下瘀血汤治疗高血压性肾损害患者夜尿增多临床研究
|
摘要
背景
高血压性肾损害是指根据高血压的程度和持续时间,引起轻重不等的肾损害。高血压性肾损害由于各种原因导致血管活性物质平衡失调、肾小动脉硬化等,使肾血流动力学发生异常,肾小管缺血,其浓缩稀释功能发生障碍。早期主要表现为夜尿增多,低比重尿、低渗透压尿。肾小球内持续高压则会引起肾小球脏层上皮细胞损伤,基底膜通透性增加,引起持续性蛋白尿。中医认为高血压性肾损害病机为本虚标实,本虚主要为脾肾亏虚,标实主要为血瘀、痰湿等,其中肾脏局部脉络瘀阻为重要病机。高血压导致的肾损害病程较长,久病入络,肾脉局部瘀血阻滞,瘀血不利则水液不循常道,发为夜尿增多。下瘀血汤由大黄、桃仁、蛰虫三味药物组成,具有活血化瘀,通络散结功效。该研究通过下瘀血汤对高血压性肾损害患者夜尿增多的疗效观察,评价下瘀血汤治疗高血压性肾损害患者夜尿增多的作用,为高血压性肾损害夜尿增多患者提供更有效的治疗方法。
目的
证实下瘀血汤对高血压性肾损害患者夜尿增多具有减少作用,同时对中医症候具有缓解作用。
方法及结果
收集高血压性肾损害患者60例,随机分为两组,对照组给予西药降压及对症治疗,治疗组在此基础上给予下瘀血汤进行治疗。分析治疗前后夜尿次数,夜尿尿量,实验室指标(血肌酐、尿素氮、尿酸、肾早损、24小时尿蛋白定量)的变化,对治疗结果采用统计描述的方法分析。结果显示：治疗组与对照组的尿NAG酶及尿微量白蛋白均有明显的下降,组间无显著性差异。治疗组夜尿次数及夜尿增多有明显改善。治疗组中医证候学积分治疗前后也有显著性差异。
结论
高血压性肾损害患者早期主要临床表现为夜尿增多,中医辨证为肾络血瘀,下瘀血汤具有活血化瘀的作用,临床可缓解夜尿增多,改善实验室指标,对减轻肾脏损害,延缓慢性肾功能不全的发展有重要作用。
Background
Hypertensive renal damage is based on the extent and duration of hypertension, renal damage caused by varying severity. Hypertensive renal damage due to various causes imbalance of vasoactive substances, renal arteriosclerosis, so that the abnormal renal hemodynamics, renal ischemia, functional disorder in its concentrated dilution. Mainly for the early increase in nocturia, low specific gravity of urine, low urinary osmolality. Continued pressure caused by renal glomerular visceral epithelial cell injury, the basement membrane permeability, causing persistent proteinuria. Chinese medicine pathogenesis of hypertensive renal injury based virtual standard and chronic illness into the network, the local blood stasis renal vein, marking the most important fact is blood stasis. Congestion Liquid disadvantage is the unusual road, hair nocturia increased. Xiayuxue soup from the rhubarb, peach, Thoroughfare shamisen drug composition, with blood circulation effect. The clinical research study under the bleeding through the soup of the nocturnal hypertension in patients with renal impairment increased the efficacy, bleeding under evaluation in the treatment of hypertensive renal damage soup caused by nocturia increased the role of those who, for the increase in nocturnal blood pressure in patients with renal impairment to provide more effective treatment.
Objective
Tom confirmed that under the congestion on hypertensive renal damage in patients with nocturia increased with mitigation.
Methods and Results
Hypertensive patients with renal impairment to collect 60 cases were randomly divided into two groups, blood pressure and symptomatic treatment given to western medicine, the treatment group was given based on the decoction for treatment under the congestion. Analysis of indicators before and after treatment in each group changes, the survey method described by statistical analysis. The results showed that:the treatment group and control group, urinaryβ2-microglobulin were significantly decreased, more meaningful decline in the treatment group, treatment group, a significant improvement in nocturia increased.
Conclusions
Hypertensive renal damage in patients with early clinical manifestations of primary nocturnal increase in TCM as blood stasis, promoting blood circulation under the congestion has the role of Tom, can alleviate nocturia increased clinical, laboratory parameters improved, and reduce kidney damage, chronic delays the development of renal dysfunction plays an important role.
高血压性肾损害是指根据高血压的程度和持续时间,引起轻重不等的肾损害。高血压性肾损害由于各种原因导致血管活性物质平衡失调、肾小动脉硬化等,使肾血流动力学发生异常,肾小管缺血,其浓缩稀释功能发生障碍。早期主要表现为夜尿增多,低比重尿、低渗透压尿。肾小球内持续高压则会引起肾小球脏层上皮细胞损伤,基底膜通透性增加,引起持续性蛋白尿。中医认为高血压性肾损害病机为本虚标实,本虚主要为脾肾亏虚,标实主要为血瘀、痰湿等,其中肾脏局部脉络瘀阻为重要病机。高血压导致的肾损害病程较长,久病入络,肾脉局部瘀血阻滞,瘀血不利则水液不循常道,发为夜尿增多。下瘀血汤由大黄、桃仁、蛰虫三味药物组成,具有活血化瘀,通络散结功效。该研究通过下瘀血汤对高血压性肾损害患者夜尿增多的疗效观察,评价下瘀血汤治疗高血压性肾损害患者夜尿增多的作用,为高血压性肾损害夜尿增多患者提供更有效的治疗方法。
目的
证实下瘀血汤对高血压性肾损害患者夜尿增多具有减少作用,同时对中医症候具有缓解作用。
方法及结果
收集高血压性肾损害患者60例,随机分为两组,对照组给予西药降压及对症治疗,治疗组在此基础上给予下瘀血汤进行治疗。分析治疗前后夜尿次数,夜尿尿量,实验室指标(血肌酐、尿素氮、尿酸、肾早损、24小时尿蛋白定量)的变化,对治疗结果采用统计描述的方法分析。结果显示：治疗组与对照组的尿NAG酶及尿微量白蛋白均有明显的下降,组间无显著性差异。治疗组夜尿次数及夜尿增多有明显改善。治疗组中医证候学积分治疗前后也有显著性差异。
结论
高血压性肾损害患者早期主要临床表现为夜尿增多,中医辨证为肾络血瘀,下瘀血汤具有活血化瘀的作用,临床可缓解夜尿增多,改善实验室指标,对减轻肾脏损害,延缓慢性肾功能不全的发展有重要作用。
Background
Hypertensive renal damage is based on the extent and duration of hypertension, renal damage caused by varying severity. Hypertensive renal damage due to various causes imbalance of vasoactive substances, renal arteriosclerosis, so that the abnormal renal hemodynamics, renal ischemia, functional disorder in its concentrated dilution. Mainly for the early increase in nocturia, low specific gravity of urine, low urinary osmolality. Continued pressure caused by renal glomerular visceral epithelial cell injury, the basement membrane permeability, causing persistent proteinuria. Chinese medicine pathogenesis of hypertensive renal injury based virtual standard and chronic illness into the network, the local blood stasis renal vein, marking the most important fact is blood stasis. Congestion Liquid disadvantage is the unusual road, hair nocturia increased. Xiayuxue soup from the rhubarb, peach, Thoroughfare shamisen drug composition, with blood circulation effect. The clinical research study under the bleeding through the soup of the nocturnal hypertension in patients with renal impairment increased the efficacy, bleeding under evaluation in the treatment of hypertensive renal damage soup caused by nocturia increased the role of those who, for the increase in nocturnal blood pressure in patients with renal impairment to provide more effective treatment.
Objective
Tom confirmed that under the congestion on hypertensive renal damage in patients with nocturia increased with mitigation.
Methods and Results
Hypertensive patients with renal impairment to collect 60 cases were randomly divided into two groups, blood pressure and symptomatic treatment given to western medicine, the treatment group was given based on the decoction for treatment under the congestion. Analysis of indicators before and after treatment in each group changes, the survey method described by statistical analysis. The results showed that:the treatment group and control group, urinaryβ2-microglobulin were significantly decreased, more meaningful decline in the treatment group, treatment group, a significant improvement in nocturia increased.
Conclusions
Hypertensive renal damage in patients with early clinical manifestations of primary nocturnal increase in TCM as blood stasis, promoting blood circulation under the congestion has the role of Tom, can alleviate nocturia increased clinical, laboratory parameters improved, and reduce kidney damage, chronic delays the development of renal dysfunction plays an important role.
引文
[1]Collins AJ,Kasjiske B, Herzog C,et al.Exceprpts from the United states Renal Data System 2003 Annual Data Report:atlas of end-stage renal disease in the United States. Am J Kid Dis,2003,42:a5-7,S1-S230.
[2]周福德,王梅.北京市血液透析的发展与质量改进.中国血液净化杂志,2006,5：117-118.
[3]卫生部心血管防治中心.中国心血管病报告2005.中国大百科全书出版社,2006：84.
[4]Nissenson AR, PereiraBJ,Collions AJ,et al. Prevalence and characteristics of individuals with chronic kidney disease in a large health maintenance organization. Am J Kidney Dis,2001,37:1177-1183.
[5]郑法雷,章友康,陈香美,谌贻璞.肾脏病临床与进展.2005年,人民军医出版社,1(1)：99.
[6]Fogo A,Yoshida Y, et al.Serial micropucture analysis of the same nephrons in chronic renal disease:study in two rat modles of glomerular sclerosis. Kidney Int,1937,31:384A.
[7]Moorhead JF, Chan MK,et al. Lipid nephrotoricity in chronic progressive glomerular and tubulointerstitial disease.Lancet,1982,2:1309.
[8]Brenner BM, Meyer TW, et al. Dietary protein and the progressive nature of kidney disease; The role of hemodynamical ly mediated glomerular injury in the pathogens is of progressive glomerular sclerosis in aging, renal ablation,and intrinsic renal disease. N Engl J Med,1982,307:652.
[9]O' Donoghue DJ.What's new in renal disease?Medicine Int 1991,3508.
[10]郑剑卿,谢秀梅,余国龙.氯沙坦对老年轻、中度原发性高血压的肾脏保护作用[J].湖南医学,2000,17(6)：169-172.
[11]张守荣,顾依群等.二甲双胍对自发性高血压大白鼠靶器官病变的影响[J].高血压杂志,2000,7(2)：155-156.
[12]Coritsidis G,Neugarten J,et al.In vivo glomerular uptake of native and oxidized low density lipoprotein.Kidney Int,1990,37:501A.
[13]Gione E.Familial lecithin:Cholesterol acyltransferase deficiencya new metabolic disease with renal involo vement. Adv Nephrol,1981,10:167.
[14]Kas isk BL,O' Donnell MP,et al.Pharmacologic treatment of hyperlipidemia reduces glomerular injury in5/6 rat nephrectomy modle of chronic renal failure. Circul Res,1988,62:367.
[15]Diammond JR. Karnovsky M. Exacerbation of chronic aminonucleoside nephrosis by dietary cholesterol supplementation. Kidney Int,1987,32:671.
[16]赵林双,廖玉华,王敏,周子华,向光大,候洁,乐岭,徐琳.β1肾上腺素受体自身抗体在高血压性肾损害致病机制的初步探讨.中国医师进修杂志,2006,29(5)：11-13.
[17]US Renal Data System. Incidence and prevalence of ESRD. USRD 1999 Annual Data Report. In:Bethesda eds. USRDS 1999 Annual Data Report,1999:25-39.
[18]Walker WG, Neaton JD,Cutler JA,et al. Renal function change in hypertensive members of the Multiple Risk Factor Intervention Trial. Racial and treatment effects. The MRFIT Research Group. JAMA,1992,268:3085-3091.
[19]Hebert LA, Kusek JW, Greene T, Effects of blood pressure control on progressive renal disease in black and whites. Modification of Diet in Renal Disease Study Group. Hypertension,1997,30:428-435.
[20]Marcantoni C,Ma LJ, Federspiel C,et al.Hypertensive nephrosclerosis in African American verus Caucasians.Kidney In,2002,62:172-180.
[21]Brenner BM, Chertow GM. Congeni tal oligonephropathy and the etiology of adul t hypertension and progressive renal injury. Am J kidney Dis,1994,23:171-175.
[22]Singh GR, Hoy WE. Kidney volume, blood pressure,and albuminuria:finding in an Australian aboriginal community. Am J kidney Dis,2004,43:254-259.
[23]吴金秀.慢性肾功能不全失代偿期的可逆因素探讨[J].中国医学工程,2006,14(2)：219-220.
[24]王海燕.肾脏病学第三版.人民卫生出版社,2008,1665.
[25]王海燕.肾脏病学第二版.人民卫生出版社,2001,1144-1179.
[26]王飞.高血压早期肾损害的监测指标.心血管病研究进展.2009,30(1)：79-83.
[27]陈红梅,朱晖,张洁,季禹乔,孙明忠.尿微量蛋白测定在高血压早期肾损害中的作用.中国误诊学杂志,2007,7(22)：22.
[28]刘嘉芳,崔蒙,徐金英,钱钢,陈浩,汪世军,唐关敏.血清胱蛋白酶抑制剂C诊断老年高血压早期肾损害.高血压杂志.2005,13(11)：691-693.
[29]Coll E, Botey A, Alvarez L, et al. Serum cystatin C as new marker for noninvasive estimation of glomerular filtration rate and as a marker for early renal impairment[J]. Am J Kidney Dis,2000,36:29-34.
[30]伍松姣,陈耀宇.血、尿β2-MG检测在原发性高血压病患者早期肾损伤中的意义.广西中西学院学报.2007,10(3)：16-17.
[31]叶松道,陈晓晴,温怀凯.尿游离轻链测定对原发性高血压早期肾损害的诊断价值.浙江医学.2005,27(11)：803-805.
[32]彭旭,陈建辉,张联娜,林平.尿沉渣分析仪联合手工镜检诊断老年人高血压性肾损害.福建医药杂志.2006,28(6)：119-120.
[33]许红强,王金萍,常丽娜.肾叶间动脉阻力指数与原发性高血压早期肾损害的相关性.安徽中医学院学报.2006,25(4)：51-52.
[34]阳晓.慢性肾脏病进展的危险因素及延缓策略[J].中国实用内科杂志,2008,28(1)：79-80.
[35]付治卿,周聊生.高血压性肾损害机制的探讨.《临床荟萃》,2004,19(8)：469-471.
[36]沈汉超.高血压肾病诊治进展.《心脑血管病防治》,2002,2(2)：5-7.
[37]COOPERME. Pathogenesis, prevention, and treatment of diabetic nephropa-thy[J], Lancet.1998,352 (6):213-219.
[38]张正秀.206例慢性肾功能不全失代偿的可逆因素分析[J]. Chinese Journalof Practical Medicine,2008,28 (2):4.
[39]刘必成.延缓慢性肾脏病进展的现代策略[J].继续医学教育,2006,20(5)：63-65.
[40]田梅.苯那普利对原发性高血压患者肾功能的影响.遵义医学院报.2005,28(5)：432-434.
[41]余学清.高血压病肾损害的诊断与治疗.中国实用内科杂志,2006,26(5)：323-325.
[42]曲红玉,郭丽.厄贝沙坦治疗老年原发性高血压的疗效及对肾功能的影响.中国药学杂志.2006,41(13)：1034-1035.
[43]SASAMURAH. Prevention of hypertensive renal damage by prepuberta treatment with ARB[J]. Nippon Rinsho,2002,60(10):1962-1967.
[44]张盛霞,宋晓,赵东太.阿托伐他汀对高血压早期肾损害的作用.齐鲁医学杂志.2009,24(2)：117-118.
[45]TONOLO G,MELIS G M, FORMATO M, et al.Additive effects of simvastatin beyond its effects on LDL cholesterol in hypertensive type 2 diabetic patients[J].Eur J Clin Invest,2000,30:980-987.
[46]李萍,张海燕,刘国良等.阿托伐他汀对人肾小球系膜细胞增殖TGF-β1 mRNA和p38 MAPK表达的影响[J].中国组织化学与细胞化学杂志,2007,16(1)：57-61.
[47]张贺,韩子明,杨达胜.洛伐他汀对肾小球硬化大鼠纤溶酶原激活物抑制剂-1和Ⅳ型胶原表达的影响[J].实用儿科临床杂志,2007,22(5)：338-339.
[48]徐坤英.保肾康治疗高血压肾脏损害临床观察.中国现代医药杂志.2005,7(6)：75.
[49]鲁端.不同类型高血压的治疗策略.全科医学临床与教育.2009,7(2)：91-92.
[50]武卫东.中西医结合治疗慢性肾功能不全46例.吉林中医药,2006,26(12)：44-45.
[51]陈莉,刘英.中西医结合治疗慢性肾功能不全疗效观察.辽宁中医杂志,2006,33(7)：852-853.
[52]张饰,丁国华,王学玉.二羟基苯磺酸钙治疗慢性肾功能不全临床疗效观察.中国医师杂志,2006,8(5)：701.
[53]王海燕.肾脏病学第二版.人民卫生出版社,2001,1144.
[54]Von Kerrebuoeck P,Abrams P, Chaikin D, et al.The standardization of terminology in nocturia:report form the Standardisation Sub-Committee of the International Continence Society[J]. Neurourol Urodyn,2002,21:179-183.
[55]李昊.急性脑血管病致尿量增多相关因素的观察.临床研究,2008,46(12)：71-72.
[56]Hetta J.The impact of sleep deprivation caused by nocturia [J].Br J Urol Int,1999,84 (Suppl.1):27-28.
[57]Jamison SJ, Phillip CG,Daniel MS, et al.The need for voiding diaries in the evaluation of men with nocturia[J].JAOA,2002,102 (5):261-265.
[58]Ali A,Snape J.Nocturia in older people:a review of causes,consequences assessment and management[J]. Int J Clin Pract,2004,58 (4):366-373.
[59]Barker JP, Mitteness LS.Nocturia in the elderly [J].Gerontolgist,1998, 28:99-104.
[60]Ouslander JG, Johnson T,Nasr S,et al.ANP levels in geriatric patients with nocturia and nursing home residents with night time incontinence [J]. JAGS,1999, 147:1439-1444.
[61]Asplund R. Nocturia, Nocturnal Polyurin, and sleep qual ity in the elderly[J].J Psycho Res,2004,56:517-525.
[62]张亚群.老年前列腺增生症夜尿病因分类和相关因素分析.博士毕业论文,2008,24-29.
[63]黄明淑.硝苯地平引起尿量增多比重下降5例报告.黑龙江医学,2003,3(27)：238.
[64]张亚群.老年前列腺增生症夜尿病因分类和相关因素分析.博士毕业论文,2008,24-29.
[65]Jamison SJ,Phillip CG, Daniel MS,et al.The need for voiding diaries in the evaluation of men with nocturia [J]. JAOA,2002,102 (5):261-265.
[66]Lackner TE. Pharmacologic management of urinary incontinence[J].Am Long Term Care,2000,8:29-37.
[67]Spinelli M,Giardiello G,Gerber M,et al.New sacral neuromodulation lead for percutaneous implantation using local anesthesia:desciption and first experience[J]. J Urol,2003,170:1905-1907.
[1]叶任高.中西医结合肾脏病学.人民卫生出版社,2003,596.
[2]郭铁标,李侠等.加味防芪地黄汤治疗高血压性肾损害所致肾功能不全疗效观察.中国中医药信息杂志,2000,7(1)：49-50.
[3]程广书.高血压性肾损害的中医药治疗思路.河南中医,2001,21(1)：31.
[4]杨赶梅,夏娣文,佘江健等.芪蛭胶囊治疗高血压肾病肾功能不全20例临床观察.中国中医药科技,2002,9(4)：232-233.
[5]左琪.杨霓芝治疗良性小动脉性肾硬化经验.中医杂志,2004,45(6)：416-417.
[6]徐宏,关建国,赵先锋.滋阴潜阳活血法治疗高血压早期肾损害37例临床观察.辽宁中医杂志,2006,33(12)：1585.
[7]郭兆安.高血压性肾损害(肾衰竭期)湿浊内蕴证的临床研究.中国中西医结合肾病杂志,2007,8(11)：664-666.
[8]唐补生.从络病学说探讨高血压肾病.中国民族民间医药,2008,17(10)：31-32.
[9]王建平,胡顺金,姚淮芳,方琦等.补阳还五汤加味对高血压性肾损害的治疗作用.中医药临床杂志,2009,21(1)：12-13.
[10]左琪,杨霓芝.杨霓芝教授论治良性小动脉性肾硬化特色摭拾.中医药学报,2004,32(2)：8-9.
[11]王耀献,高菁.肾脏病中西医诊治.辽宁科学技术出版社,2005.374-385.
[13]张琪,朱建军,袁杰.保元灌肠液治疗高血压患者早期肾脏损害60例.南京中医药大学学报(自然科学版),2001,17(3)：189-190.
[14]杨赶梅,夏娣文,佘江健等.芪蛭胶囊治疗高血压肾病肾功能不全20例临床观察.中国中医药科技,2002,9(4)：232-233.
[15]姚纲炼,桂保松等.黄芪注射液对降低高血压性肾损害尿蛋白含量的作用.陕西医学杂志,2002,31(4)：341-342
[16]倪小玲,王砾等.黄芪治疗老年原发性高血压性肾损害疗效观察.中国医院药学杂志,2004,24(11)：700.
[17]汤归春,莫耘松,陈薇,鲁贵春等.黄芪对高血压病早期肾损害的保护作用,现代中西医结合杂志,2006,15(1)：26-27.
[18]吴学森,赵敏.黄芪注射液治疗原发性高血压肾脏损害疗效观察.基层医学论坛,2007,11(8)：717-718.
[19]曹阳.中药穴位注射治疗高血压性肾损害临床观察.中国针灸,2005,25(1)：21-23.
[20]孟伟.滋阴降火通络汤治疗高血压病早期肾损害的临床研究.山东中医药大学学报,27(5)：364-366.
[21]张天斗,李承禧.六位地黄丸对老年性高血压患者肾保护作用的临床研究.世界科学技术-中医药现代化,2006,8(2)：102-104.
[22]杨运清.天麻地黄饮降压及干预高血压病肾损害66例观察.陕西中医,2007,28(7)：835-837.
[23]王建彬,戴小华,杨帆,顾建霞,董梅,邵正斌,周宜轩.养肝益水颗粒对高血压病早期肾损害多重危险因素的影响.医学研究杂志,2008,37(9)：64-66.
[24]魏国健,钟培金,丘伟中.中西医结合治疗高血压病早期肾损害临床观察.现代医院,2006,6(3)：67-69.
[25]王令谆.中西医结合治疗原发性高血压病早期肾损害的临床观察.南京中医药大学学报,2005,21(6)：366-368.
[26]吴海峰,范丹阳,徐爱莲.中西医结合治疗老年人高血压病合并夜尿增多症105例.浙江中医杂志,2007,42(2)：88.
[27]徐巨海.夜尿增多是肾功能减退的早期信号.家庭医学,2003,5：22.
[28]王源声.中医治疗夜尿增多举隅.包头医学,2000,24(2)：30-31.
[29]陈明,龙子江,卞海,王靓,王雅娟,王桐生.补肾缩泉胶囊对老年性夜尿增多症模型及老年大鼠尿量的影响.中国中医药科技,2007,14(5)：337-338.
[30]彭述宪.下瘀血汤的临床运用.湖南中医杂志,1991,2：20-21.
[31]顾文忠.下瘀血汤治验一则.实用中医药杂志,2002,18(7)：39.
[32]马久明.《金匮要略》方验案三则.《甘肃中医》,2000,(7)：20-21.
[33]周晨晖.下瘀血汤加味治疗产后腹型血朴啉病11例.实用中医药杂志,1999,15(4)：13.
[1]王建平,胡顺金,姚淮芳,方琦等.补阳还五汤加味对高血压性肾损害的治疗作用.中医药临床杂志,2009,21(1)：12-13.
[2]唐补生.从络病学说探讨高血压肾病.中国民族民间医药,2008,17(10)：31-32.
[3]郭兆安.高血压性肾损害(肾衰竭期)湿浊内蕴证的临床研究.中国中西医结合肾病杂志,2007,8(11)：664-666.
[4]徐宏,关建国,赵先锋.滋阴潜阳活血法治疗高血压早期肾损害37例临床观察.辽宁中医杂志,2006,33(12)：1585.
[5]吴海峰,范丹阳,徐爱莲.中西医结合治疗老年人高血压病合并夜尿增多症105例.浙江中医杂志,2007,42(2)：88.
[6]徐巨海.夜尿增多是肾功能减退的早期信号.家庭医学,2003,5：22.
[7]王源声.中医治疗夜尿增多举隅.包头医学,2000,24(2)：30-31.
[8]陈明,龙子江,卞海,王靓,王雅娟,王桐生.补肾缩泉胶囊对老年性夜尿增多症模型及老年大鼠尿量的影响.中国中医药科技,2007,14(5)：337-338.
[9]彭述宪.下瘀血汤的临床运用.湖南中医杂志,1991,2：20-21.
[10]顾文忠.下瘀血汤治验一则.实用中医药杂志,2002,18(7)：39.
[11]马久明.《金匮要略》方验案三则.《甘肃中医》,2000,(7)：20-21.
[12]周晨晖.下瘀血汤加味治疗产后腹型血朴啉病11例.实用中医药杂志,1999,15(4)：13.
[2]周福德,王梅.北京市血液透析的发展与质量改进.中国血液净化杂志,2006,5：117-118.
[3]卫生部心血管防治中心.中国心血管病报告2005.中国大百科全书出版社,2006：84.
[4]Nissenson AR, PereiraBJ,Collions AJ,et al. Prevalence and characteristics of individuals with chronic kidney disease in a large health maintenance organization. Am J Kidney Dis,2001,37:1177-1183.
[5]郑法雷,章友康,陈香美,谌贻璞.肾脏病临床与进展.2005年,人民军医出版社,1(1)：99.
[6]Fogo A,Yoshida Y, et al.Serial micropucture analysis of the same nephrons in chronic renal disease:study in two rat modles of glomerular sclerosis. Kidney Int,1937,31:384A.
[7]Moorhead JF, Chan MK,et al. Lipid nephrotoricity in chronic progressive glomerular and tubulointerstitial disease.Lancet,1982,2:1309.
[8]Brenner BM, Meyer TW, et al. Dietary protein and the progressive nature of kidney disease; The role of hemodynamical ly mediated glomerular injury in the pathogens is of progressive glomerular sclerosis in aging, renal ablation,and intrinsic renal disease. N Engl J Med,1982,307:652.
[9]O' Donoghue DJ.What's new in renal disease?Medicine Int 1991,3508.
[10]郑剑卿,谢秀梅,余国龙.氯沙坦对老年轻、中度原发性高血压的肾脏保护作用[J].湖南医学,2000,17(6)：169-172.
[11]张守荣,顾依群等.二甲双胍对自发性高血压大白鼠靶器官病变的影响[J].高血压杂志,2000,7(2)：155-156.
[12]Coritsidis G,Neugarten J,et al.In vivo glomerular uptake of native and oxidized low density lipoprotein.Kidney Int,1990,37:501A.
[13]Gione E.Familial lecithin:Cholesterol acyltransferase deficiencya new metabolic disease with renal involo vement. Adv Nephrol,1981,10:167.
[14]Kas isk BL,O' Donnell MP,et al.Pharmacologic treatment of hyperlipidemia reduces glomerular injury in5/6 rat nephrectomy modle of chronic renal failure. Circul Res,1988,62:367.
[15]Diammond JR. Karnovsky M. Exacerbation of chronic aminonucleoside nephrosis by dietary cholesterol supplementation. Kidney Int,1987,32:671.
[16]赵林双,廖玉华,王敏,周子华,向光大,候洁,乐岭,徐琳.β1肾上腺素受体自身抗体在高血压性肾损害致病机制的初步探讨.中国医师进修杂志,2006,29(5)：11-13.
[17]US Renal Data System. Incidence and prevalence of ESRD. USRD 1999 Annual Data Report. In:Bethesda eds. USRDS 1999 Annual Data Report,1999:25-39.
[18]Walker WG, Neaton JD,Cutler JA,et al. Renal function change in hypertensive members of the Multiple Risk Factor Intervention Trial. Racial and treatment effects. The MRFIT Research Group. JAMA,1992,268:3085-3091.
[19]Hebert LA, Kusek JW, Greene T, Effects of blood pressure control on progressive renal disease in black and whites. Modification of Diet in Renal Disease Study Group. Hypertension,1997,30:428-435.
[20]Marcantoni C,Ma LJ, Federspiel C,et al.Hypertensive nephrosclerosis in African American verus Caucasians.Kidney In,2002,62:172-180.
[21]Brenner BM, Chertow GM. Congeni tal oligonephropathy and the etiology of adul t hypertension and progressive renal injury. Am J kidney Dis,1994,23:171-175.
[22]Singh GR, Hoy WE. Kidney volume, blood pressure,and albuminuria:finding in an Australian aboriginal community. Am J kidney Dis,2004,43:254-259.
[23]吴金秀.慢性肾功能不全失代偿期的可逆因素探讨[J].中国医学工程,2006,14(2)：219-220.
[24]王海燕.肾脏病学第三版.人民卫生出版社,2008,1665.
[25]王海燕.肾脏病学第二版.人民卫生出版社,2001,1144-1179.
[26]王飞.高血压早期肾损害的监测指标.心血管病研究进展.2009,30(1)：79-83.
[27]陈红梅,朱晖,张洁,季禹乔,孙明忠.尿微量蛋白测定在高血压早期肾损害中的作用.中国误诊学杂志,2007,7(22)：22.
[28]刘嘉芳,崔蒙,徐金英,钱钢,陈浩,汪世军,唐关敏.血清胱蛋白酶抑制剂C诊断老年高血压早期肾损害.高血压杂志.2005,13(11)：691-693.
[29]Coll E, Botey A, Alvarez L, et al. Serum cystatin C as new marker for noninvasive estimation of glomerular filtration rate and as a marker for early renal impairment[J]. Am J Kidney Dis,2000,36:29-34.
[30]伍松姣,陈耀宇.血、尿β2-MG检测在原发性高血压病患者早期肾损伤中的意义.广西中西学院学报.2007,10(3)：16-17.
[31]叶松道,陈晓晴,温怀凯.尿游离轻链测定对原发性高血压早期肾损害的诊断价值.浙江医学.2005,27(11)：803-805.
[32]彭旭,陈建辉,张联娜,林平.尿沉渣分析仪联合手工镜检诊断老年人高血压性肾损害.福建医药杂志.2006,28(6)：119-120.
[33]许红强,王金萍,常丽娜.肾叶间动脉阻力指数与原发性高血压早期肾损害的相关性.安徽中医学院学报.2006,25(4)：51-52.
[34]阳晓.慢性肾脏病进展的危险因素及延缓策略[J].中国实用内科杂志,2008,28(1)：79-80.
[35]付治卿,周聊生.高血压性肾损害机制的探讨.《临床荟萃》,2004,19(8)：469-471.
[36]沈汉超.高血压肾病诊治进展.《心脑血管病防治》,2002,2(2)：5-7.
[37]COOPERME. Pathogenesis, prevention, and treatment of diabetic nephropa-thy[J], Lancet.1998,352 (6):213-219.
[38]张正秀.206例慢性肾功能不全失代偿的可逆因素分析[J]. Chinese Journalof Practical Medicine,2008,28 (2):4.
[39]刘必成.延缓慢性肾脏病进展的现代策略[J].继续医学教育,2006,20(5)：63-65.
[40]田梅.苯那普利对原发性高血压患者肾功能的影响.遵义医学院报.2005,28(5)：432-434.
[41]余学清.高血压病肾损害的诊断与治疗.中国实用内科杂志,2006,26(5)：323-325.
[42]曲红玉,郭丽.厄贝沙坦治疗老年原发性高血压的疗效及对肾功能的影响.中国药学杂志.2006,41(13)：1034-1035.
[43]SASAMURAH. Prevention of hypertensive renal damage by prepuberta treatment with ARB[J]. Nippon Rinsho,2002,60(10):1962-1967.
[44]张盛霞,宋晓,赵东太.阿托伐他汀对高血压早期肾损害的作用.齐鲁医学杂志.2009,24(2)：117-118.
[45]TONOLO G,MELIS G M, FORMATO M, et al.Additive effects of simvastatin beyond its effects on LDL cholesterol in hypertensive type 2 diabetic patients[J].Eur J Clin Invest,2000,30:980-987.
[46]李萍,张海燕,刘国良等.阿托伐他汀对人肾小球系膜细胞增殖TGF-β1 mRNA和p38 MAPK表达的影响[J].中国组织化学与细胞化学杂志,2007,16(1)：57-61.
[47]张贺,韩子明,杨达胜.洛伐他汀对肾小球硬化大鼠纤溶酶原激活物抑制剂-1和Ⅳ型胶原表达的影响[J].实用儿科临床杂志,2007,22(5)：338-339.
[48]徐坤英.保肾康治疗高血压肾脏损害临床观察.中国现代医药杂志.2005,7(6)：75.
[49]鲁端.不同类型高血压的治疗策略.全科医学临床与教育.2009,7(2)：91-92.
[50]武卫东.中西医结合治疗慢性肾功能不全46例.吉林中医药,2006,26(12)：44-45.
[51]陈莉,刘英.中西医结合治疗慢性肾功能不全疗效观察.辽宁中医杂志,2006,33(7)：852-853.
[52]张饰,丁国华,王学玉.二羟基苯磺酸钙治疗慢性肾功能不全临床疗效观察.中国医师杂志,2006,8(5)：701.
[53]王海燕.肾脏病学第二版.人民卫生出版社,2001,1144.
[54]Von Kerrebuoeck P,Abrams P, Chaikin D, et al.The standardization of terminology in nocturia:report form the Standardisation Sub-Committee of the International Continence Society[J]. Neurourol Urodyn,2002,21:179-183.
[55]李昊.急性脑血管病致尿量增多相关因素的观察.临床研究,2008,46(12)：71-72.
[56]Hetta J.The impact of sleep deprivation caused by nocturia [J].Br J Urol Int,1999,84 (Suppl.1):27-28.
[57]Jamison SJ, Phillip CG,Daniel MS, et al.The need for voiding diaries in the evaluation of men with nocturia[J].JAOA,2002,102 (5):261-265.
[58]Ali A,Snape J.Nocturia in older people:a review of causes,consequences assessment and management[J]. Int J Clin Pract,2004,58 (4):366-373.
[59]Barker JP, Mitteness LS.Nocturia in the elderly [J].Gerontolgist,1998, 28:99-104.
[60]Ouslander JG, Johnson T,Nasr S,et al.ANP levels in geriatric patients with nocturia and nursing home residents with night time incontinence [J]. JAGS,1999, 147:1439-1444.
[61]Asplund R. Nocturia, Nocturnal Polyurin, and sleep qual ity in the elderly[J].J Psycho Res,2004,56:517-525.
[62]张亚群.老年前列腺增生症夜尿病因分类和相关因素分析.博士毕业论文,2008,24-29.
[63]黄明淑.硝苯地平引起尿量增多比重下降5例报告.黑龙江医学,2003,3(27)：238.
[64]张亚群.老年前列腺增生症夜尿病因分类和相关因素分析.博士毕业论文,2008,24-29.
[65]Jamison SJ,Phillip CG, Daniel MS,et al.The need for voiding diaries in the evaluation of men with nocturia [J]. JAOA,2002,102 (5):261-265.
[66]Lackner TE. Pharmacologic management of urinary incontinence[J].Am Long Term Care,2000,8:29-37.
[67]Spinelli M,Giardiello G,Gerber M,et al.New sacral neuromodulation lead for percutaneous implantation using local anesthesia:desciption and first experience[J]. J Urol,2003,170:1905-1907.
[1]叶任高.中西医结合肾脏病学.人民卫生出版社,2003,596.
[2]郭铁标,李侠等.加味防芪地黄汤治疗高血压性肾损害所致肾功能不全疗效观察.中国中医药信息杂志,2000,7(1)：49-50.
[3]程广书.高血压性肾损害的中医药治疗思路.河南中医,2001,21(1)：31.
[4]杨赶梅,夏娣文,佘江健等.芪蛭胶囊治疗高血压肾病肾功能不全20例临床观察.中国中医药科技,2002,9(4)：232-233.
[5]左琪.杨霓芝治疗良性小动脉性肾硬化经验.中医杂志,2004,45(6)：416-417.
[6]徐宏,关建国,赵先锋.滋阴潜阳活血法治疗高血压早期肾损害37例临床观察.辽宁中医杂志,2006,33(12)：1585.
[7]郭兆安.高血压性肾损害(肾衰竭期)湿浊内蕴证的临床研究.中国中西医结合肾病杂志,2007,8(11)：664-666.
[8]唐补生.从络病学说探讨高血压肾病.中国民族民间医药,2008,17(10)：31-32.
[9]王建平,胡顺金,姚淮芳,方琦等.补阳还五汤加味对高血压性肾损害的治疗作用.中医药临床杂志,2009,21(1)：12-13.
[10]左琪,杨霓芝.杨霓芝教授论治良性小动脉性肾硬化特色摭拾.中医药学报,2004,32(2)：8-9.
[11]王耀献,高菁.肾脏病中西医诊治.辽宁科学技术出版社,2005.374-385.
[13]张琪,朱建军,袁杰.保元灌肠液治疗高血压患者早期肾脏损害60例.南京中医药大学学报(自然科学版),2001,17(3)：189-190.
[14]杨赶梅,夏娣文,佘江健等.芪蛭胶囊治疗高血压肾病肾功能不全20例临床观察.中国中医药科技,2002,9(4)：232-233.
[15]姚纲炼,桂保松等.黄芪注射液对降低高血压性肾损害尿蛋白含量的作用.陕西医学杂志,2002,31(4)：341-342
[16]倪小玲,王砾等.黄芪治疗老年原发性高血压性肾损害疗效观察.中国医院药学杂志,2004,24(11)：700.
[17]汤归春,莫耘松,陈薇,鲁贵春等.黄芪对高血压病早期肾损害的保护作用,现代中西医结合杂志,2006,15(1)：26-27.
[18]吴学森,赵敏.黄芪注射液治疗原发性高血压肾脏损害疗效观察.基层医学论坛,2007,11(8)：717-718.
[19]曹阳.中药穴位注射治疗高血压性肾损害临床观察.中国针灸,2005,25(1)：21-23.
[20]孟伟.滋阴降火通络汤治疗高血压病早期肾损害的临床研究.山东中医药大学学报,27(5)：364-366.
[21]张天斗,李承禧.六位地黄丸对老年性高血压患者肾保护作用的临床研究.世界科学技术-中医药现代化,2006,8(2)：102-104.
[22]杨运清.天麻地黄饮降压及干预高血压病肾损害66例观察.陕西中医,2007,28(7)：835-837.
[23]王建彬,戴小华,杨帆,顾建霞,董梅,邵正斌,周宜轩.养肝益水颗粒对高血压病早期肾损害多重危险因素的影响.医学研究杂志,2008,37(9)：64-66.
[24]魏国健,钟培金,丘伟中.中西医结合治疗高血压病早期肾损害临床观察.现代医院,2006,6(3)：67-69.
[25]王令谆.中西医结合治疗原发性高血压病早期肾损害的临床观察.南京中医药大学学报,2005,21(6)：366-368.
[26]吴海峰,范丹阳,徐爱莲.中西医结合治疗老年人高血压病合并夜尿增多症105例.浙江中医杂志,2007,42(2)：88.
[27]徐巨海.夜尿增多是肾功能减退的早期信号.家庭医学,2003,5：22.
[28]王源声.中医治疗夜尿增多举隅.包头医学,2000,24(2)：30-31.
[29]陈明,龙子江,卞海,王靓,王雅娟,王桐生.补肾缩泉胶囊对老年性夜尿增多症模型及老年大鼠尿量的影响.中国中医药科技,2007,14(5)：337-338.
[30]彭述宪.下瘀血汤的临床运用.湖南中医杂志,1991,2：20-21.
[31]顾文忠.下瘀血汤治验一则.实用中医药杂志,2002,18(7)：39.
[32]马久明.《金匮要略》方验案三则.《甘肃中医》,2000,(7)：20-21.
[33]周晨晖.下瘀血汤加味治疗产后腹型血朴啉病11例.实用中医药杂志,1999,15(4)：13.
[1]王建平,胡顺金,姚淮芳,方琦等.补阳还五汤加味对高血压性肾损害的治疗作用.中医药临床杂志,2009,21(1)：12-13.
[2]唐补生.从络病学说探讨高血压肾病.中国民族民间医药,2008,17(10)：31-32.
[3]郭兆安.高血压性肾损害(肾衰竭期)湿浊内蕴证的临床研究.中国中西医结合肾病杂志,2007,8(11)：664-666.
[4]徐宏,关建国,赵先锋.滋阴潜阳活血法治疗高血压早期肾损害37例临床观察.辽宁中医杂志,2006,33(12)：1585.
[5]吴海峰,范丹阳,徐爱莲.中西医结合治疗老年人高血压病合并夜尿增多症105例.浙江中医杂志,2007,42(2)：88.
[6]徐巨海.夜尿增多是肾功能减退的早期信号.家庭医学,2003,5：22.
[7]王源声.中医治疗夜尿增多举隅.包头医学,2000,24(2)：30-31.
[8]陈明,龙子江,卞海,王靓,王雅娟,王桐生.补肾缩泉胶囊对老年性夜尿增多症模型及老年大鼠尿量的影响.中国中医药科技,2007,14(5)：337-338.
[9]彭述宪.下瘀血汤的临床运用.湖南中医杂志,1991,2：20-21.
[10]顾文忠.下瘀血汤治验一则.实用中医药杂志,2002,18(7)：39.
[11]马久明.《金匮要略》方验案三则.《甘肃中医》,2000,(7)：20-21.
[12]周晨晖.下瘀血汤加味治疗产后腹型血朴啉病11例.实用中医药杂志,1999,15(4)：13.