张琪教授治疗慢性肾衰竭辨治规律及疗效评价的研究
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摘要
本研究通过回顾性及前瞻性的临床研究,采用循证医学及流行病学方法,总结著名中医临床家张琪教授治疗慢性肾衰竭(CRF)的辨治规律,并进行客观疗效评价,在此基础上全面总结其学术思想。
通过回顾分析100例CRF患者病例,总结了导师张琪教授治疗CRF的主要证型、治法、方药,并研究了中医证型与CRF临床分期的相关性。研究结果表明,脾肾两虚、湿毒内蕴、血络瘀阻、正虚邪实、虚实夹杂为CRF病机演变的基本特征。CRF的本虚证主要包括脾肾气虚证、脾肾阳虚证、气阴两虚证、肝肾阴虚证、阴阳两虚证,标实证主要包括血瘀证、湿热证、湿浊证、水湿证,风动证及风燥证。肾功能不全代偿期以脾肾气虚证为主,肾功能不全失代偿期以脾肾阳虚证、气阴两虚证、阴阳两虚证为主,肾功能衰竭期以阴阳两虚证及脾肾阳虚证为主。在CRF临床分期各阶段均可兼见血瘀证、湿热证、湿浊证、水湿证,风动证及风燥证多见于肾功能衰竭期。补脾肾、泄湿浊、活血解毒,是其基本的治则治法,其代表方剂包括参芪地黄汤、真武汤、归芍六君子汤、杞菊地黄丸、地黄饮子、五苓散、温胆汤、化浊饮、加味甘露饮、解毒活血汤等,并根据标本缓急遣方用药。
通过对61例CRF患者进行前瞻性研究,观察了CRF中医证型与BUN、Scr、尿蛋白定量、血清钙磷、RBC、Hb及血管活性物质ET、Ang-Ⅱ、NO、6-Keto-PGF_(1α)各客观指标的相关性,及中医辨证治疗的客观疗效。结果表明,脾肾气虚证BUN、Scr、尿蛋白定量升高水平与RBC、Hb降低水平及钙磷代谢异常程度最低,阴阳两虚证BUN、Scr、尿蛋白定量升高水平与RBC、Hb降低水平及钙磷代谢异常程度最高。CRF时血管活性物质ET、Ang-Ⅱ明显升高,NO、6-Keto-PGF_(1α)水平明显降低,并与中医证型具有一定的相关性。其中脾肾气虚证ET、Ang-Ⅱ升高水平与NO、6-Keto-PGF_(1α)降低水平最低;阴阳两虚证ET、Ang-Ⅱ升高水平与NO、6-Keto-PGF_(1α)降低水平最为显著。因此,通过CRF
Through retrospective and prospective clinical study by the method of evidence-based medicine and epidemiology,the researcher summarized the treatment rules based on syndrome differentiation of Professor Zhang Qi on teating chronic renal failure(CRF), made an objective evaluation of therapeutic efficiency and summarized his academic thought.Through the retrospective study on 100 CRF cases,the researcher summarized the syndrome types,therapeutic methods and prescriptions of Professor Zhang Qi on teating CRF,and researched the relation between syndrome types and clinical phases of renal failure.The results show that the basic characteristic of CRF mechanism development is hypofunction of spleen and kidney,accumulation of noxious damp,blood stasis in superficial venules,deficiency of genuine qi and excess of pathogenic factor,deficiency complicated with excess.Deficiency syndrome as primary include deficiency of spleen-qi and kidney-qi, deficiency of spleen-yang and kidney-yang, deficiency of both qi and yin, deficiency of liver-yin and kiney-yin, deficiency of both yin and yang.Excess syndrome as secondary include blood stasis,damp-heat,damp,fluid and damp,wind srirring,wind-dryness.The compensatory phase of renal insufficiency is major in deficiency of spleen-qi and kidney-qi syndrome.The decompensatory phase of renal insufficiency is major in deficiency of spleen-yang and kidney-yang syndrome, deficiency of both qi and yin syndrome, deficiency of both yin and yang syndrome. The phase of renal failure is major in yin and yang syndrome, deficiency of spleen-yang and kidney-yang syndrome. Blood stasis,damp-heat,damp,fluid and damp can appear in any phase of renal failure. Wind srirring and wind-dryness mainly appear in phase of renal failure.The basic
therapeutic method on CRF is tonifying spleen and kidney,purging damp,promoting blood circulation to remove blood stasis.The representative prescriptions include Shenqi Dihuang Tang,Zhenwu Tang,Guishao Liujunzi Tang,Qiju Dihuang Wan,Dihuang Yinzi,Wuling San,Wendan Tang,Huazhuo Yin,Jiawei Ganlu Yinjiedu Huoxue Tang.Through prospective clinical study on 61 CRF patients, the researcher researched the relation between CRF syndrome types and blood urea nitrogen (BUN), serum creatinine (Scr),quantity of urinary protein,serum Ca and P,vaso-active substance such as endothelin (ET)> Angiotensin II (Ang-II ),nitric oxide (NO)> 6-Keto-PGFia , and made an objective evaluation of therapeutic efficiency.The results show that in the CRF patients of deficiency of spleen-qi and kidney-qi syndrome, elevation of BUN,Scr and quantity of urinary protein , loss of RBC,Hb and serum Ca and P metabolism abnormality is lowest. In the patients of deficiency of both yin and yang syndrome, elevation of BUN,Scr and quantity of urinary protein , loss of RBC,Hb and serum Ca and P metabolism abnormality is most obvious.The vaso-active substance ET , Ang-II of CRF patients obviously elevate,and NO,6-Keto-PGFia obviously descend. In the patients of deficiency of spleen-qi and kidney-qi syndrome, elevation of ET , Ang-II and loss of NO,6-Keto-PGFia is lowest,which in the patients of deficiency of both yin and yang syndrome is most obvious.So the relation between CRF syndrome types and objective indexes can provide objective basis for clinical treatment based on syndrome differentiation.The therapeutic efficiency of TCM treatment base on syndrome differentiation on CRF is exact,which can obviously improve the clinical syptoms and life qulity of CRF patients,the total effective rate amount to 80.33%.Moreover, it can obviously descend BUN,Scr of CRF patients,reduce quantity of urinary
protein,elevate RBC,Hb,adjust serum Ca and P metabolism abnormality,and it can also descend ET, Ang- II ,and elevate NO,6-Keto-PGFiaof patients,the improvement of which provide basis for objective evaluation of therapeutic efficiency.
通过回顾分析100例CRF患者病例,总结了导师张琪教授治疗CRF的主要证型、治法、方药,并研究了中医证型与CRF临床分期的相关性。研究结果表明,脾肾两虚、湿毒内蕴、血络瘀阻、正虚邪实、虚实夹杂为CRF病机演变的基本特征。CRF的本虚证主要包括脾肾气虚证、脾肾阳虚证、气阴两虚证、肝肾阴虚证、阴阳两虚证,标实证主要包括血瘀证、湿热证、湿浊证、水湿证,风动证及风燥证。肾功能不全代偿期以脾肾气虚证为主,肾功能不全失代偿期以脾肾阳虚证、气阴两虚证、阴阳两虚证为主,肾功能衰竭期以阴阳两虚证及脾肾阳虚证为主。在CRF临床分期各阶段均可兼见血瘀证、湿热证、湿浊证、水湿证,风动证及风燥证多见于肾功能衰竭期。补脾肾、泄湿浊、活血解毒,是其基本的治则治法,其代表方剂包括参芪地黄汤、真武汤、归芍六君子汤、杞菊地黄丸、地黄饮子、五苓散、温胆汤、化浊饮、加味甘露饮、解毒活血汤等,并根据标本缓急遣方用药。
通过对61例CRF患者进行前瞻性研究,观察了CRF中医证型与BUN、Scr、尿蛋白定量、血清钙磷、RBC、Hb及血管活性物质ET、Ang-Ⅱ、NO、6-Keto-PGF_(1α)各客观指标的相关性,及中医辨证治疗的客观疗效。结果表明,脾肾气虚证BUN、Scr、尿蛋白定量升高水平与RBC、Hb降低水平及钙磷代谢异常程度最低,阴阳两虚证BUN、Scr、尿蛋白定量升高水平与RBC、Hb降低水平及钙磷代谢异常程度最高。CRF时血管活性物质ET、Ang-Ⅱ明显升高,NO、6-Keto-PGF_(1α)水平明显降低,并与中医证型具有一定的相关性。其中脾肾气虚证ET、Ang-Ⅱ升高水平与NO、6-Keto-PGF_(1α)降低水平最低;阴阳两虚证ET、Ang-Ⅱ升高水平与NO、6-Keto-PGF_(1α)降低水平最为显著。因此,通过CRF
Through retrospective and prospective clinical study by the method of evidence-based medicine and epidemiology,the researcher summarized the treatment rules based on syndrome differentiation of Professor Zhang Qi on teating chronic renal failure(CRF), made an objective evaluation of therapeutic efficiency and summarized his academic thought.Through the retrospective study on 100 CRF cases,the researcher summarized the syndrome types,therapeutic methods and prescriptions of Professor Zhang Qi on teating CRF,and researched the relation between syndrome types and clinical phases of renal failure.The results show that the basic characteristic of CRF mechanism development is hypofunction of spleen and kidney,accumulation of noxious damp,blood stasis in superficial venules,deficiency of genuine qi and excess of pathogenic factor,deficiency complicated with excess.Deficiency syndrome as primary include deficiency of spleen-qi and kidney-qi, deficiency of spleen-yang and kidney-yang, deficiency of both qi and yin, deficiency of liver-yin and kiney-yin, deficiency of both yin and yang.Excess syndrome as secondary include blood stasis,damp-heat,damp,fluid and damp,wind srirring,wind-dryness.The compensatory phase of renal insufficiency is major in deficiency of spleen-qi and kidney-qi syndrome.The decompensatory phase of renal insufficiency is major in deficiency of spleen-yang and kidney-yang syndrome, deficiency of both qi and yin syndrome, deficiency of both yin and yang syndrome. The phase of renal failure is major in yin and yang syndrome, deficiency of spleen-yang and kidney-yang syndrome. Blood stasis,damp-heat,damp,fluid and damp can appear in any phase of renal failure. Wind srirring and wind-dryness mainly appear in phase of renal failure.The basic
therapeutic method on CRF is tonifying spleen and kidney,purging damp,promoting blood circulation to remove blood stasis.The representative prescriptions include Shenqi Dihuang Tang,Zhenwu Tang,Guishao Liujunzi Tang,Qiju Dihuang Wan,Dihuang Yinzi,Wuling San,Wendan Tang,Huazhuo Yin,Jiawei Ganlu Yinjiedu Huoxue Tang.Through prospective clinical study on 61 CRF patients, the researcher researched the relation between CRF syndrome types and blood urea nitrogen (BUN), serum creatinine (Scr),quantity of urinary protein,serum Ca and P,vaso-active substance such as endothelin (ET)> Angiotensin II (Ang-II ),nitric oxide (NO)> 6-Keto-PGFia , and made an objective evaluation of therapeutic efficiency.The results show that in the CRF patients of deficiency of spleen-qi and kidney-qi syndrome, elevation of BUN,Scr and quantity of urinary protein , loss of RBC,Hb and serum Ca and P metabolism abnormality is lowest. In the patients of deficiency of both yin and yang syndrome, elevation of BUN,Scr and quantity of urinary protein , loss of RBC,Hb and serum Ca and P metabolism abnormality is most obvious.The vaso-active substance ET , Ang-II of CRF patients obviously elevate,and NO,6-Keto-PGFia obviously descend. In the patients of deficiency of spleen-qi and kidney-qi syndrome, elevation of ET , Ang-II and loss of NO,6-Keto-PGFia is lowest,which in the patients of deficiency of both yin and yang syndrome is most obvious.So the relation between CRF syndrome types and objective indexes can provide objective basis for clinical treatment based on syndrome differentiation.The therapeutic efficiency of TCM treatment base on syndrome differentiation on CRF is exact,which can obviously improve the clinical syptoms and life qulity of CRF patients,the total effective rate amount to 80.33%.Moreover, it can obviously descend BUN,Scr of CRF patients,reduce quantity of urinary
protein,elevate RBC,Hb,adjust serum Ca and P metabolism abnormality,and it can also descend ET, Ang- II ,and elevate NO,6-Keto-PGFiaof patients,the improvement of which provide basis for objective evaluation of therapeutic efficiency.
引文
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