and triglyceride,high-density lipoprotein, LDL and coagulation,urine PDF.
Results:
1.The points of Qi deficiency and Blood stasis after treatment in patients with Tongmai Oral Solution than before significantly reduced(P＜0.05), prompt treatment through Tongmai Oral Solution reduce idiopathic FSGS patients with symptoms of Qi deficiency and blood stasis.
2.The study suggested that the quantitative of ptoteinuria in 24 hour were significantly decreased(P＜0.05)after the treatment than before,prompted the treatment Tongmai oral solution may be reduce proteinuria of idiopathic FSGS patients.Before and after the treatment of urinary malformed red blood cell count were no significant difference,there is no evidence prompted the treatment of Tongmai oral solution may be reduce idiopathic FSGS patients to the role of hematuria.
3.Serum albumin compared before and after treatment were significantly increased,suggesting that Tongmai oral solution for patients with FSGS may promote albumin synthesis,but its role may also be achieved by reducing proteinuria,Its increased serum albumin mechanism to be further elaborated. Hemoglobin before and after the treatment showed no significant difference (P＞0.05),prompted Tongmai oral solution in the short term treatment of hemoglobin no significant impact,but clinical data analysis,research in patients with anemia only for four people(13%),But were mild anemia,is whether its for its role in improving the anemia could not be ascertained. Two groups of blood urea nitrogen and serum creatinine before and after the treatment showed no significant difference(P＞0.05),suggesting that Tongmai oral solution in the short term treatment may protect kidney function.
4.After the treatment the cholesterol,low-density lipoprotein dropped significantly,and the high-density lipoprotein marked increase. triglycerides after the treatment showed no significant difference(P＞0.05). This study suggested that Tongmai oral solution for patients to adjust FSGS lipid metabolism,and by improving patients with abnormal blood lipids,may have the protection of kidney function.
5.There were no significant difference in the concentration of the blood PT and APTT between pre- and post- treatment,but significant difference in the concentration of blood Fg and urine FDP。It prompted that Tongmai oral solution improve hypercoagulability。
Conclusion:
1.Qi deficiency and blood stasis type existed in the majority of patients with FSGS.The points of Qi deficiency and Blood stasis before treatment further integration with the course was positively correlated.The points of Qi deficiency and Blood stasis after treatment in patients with Tongmai Oral Solution than before significantly reduced.
2.The research suggested that the treatment with Tongmai Oral Solution may be reduce proteinuria in patients with FSGS,elevated blood albumin,improved lipid disorders and kidney and blood hypercoagulability,may have the protection of kidney function.
引文
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