商陆对肾病综合征水肿湿热证的临床治疗作用观察与分析
摘要
目的：本研究通过对两种剂量(常规剂量和小剂量)商陆治疗肾病综合征水肿湿热证的疗效、毒副作用及剂量与疗效相关性的观察,进行分析总结,为更好的继承和创新中医药事业做研究,以期更好的指导临床。
方法：本研究将30例肾病综合征水肿湿热证的患者随机分为常规剂量商陆(8-10g)组15例,小剂量商陆(4-6g)组15例,所有患者均在西医基础治疗上(不包括利尿剂)服用含不同剂量商陆的中药煎剂,疗程为7天,观察患者治疗前后24小时尿量、体重、水肿轻重程度、大便等变化情况。采用SPSS17.0统计软件包进行统计学处理,计量资料用(X±S)表示,组内比较用配对t检验,组间比较用独立样本t检验；计数资料用X2检验。P<0.05为有统计学意义。
结果：(1)常规剂量组总有效率46.7%,小剂量组总有效率60.0%,两组疗效无显著性差异。两组患者治疗前后其尿量、体重、水肿等疗效性指标经统计学分析亦无显著性差异。(2)两组均能有效改善患者的中医证候,但组间相比无统计学差异(P>0.05)。(3)两组病例治疗前后在安全性指标方面无显著性差异(P>0.05)。
结论：常规剂量及小剂量商陆合四妙散治疗肾病综合征水肿湿热证,均能有效改善患者临床症状、体征,但二组均未能体现明显的攻逐作用,常规剂量及小剂量商陆用于肾病综合征水肿湿热证基本是安全的。
Objetive:Observe the effects, side effect and dosages-effect relationship of two doses(conventional dose and small dose) Phytolacca therapy on Damp-heat of edema in nephritic syndrome, appraise to its validity and security, in order to guide the clinical treatment.
Methods:In this study,30example patients with nephritic syndrome edema damp-heat are divided into2groups, in the ratio of1:1,15patients with conventional dose and15patients with small dose. Treatment for7days. Observe the24-hour urine, body weight, feces, edema grade, side effect before and after treatment. The statistics were treated by statistical package SPSS17.0. Measurement datas were described with mean±standard deviation (X±S). The main measurement datas before and after treatment was compared with matched-pairs t-test. comparison between groups use independent sample-t-test. Enumeration data were chi-square tested and P<0.05for statistical significance.
Results:(1) The efficiency of conventional dose group is46.7%, the small dose60.0%. The two groups are no significant difference in efficacy.(2) In the two groups, the symptom score improved obviously, but have no significant differcnces(P>0.05).(3) The safety index before and after treatment have no significant difference both of the group (P>0.05).
Conclusion:Both of the treatment of conventional dose and small dose can improve clinical symptoms and physical signs, but no significant differences in purgation and diuresis. The conventional dose and small dose of Phytolacca in treatment of nephritic syndrome is safe.
方法：本研究将30例肾病综合征水肿湿热证的患者随机分为常规剂量商陆(8-10g)组15例,小剂量商陆(4-6g)组15例,所有患者均在西医基础治疗上(不包括利尿剂)服用含不同剂量商陆的中药煎剂,疗程为7天,观察患者治疗前后24小时尿量、体重、水肿轻重程度、大便等变化情况。采用SPSS17.0统计软件包进行统计学处理,计量资料用(X±S)表示,组内比较用配对t检验,组间比较用独立样本t检验；计数资料用X2检验。P<0.05为有统计学意义。
结果：(1)常规剂量组总有效率46.7%,小剂量组总有效率60.0%,两组疗效无显著性差异。两组患者治疗前后其尿量、体重、水肿等疗效性指标经统计学分析亦无显著性差异。(2)两组均能有效改善患者的中医证候,但组间相比无统计学差异(P>0.05)。(3)两组病例治疗前后在安全性指标方面无显著性差异(P>0.05)。
结论：常规剂量及小剂量商陆合四妙散治疗肾病综合征水肿湿热证,均能有效改善患者临床症状、体征,但二组均未能体现明显的攻逐作用,常规剂量及小剂量商陆用于肾病综合征水肿湿热证基本是安全的。
Objetive:Observe the effects, side effect and dosages-effect relationship of two doses(conventional dose and small dose) Phytolacca therapy on Damp-heat of edema in nephritic syndrome, appraise to its validity and security, in order to guide the clinical treatment.
Methods:In this study,30example patients with nephritic syndrome edema damp-heat are divided into2groups, in the ratio of1:1,15patients with conventional dose and15patients with small dose. Treatment for7days. Observe the24-hour urine, body weight, feces, edema grade, side effect before and after treatment. The statistics were treated by statistical package SPSS17.0. Measurement datas were described with mean±standard deviation (X±S). The main measurement datas before and after treatment was compared with matched-pairs t-test. comparison between groups use independent sample-t-test. Enumeration data were chi-square tested and P<0.05for statistical significance.
Results:(1) The efficiency of conventional dose group is46.7%, the small dose60.0%. The two groups are no significant difference in efficacy.(2) In the two groups, the symptom score improved obviously, but have no significant differcnces(P>0.05).(3) The safety index before and after treatment have no significant difference both of the group (P>0.05).
Conclusion:Both of the treatment of conventional dose and small dose can improve clinical symptoms and physical signs, but no significant differences in purgation and diuresis. The conventional dose and small dose of Phytolacca in treatment of nephritic syndrome is safe.
引文
[1]林启展,董金莉,潘碧琦,等.张琪教授治疗肾性水肿的经验[J].四川中医,2006,24(7)：1.
[2]张宁.董建华教授论治肾性水肿[J].新中医,1992(12)：17.
[3]陈以君.谈肾性水肿的中医治法[J].福建中医学院学报,1993,3(4)：210.
[4]侯宝华.“水肿方”治疗难治性肾病综合征临床观察[J].中国冶金工业医学杂志,2006,23(2)：258.
[5]聂莉芳.肾性水肿的中医辨治规律探讨[J].北京中医学院学报,1990,13(6)：26-27.
[6]吕静,庞立健.中医对肾性水肿的认识[J].吉林中医药,2008,28(2)：82-83.
[7]车德亚,陈新.水肿从肝论治探识[J].四川中医,2010,28(5)：33-35
[8]傅文录,喻争鸣主编.肾病名医秘验绝技[M].北京：人民军医出版社,2004,139-140.
[9]张小云,马红珍.《伤寒论》治疗肾性水肿九法[J].浙江中医药大学学报,2006,30(3)：229-230.
[10]李培旭,安艳秋.运用经方治疗肾病性水肿[J].辽宁中医学院学报,1999,1(1)：19-20.
[11]王永钧.肾性水肿证治八法[J].浙江中医学院学报,2004,28(2)：4-7.
[12]孙素贞.肾性水肿从肺治疗四法[J].中医药学报,1998,1-5.
[13]史建伟,马红献.辨证治疗慢性肾源性水肿[J].河北中医学院学报,1995,10(4)：11-13.
[14]干琳,张春崧.陈以平教授辨治肾病性水肿的基本法则[J].中国中西医结合肾脏病杂志,2010,11(3)：195-196.
[15]张艳枫,张宏伟,霍东增.从《内经》论肾性水肿的辨证论治[J].河北中医,2009,31(8)：1171.
[16]马柳玲.从五行学说浅议肾性水肿病的从肺脾肾论治[J].新中医,2010,42(2)：114-115.
[17]陈磊鑫.刘春莹主任医师治疗难治性肾性水肿经验[J].中国中医急症,2011,20(8)：1241-1242.
[18]孙红颖.妓莉芳教授辨治难治性肾病综合征水肿的临证经验[J].中国中西结合肾病杂志,2004,5(9)：499-500.
[19]陈延强,黄玉茵,肖敬.史伟辛开苦降法论治难治性肾病综合征水肿的经验[J].辽宁中医杂志,2009,36(6)：882-884.
[20]周洪彬.周灿文任医师诊治肾性水肿经验介绍[J].新中医,2008,40(3)：8-9.
[21]Rodriguez Iturbe B, Herrera Acosta J, Johnson R J. Interstitial inflammation, sodium retention, and the Pathogenesis of nphrotic edma:A unifying hypothesis[J]. Kidney International.2002,62:1379-1384.
[22]Sala C, Bedogna V, Gammaro L, et al. Central role of vasopressin in sodium/water retention in hypervolemic nephritic patients:A unifying hypothesis[J]. J Nephrol.2004,17:653-657.
[23]Deschenes G, Feraille E, Doucet A, Mechanisms of oedema in nephrotic syndrome:old theories and new ideas[J]. Nephrol Dial Transplant.2003,18(3):454-456.
[24]Camiei M. Molecular pathogenetic mechanisms of nephritic odema:progress in understanding[J]. Biomedicine & Pharmacotherapy,2005,59:215-223.
[25]费芸芸,吴永贵.肾病综合征水肿的发病机制及治疗研究进展[J].安徽医学,32(2)：220-222
[26]Deschenes G, Doucet A. Collecting duct (Na+/K+-ATPase) activity is correlated with urinary sodium excretion in rat nephrotic syndromes[J]. J Am Soc Nephrol.2000,11(6):604-615.
[27]Zacchia M, Trepiccione F, Morelli F, et al. Nephrotic syndrome:new concepts in the pathophysiology of sodium retention[J]. J Nephrol.2008,21(6):836-842.
[28]Camici M, Molecular pathogenetic mechanisms of nephritic edema:progress in understanding[J]. Biomed Pharmacother.2005,59(5):215-223.
[29]王秋艳,杨玉秀.内皮素、降钙基因相光肽与原发性肾病综合征关系探讨[J].中国医科大学学报,2000,29(1)：66-67.
[30]柳继兴,宋霞,李桂英,等.肾病综合征患者血浆AVP及尿液AQP2水平观察[J].解放军预防医学杂志,2009,27(3)：223.
[31]易著文.肾性水肿的利尿剂治疗[J].儿科药学杂志,2010,16(6)：1-3.
[32]Elwell R J, Spencer A P, Eisele G. Combined furosemide and human albumin treatment for diuretic-resistant edema[J]. Ann Pharmacother,2003,37:695-700.
[33]钟旭辉,黄建萍.肾病综合征患儿水肿发生机制及治疗[J].临床儿科杂志.2007,25(4)：251-254.
[34]杨宝峰.药理学[M].北京：人民卫生出版,2006：235-242.
[35]Gaurav K., Rudolph P, Abubakr A, et al. Treatment of severe edema in children with nephrotic syndrome with diuretics alone-a prospective study[J], Clin J Am Soc Nephrol.2009,4:907-913.
[36]Bernheim J. Efficacy of intravenous albumin administration in hypoalbuminemic patients:Why and when [J]. J Israel Medical Association,2005,7(2):113-115.
[37]Rego F E, Casoni W. The effect of albumin and furosemide administration in children with primary nephrotic syndrome (author's transl)[J]. Rev Bras Pesqui Med Biol,1977,10(5):299-304
[38]Rajmohan D, Pankaj H, Arvind B. Randomized cross-over trial comparing albumin and frusemide infusions in nephritic syndrome[J]. Pediatr Nephol.2009.24:775-782.
[39]Tsukada M, Shintome M, Matsui T, et al. Effects of recombinant human serum albumin on ascites in rats with puromycin aminonucleoside-induced nephropathy[J]. Gen Pharmacol,1998,31(2):209-214.
[40]Anil V, Mukta M, Arvind B. Management of Edema in Nephrotic Syndrome [J]. Indian Pediatrics,2004, 41:787-795.
[41]Fliser D, Zurbruggen I, Mutschler E, et al. Coadministralion of albumin and furosemide in patients with the nephritic syndrome[J]. Kidney hit,1999,55:629-634.
[42]张道有,叶任高,李幼姬,等.静注人体白蛋白对肾病综合征的不利影响[J].中华肾脏杂志,1996,12(3)：144-146.
[43]刘罗进,梁开,李爱玲,等.低分子右旋糖酐加速尿对肾病综合者利尿作用与高凝状态的影响[J].广东医学院学报,2003,21(3)：230-234.
[44]张曦,赵从禄,朱永平,等.200例肾病综合征并严重水肿中患者的治疗探讨[J].大理医学院学报,1999,8(2)：17-18.
[45]Klepikov P V, Tsogtboiar D, Ennolenko V M, Milovanor IuS. Use of isolated ultrafiltration in nephritic edema resistant to diuretics[J]. TerArkh,1989,61(6):94-96.
[46]Otasubo S, Akiba T. Thetreatlnentofrefraetoryedema[J]. Nippon Rinsho,2005,63(1):140-143.
[47]贾金萍,秦雪梅,李青山.商陆化学成分和药理作用的研究进展[J].山西医科大学学报,2003,34(1)：89.
[48]赵一,等.炮制对商陆毒性和药效的影响[J].中国中药杂志,1991,16：467.
[49]查文清,王孝涛,原思通.直序商陆炮制品毒性成分测定[J].安徽中医学院学报,2000,19(4)：56-58.
[2]张宁.董建华教授论治肾性水肿[J].新中医,1992(12)：17.
[3]陈以君.谈肾性水肿的中医治法[J].福建中医学院学报,1993,3(4)：210.
[4]侯宝华.“水肿方”治疗难治性肾病综合征临床观察[J].中国冶金工业医学杂志,2006,23(2)：258.
[5]聂莉芳.肾性水肿的中医辨治规律探讨[J].北京中医学院学报,1990,13(6)：26-27.
[6]吕静,庞立健.中医对肾性水肿的认识[J].吉林中医药,2008,28(2)：82-83.
[7]车德亚,陈新.水肿从肝论治探识[J].四川中医,2010,28(5)：33-35
[8]傅文录,喻争鸣主编.肾病名医秘验绝技[M].北京：人民军医出版社,2004,139-140.
[9]张小云,马红珍.《伤寒论》治疗肾性水肿九法[J].浙江中医药大学学报,2006,30(3)：229-230.
[10]李培旭,安艳秋.运用经方治疗肾病性水肿[J].辽宁中医学院学报,1999,1(1)：19-20.
[11]王永钧.肾性水肿证治八法[J].浙江中医学院学报,2004,28(2)：4-7.
[12]孙素贞.肾性水肿从肺治疗四法[J].中医药学报,1998,1-5.
[13]史建伟,马红献.辨证治疗慢性肾源性水肿[J].河北中医学院学报,1995,10(4)：11-13.
[14]干琳,张春崧.陈以平教授辨治肾病性水肿的基本法则[J].中国中西医结合肾脏病杂志,2010,11(3)：195-196.
[15]张艳枫,张宏伟,霍东增.从《内经》论肾性水肿的辨证论治[J].河北中医,2009,31(8)：1171.
[16]马柳玲.从五行学说浅议肾性水肿病的从肺脾肾论治[J].新中医,2010,42(2)：114-115.
[17]陈磊鑫.刘春莹主任医师治疗难治性肾性水肿经验[J].中国中医急症,2011,20(8)：1241-1242.
[18]孙红颖.妓莉芳教授辨治难治性肾病综合征水肿的临证经验[J].中国中西结合肾病杂志,2004,5(9)：499-500.
[19]陈延强,黄玉茵,肖敬.史伟辛开苦降法论治难治性肾病综合征水肿的经验[J].辽宁中医杂志,2009,36(6)：882-884.
[20]周洪彬.周灿文任医师诊治肾性水肿经验介绍[J].新中医,2008,40(3)：8-9.
[21]Rodriguez Iturbe B, Herrera Acosta J, Johnson R J. Interstitial inflammation, sodium retention, and the Pathogenesis of nphrotic edma:A unifying hypothesis[J]. Kidney International.2002,62:1379-1384.
[22]Sala C, Bedogna V, Gammaro L, et al. Central role of vasopressin in sodium/water retention in hypervolemic nephritic patients:A unifying hypothesis[J]. J Nephrol.2004,17:653-657.
[23]Deschenes G, Feraille E, Doucet A, Mechanisms of oedema in nephrotic syndrome:old theories and new ideas[J]. Nephrol Dial Transplant.2003,18(3):454-456.
[24]Camiei M. Molecular pathogenetic mechanisms of nephritic odema:progress in understanding[J]. Biomedicine & Pharmacotherapy,2005,59:215-223.
[25]费芸芸,吴永贵.肾病综合征水肿的发病机制及治疗研究进展[J].安徽医学,32(2)：220-222
[26]Deschenes G, Doucet A. Collecting duct (Na+/K+-ATPase) activity is correlated with urinary sodium excretion in rat nephrotic syndromes[J]. J Am Soc Nephrol.2000,11(6):604-615.
[27]Zacchia M, Trepiccione F, Morelli F, et al. Nephrotic syndrome:new concepts in the pathophysiology of sodium retention[J]. J Nephrol.2008,21(6):836-842.
[28]Camici M, Molecular pathogenetic mechanisms of nephritic edema:progress in understanding[J]. Biomed Pharmacother.2005,59(5):215-223.
[29]王秋艳,杨玉秀.内皮素、降钙基因相光肽与原发性肾病综合征关系探讨[J].中国医科大学学报,2000,29(1)：66-67.
[30]柳继兴,宋霞,李桂英,等.肾病综合征患者血浆AVP及尿液AQP2水平观察[J].解放军预防医学杂志,2009,27(3)：223.
[31]易著文.肾性水肿的利尿剂治疗[J].儿科药学杂志,2010,16(6)：1-3.
[32]Elwell R J, Spencer A P, Eisele G. Combined furosemide and human albumin treatment for diuretic-resistant edema[J]. Ann Pharmacother,2003,37:695-700.
[33]钟旭辉,黄建萍.肾病综合征患儿水肿发生机制及治疗[J].临床儿科杂志.2007,25(4)：251-254.
[34]杨宝峰.药理学[M].北京：人民卫生出版,2006：235-242.
[35]Gaurav K., Rudolph P, Abubakr A, et al. Treatment of severe edema in children with nephrotic syndrome with diuretics alone-a prospective study[J], Clin J Am Soc Nephrol.2009,4:907-913.
[36]Bernheim J. Efficacy of intravenous albumin administration in hypoalbuminemic patients:Why and when [J]. J Israel Medical Association,2005,7(2):113-115.
[37]Rego F E, Casoni W. The effect of albumin and furosemide administration in children with primary nephrotic syndrome (author's transl)[J]. Rev Bras Pesqui Med Biol,1977,10(5):299-304
[38]Rajmohan D, Pankaj H, Arvind B. Randomized cross-over trial comparing albumin and frusemide infusions in nephritic syndrome[J]. Pediatr Nephol.2009.24:775-782.
[39]Tsukada M, Shintome M, Matsui T, et al. Effects of recombinant human serum albumin on ascites in rats with puromycin aminonucleoside-induced nephropathy[J]. Gen Pharmacol,1998,31(2):209-214.
[40]Anil V, Mukta M, Arvind B. Management of Edema in Nephrotic Syndrome [J]. Indian Pediatrics,2004, 41:787-795.
[41]Fliser D, Zurbruggen I, Mutschler E, et al. Coadministralion of albumin and furosemide in patients with the nephritic syndrome[J]. Kidney hit,1999,55:629-634.
[42]张道有,叶任高,李幼姬,等.静注人体白蛋白对肾病综合征的不利影响[J].中华肾脏杂志,1996,12(3)：144-146.
[43]刘罗进,梁开,李爱玲,等.低分子右旋糖酐加速尿对肾病综合者利尿作用与高凝状态的影响[J].广东医学院学报,2003,21(3)：230-234.
[44]张曦,赵从禄,朱永平,等.200例肾病综合征并严重水肿中患者的治疗探讨[J].大理医学院学报,1999,8(2)：17-18.
[45]Klepikov P V, Tsogtboiar D, Ennolenko V M, Milovanor IuS. Use of isolated ultrafiltration in nephritic edema resistant to diuretics[J]. TerArkh,1989,61(6):94-96.
[46]Otasubo S, Akiba T. Thetreatlnentofrefraetoryedema[J]. Nippon Rinsho,2005,63(1):140-143.
[47]贾金萍,秦雪梅,李青山.商陆化学成分和药理作用的研究进展[J].山西医科大学学报,2003,34(1)：89.
[48]赵一,等.炮制对商陆毒性和药效的影响[J].中国中药杂志,1991,16：467.
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