祛瘀降浊法治疗慢性肾功能衰竭的临床研究
|
摘要
目的:观察在西医基础治疗上,予加味桂枝茯苓丸为主方随症加减,治疗血瘀湿浊型慢性肾衰的临床疗效,探讨中西医结合治疗本病的优势和可行性,为进一步改良及推广配方打下基础。
方法:本研究收集慢性肾衰患者符合中医血瘀湿浊型患者60例,并随机分为2组,试验组、对照组各30例。对照组予控制血压、升血红蛋白、纠正水电解质紊乱等西医基础治疗,试验组在西医基础治疗上加用加味桂枝茯苓丸,疗程为二个月。观察临床症状、体征及实验室检查指标的变化,并对症状及体征进行量化评分,作出疗效评价。
结果:加味桂枝茯苓丸治疗血瘀湿浊型慢性肾衰,总有效率试验组明显优于对照组, P<0.01,统计学差异显著;显效率试验组优于对照组,P<0.05,有统计学差异。加味桂枝茯苓丸在改善脾肾亏虚,血瘀湿浊型慢性肾衰竭的中医各证候方面、降低尿蛋白定量和提高血浆白蛋白水平方面以及对肌酐清除率、血肌酐、尿素氮、电解质、酸碱平衡的调节有明显作用,且安全性好,不良反应发生率低。
结论:加味桂枝茯苓丸配合西医基础治疗慢性肾衰血瘀湿浊型,能显著改善患者面色晦暗、腰痛、肢体困重、脘腹胀满等症状,从而显示出中西医结合治疗本病的优势,但是否有助于提高慢性肾衰缓解率有待大样本的进一步研究。
Objective: to observe the basic therapy in western medicine,grant guizhi poria cocos pill with add and subtract,give priority to party blood stasis syndrome treatment of chronic renal failure with wet chaotic,explore the clinical curative effect of combining traditional Chinese and western medicine treatment of the disease,the superiority and feasibility for further improvement and promotion formula to lay the foundation.
Methods: the study collect patients with chronic renal failure with wet chaotic TCM blood stasis,and 60 cases of patients were randomly divided into two groups, each group,the control group,30 cases. The control group to control blood pressure, litres of hemoglobin,drop proteinuria based therapy,such as western medicine group based in western medicine treatment combined with flavored guizhi poria cocos pills, treatment for two months. Observe clinical symptoms,signs and laboratory index changes,and symptoms and signs,make a grade quantitatively effect assessment.
Results: flavored guizhi poria cocos pill treatment and blood stasis wet chaotic, the total effective rate of chronic renal failure,apparently intellectual than in control group (53.33%),the treatment group compared with controls statistically significant (P < 0.01);Clinical control 6.70% 16.67%,better than control. Flavored guizhi poria cocos shot in the spleen and kidney deficiency,and improve blood stasis wet muddy type of chronic renal failure TCM every syndrome,lower urine protein quantitative and improving plasma albumin levels of creatinine clearance,and serum creatinine,blood urea nitrogen regulation have obvious therapy,and good safety and adverse reaction rate low.
Conclusion: flavored with western medicine foundation guizhi poria cocos pill treatment of chronic renal failure and blood stasis wet muddy type,can significantly improve patients' pale skin armor noontide,fault,the body is trapped heavy,wan abdominal distension full,and such clinical manifestations of this show the advantage of combining traditional Chinese and western medicine treatment,whether to help improve chronic renal failure remission rates further research needs to be large sample.
方法:本研究收集慢性肾衰患者符合中医血瘀湿浊型患者60例,并随机分为2组,试验组、对照组各30例。对照组予控制血压、升血红蛋白、纠正水电解质紊乱等西医基础治疗,试验组在西医基础治疗上加用加味桂枝茯苓丸,疗程为二个月。观察临床症状、体征及实验室检查指标的变化,并对症状及体征进行量化评分,作出疗效评价。
结果:加味桂枝茯苓丸治疗血瘀湿浊型慢性肾衰,总有效率试验组明显优于对照组, P<0.01,统计学差异显著;显效率试验组优于对照组,P<0.05,有统计学差异。加味桂枝茯苓丸在改善脾肾亏虚,血瘀湿浊型慢性肾衰竭的中医各证候方面、降低尿蛋白定量和提高血浆白蛋白水平方面以及对肌酐清除率、血肌酐、尿素氮、电解质、酸碱平衡的调节有明显作用,且安全性好,不良反应发生率低。
结论:加味桂枝茯苓丸配合西医基础治疗慢性肾衰血瘀湿浊型,能显著改善患者面色晦暗、腰痛、肢体困重、脘腹胀满等症状,从而显示出中西医结合治疗本病的优势,但是否有助于提高慢性肾衰缓解率有待大样本的进一步研究。
Objective: to observe the basic therapy in western medicine,grant guizhi poria cocos pill with add and subtract,give priority to party blood stasis syndrome treatment of chronic renal failure with wet chaotic,explore the clinical curative effect of combining traditional Chinese and western medicine treatment of the disease,the superiority and feasibility for further improvement and promotion formula to lay the foundation.
Methods: the study collect patients with chronic renal failure with wet chaotic TCM blood stasis,and 60 cases of patients were randomly divided into two groups, each group,the control group,30 cases. The control group to control blood pressure, litres of hemoglobin,drop proteinuria based therapy,such as western medicine group based in western medicine treatment combined with flavored guizhi poria cocos pills, treatment for two months. Observe clinical symptoms,signs and laboratory index changes,and symptoms and signs,make a grade quantitatively effect assessment.
Results: flavored guizhi poria cocos pill treatment and blood stasis wet chaotic, the total effective rate of chronic renal failure,apparently intellectual than in control group (53.33%),the treatment group compared with controls statistically significant (P < 0.01);Clinical control 6.70% 16.67%,better than control. Flavored guizhi poria cocos shot in the spleen and kidney deficiency,and improve blood stasis wet muddy type of chronic renal failure TCM every syndrome,lower urine protein quantitative and improving plasma albumin levels of creatinine clearance,and serum creatinine,blood urea nitrogen regulation have obvious therapy,and good safety and adverse reaction rate low.
Conclusion: flavored with western medicine foundation guizhi poria cocos pill treatment of chronic renal failure and blood stasis wet muddy type,can significantly improve patients' pale skin armor noontide,fault,the body is trapped heavy,wan abdominal distension full,and such clinical manifestations of this show the advantage of combining traditional Chinese and western medicine treatment,whether to help improve chronic renal failure remission rates further research needs to be large sample.
引文
[1]黎磊石,刘志红.中国肾脏病学:人民军医出版社,2008年8月.
[2] Couser WG,Shah S,Kopple J,et al.A call on action on world kidney day,8 March 2007.Kidney Int,2007,71:369-370.
[3]中华人民共和国国家标准中医临床诊疗术语证候部分.国家技术监督局,1997,03,04.
[4]郑筱英,任德权等.《中药新药临床研究指导原则》[M] .中国中医药科技出版社,2002年5月.
[5]中华人民共和国国家标准中医临床诊疗术语.国家中医药管理局科技教育司.
[6]李桂源,吴伟康,欧阳静萍.病理生理学[M],北京:人民卫生出版社,2010:421-422.
[7]郑平东.慢性肾衰竭病因病机与临证辨治[J] .上海中医院大学学报,2008,22(2):1-3.
[8]焦安钦,傅兴蓝.慢性肾衰竭的病机特点及治疗对策[J] .山东中医药大学学报,2001,25(2):90-92.
[9]傅文录主编.专科专病临床经验丛书·肾脏病,北京:人民卫生出版社,2006 :337.
[10]黄志华,张双善,汤宝玉等.陕西中医,1991,12(7):30.
[11]江德乐.实用中西医结台杂志.1990,3(5):29.
[12]张灵华.丹皮酚的药理临床研究进展[J].中国中西医结合杂志,1996,16(3):187—189.
[13]曹惠云.桂枝茯苓丸在日本的研究与应用[J].国外医学中医中药分册, 2003 25(2):78.
[14]张宏文,金玉.苦参碱对大鼠肾小球硬化早期防护作用的实验研究[J].中华儿科杂志,2004,42(80):739—740.
[15]李芳.桂枝茯苓丸加味治疗紫癜性肾炎34例[J] .辽宁中医药大学学报,2007,9(1):103.
[16]时振声.时氏中医肾脏病学.北京:中国医药科技出版社.1987. 825.
[17]何灵芝,李学铭.桂枝茯苓丸治疗糖尿病肾病肾功能不全20例[J] .浙江中西医结合杂志,2001,11(9):581.
[18]张金喜,林翠茹.大黄临床应用研究进展[J] .江苏中医药,2010,42(5):80-81.
[19]应汝炯,指导:沈惠风.大黄对慢性肾功能衰竭作用机理的研究进展[J] .云南中医学院学报,2006,29(4):51-54.
[20]杨俊伟,黎磊石.大黄对延缓慢性肾衰发展的实验究[J] .中华肾脏病杂志, 1993, 19(2):65.
[21]西冈五夫.大黄的生物活性及其成份[J] .国外医学中医药分册,1986,3(8):27.
[22]郑丰,黄宁昌,钱斌等.大黄抑制近端小管和髓袢升支粗段小管Na—K—ATP酶活性.肾脏病与透析肾移植杂志,1995,4 (4):307.
[23]黎磊石.中国的终末期肾病[J].肾脏病与透析肾移植杂志.1995,4(1) :18.
[24]大甫彦吉.大黄的药理药效[J].国外医学·中医中药分册.1992,14 (3):171.
[25]朱加明,刘志红,黄燕飞等.大黄酸对db/ db小鼠糖尿病肾病疗的观察[J].肾脏病与透析肾移植杂志.2002,11(1):3.
[26]吕兴年,李凤欣,钟起哲等.大黄醇提片治疗高脂血症68例观察[J].中西医结合杂志,1991,11(1):161.
[27]西冈五夫.大黄的生物活性及其成份[J].国外医学·中医药分册,1986,3(8):27.
[28]王丽英,张丽珍,鲁刚英.大黄药理作用研究进展.时珍国医国药, 2000,11(4) : 381.
[29]柯凌.大黄的药理及其在肾脏病中的运用[J].中国中西医结合肾病杂志, 2001, 2(6):347.
[30]赵建一.桂枝的药理研究及临床新用[J] .光明中医,2010,25(8):1546.
[31]孙伟.泄浊之品在慢性肾功能不全治疗中的应用[J] .江苏中医药,2007,37(7):7-8.
[1]叶任高.临床肾脏病学[M],北京:人民卫生出版社,1997:320
[2]史伟.慢性肾功能衰竭的中医治则与用药[J].江苏中医药,2007,39(7):1-2
[3]陈志强,荣晓琦.慢性肾功能衰竭的治法探讨[J] .河南中医,2002,22(1):17 - 18.
[4]姚源璋,片昌兴.慢性肾功能衰竭辨证规律探讨[J ] .中国中医药信息杂志,2003,10(4):71.
[5]张志明.慢性肾功能衰竭的中医药治疗[J] .江西中医学院学报,2004,16(6):15 - 16.
[6]沈庆法.慢性肾衰竭的中医药治疗作用[J] .上海中医药杂志,2006,40(9):37 - 38.
[7]卢立新,牛春涛.慢住肾衰竭诊治思路[J ] .山东中医杂志,2000,19(4):198 - 199.
[8]王永均.治疗慢性肾功能衰竭实践和体会[J] .浙江中医学院学报,2003,27(3):1 - 5.
[9]田耘.杜雨茂教授辨治慢性肾功能衰竭经验[J] .陕西中医学院学报(J),2000,23 4 :10.
[10]姜林芳,吕春玲.王法德辨治慢性肾功能不全经验[J ] .中国中医急症,2004,13(10):678.
[11]杜晓燕,王学玉.杏丁注射液治疗慢性肾功能不全的疗效观察[J] .中国医药论坛,2006,4(6):18 - 19.
[12]何学红,马进.肾康注射液治疗慢性肾功能衰竭临床实验疗效分析[J] .辽宁中医杂志,2004,31(7):579.
[13]张琳,杨洪涛,邢海涛.黄芪注射液穴位注射治疗慢性肾衰竭43例临床观察[J] .中国中西医结合肾病杂志, 2003, 4(12):720 - 721.
[14]叶任高.内科学[M],北京:人民卫生出版社,2002,5版:569
[15]王海燕.肾脏病学[M],北京:人民卫生出版社,1996,2版:1385.
[16]赵静,孙伟.影响慢性肾脏病2～3期的危险因素及治疗进展.中国中西医结合肾病杂志,2009,10(4):362.
[2] Couser WG,Shah S,Kopple J,et al.A call on action on world kidney day,8 March 2007.Kidney Int,2007,71:369-370.
[3]中华人民共和国国家标准中医临床诊疗术语证候部分.国家技术监督局,1997,03,04.
[4]郑筱英,任德权等.《中药新药临床研究指导原则》[M] .中国中医药科技出版社,2002年5月.
[5]中华人民共和国国家标准中医临床诊疗术语.国家中医药管理局科技教育司.
[6]李桂源,吴伟康,欧阳静萍.病理生理学[M],北京:人民卫生出版社,2010:421-422.
[7]郑平东.慢性肾衰竭病因病机与临证辨治[J] .上海中医院大学学报,2008,22(2):1-3.
[8]焦安钦,傅兴蓝.慢性肾衰竭的病机特点及治疗对策[J] .山东中医药大学学报,2001,25(2):90-92.
[9]傅文录主编.专科专病临床经验丛书·肾脏病,北京:人民卫生出版社,2006 :337.
[10]黄志华,张双善,汤宝玉等.陕西中医,1991,12(7):30.
[11]江德乐.实用中西医结台杂志.1990,3(5):29.
[12]张灵华.丹皮酚的药理临床研究进展[J].中国中西医结合杂志,1996,16(3):187—189.
[13]曹惠云.桂枝茯苓丸在日本的研究与应用[J].国外医学中医中药分册, 2003 25(2):78.
[14]张宏文,金玉.苦参碱对大鼠肾小球硬化早期防护作用的实验研究[J].中华儿科杂志,2004,42(80):739—740.
[15]李芳.桂枝茯苓丸加味治疗紫癜性肾炎34例[J] .辽宁中医药大学学报,2007,9(1):103.
[16]时振声.时氏中医肾脏病学.北京:中国医药科技出版社.1987. 825.
[17]何灵芝,李学铭.桂枝茯苓丸治疗糖尿病肾病肾功能不全20例[J] .浙江中西医结合杂志,2001,11(9):581.
[18]张金喜,林翠茹.大黄临床应用研究进展[J] .江苏中医药,2010,42(5):80-81.
[19]应汝炯,指导:沈惠风.大黄对慢性肾功能衰竭作用机理的研究进展[J] .云南中医学院学报,2006,29(4):51-54.
[20]杨俊伟,黎磊石.大黄对延缓慢性肾衰发展的实验究[J] .中华肾脏病杂志, 1993, 19(2):65.
[21]西冈五夫.大黄的生物活性及其成份[J] .国外医学中医药分册,1986,3(8):27.
[22]郑丰,黄宁昌,钱斌等.大黄抑制近端小管和髓袢升支粗段小管Na—K—ATP酶活性.肾脏病与透析肾移植杂志,1995,4 (4):307.
[23]黎磊石.中国的终末期肾病[J].肾脏病与透析肾移植杂志.1995,4(1) :18.
[24]大甫彦吉.大黄的药理药效[J].国外医学·中医中药分册.1992,14 (3):171.
[25]朱加明,刘志红,黄燕飞等.大黄酸对db/ db小鼠糖尿病肾病疗的观察[J].肾脏病与透析肾移植杂志.2002,11(1):3.
[26]吕兴年,李凤欣,钟起哲等.大黄醇提片治疗高脂血症68例观察[J].中西医结合杂志,1991,11(1):161.
[27]西冈五夫.大黄的生物活性及其成份[J].国外医学·中医药分册,1986,3(8):27.
[28]王丽英,张丽珍,鲁刚英.大黄药理作用研究进展.时珍国医国药, 2000,11(4) : 381.
[29]柯凌.大黄的药理及其在肾脏病中的运用[J].中国中西医结合肾病杂志, 2001, 2(6):347.
[30]赵建一.桂枝的药理研究及临床新用[J] .光明中医,2010,25(8):1546.
[31]孙伟.泄浊之品在慢性肾功能不全治疗中的应用[J] .江苏中医药,2007,37(7):7-8.
[1]叶任高.临床肾脏病学[M],北京:人民卫生出版社,1997:320
[2]史伟.慢性肾功能衰竭的中医治则与用药[J].江苏中医药,2007,39(7):1-2
[3]陈志强,荣晓琦.慢性肾功能衰竭的治法探讨[J] .河南中医,2002,22(1):17 - 18.
[4]姚源璋,片昌兴.慢性肾功能衰竭辨证规律探讨[J ] .中国中医药信息杂志,2003,10(4):71.
[5]张志明.慢性肾功能衰竭的中医药治疗[J] .江西中医学院学报,2004,16(6):15 - 16.
[6]沈庆法.慢性肾衰竭的中医药治疗作用[J] .上海中医药杂志,2006,40(9):37 - 38.
[7]卢立新,牛春涛.慢住肾衰竭诊治思路[J ] .山东中医杂志,2000,19(4):198 - 199.
[8]王永均.治疗慢性肾功能衰竭实践和体会[J] .浙江中医学院学报,2003,27(3):1 - 5.
[9]田耘.杜雨茂教授辨治慢性肾功能衰竭经验[J] .陕西中医学院学报(J),2000,23 4 :10.
[10]姜林芳,吕春玲.王法德辨治慢性肾功能不全经验[J ] .中国中医急症,2004,13(10):678.
[11]杜晓燕,王学玉.杏丁注射液治疗慢性肾功能不全的疗效观察[J] .中国医药论坛,2006,4(6):18 - 19.
[12]何学红,马进.肾康注射液治疗慢性肾功能衰竭临床实验疗效分析[J] .辽宁中医杂志,2004,31(7):579.
[13]张琳,杨洪涛,邢海涛.黄芪注射液穴位注射治疗慢性肾衰竭43例临床观察[J] .中国中西医结合肾病杂志, 2003, 4(12):720 - 721.
[14]叶任高.内科学[M],北京:人民卫生出版社,2002,5版:569
[15]王海燕.肾脏病学[M],北京:人民卫生出版社,1996,2版:1385.
[16]赵静,孙伟.影响慢性肾脏病2～3期的危险因素及治疗进展.中国中西医结合肾病杂志,2009,10(4):362.