益肾清热利湿法治疗下焦湿热型IgA肾病
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摘要
目的探讨益肾清热利湿法对下焦湿热型Ig A肾病患者中医证候及血清炎症因子的影响。方法选取我院收治的下焦湿热型Ig A肾病患者72例,依据随机数字表法分为对照组与治疗组,各36例。对照组给予常规治疗,治疗组在对照组的基础上应用益肾清热利湿法,2组患者进行为期3个月的治疗。比较2组患者治疗前后下焦湿热型中医证候积分、α1-微球蛋白(α1-MG)、视黄醇结合蛋白(RBP)、β2-微球蛋白(β2-MG)、血清炎性因子、24小时尿蛋白定量和尿红细胞计数变化情况,并计算临床总有效率。结果治疗组中医证候积分降低较对照组更为明显(P <0.05);治疗组α1-MG、RBP、β2-MG水平较对照组降低更为明显(P <0.05);治疗组TNF-α、IL-6、IL-15水平较对照组降低更为明显(P <0.05);治疗组24小时尿蛋白定量和尿红细胞计数较对照组降低更为明显(P <0.05);治疗组临床总有效率为88.89%,优于对照组的66.66%(P <0.05)。结论益肾清热利湿法可以改善下焦湿热型Ig A肾病患者临床症状和体征,有较好的的治疗效果。
Objective To investigate the ef fect of tonifying kidney, clearing heatand promoting diuresis on TCM syndromes and serum inflammatory factors of IgA nephropathy patients with damp-heat in lower jiao. Methods 72 IgA nephropathy patients with damp-heat in lower jiao admitted to our hospital were selected and randomly divided into treatment group and control group with 36 cases in each group according to the table of random number. The control group was given routine treatment, while the treatment group was treated with the method of tonifying kidney, clearing heat and promoting diuresis on the basis of the control group, both groups of patients were treated for 3 months. The TCM symptom scores of damp-heat in lower jiao, the level of alpha 1-microglobulin(α1-MG),retinol binding protein(RBP), beta 2-microglobulin(β2-MG), and serum inflammatory factors, the changes of 24-hour urinary protein quantitation and urinary red blood cell count between the two groups were compared before and after treatment, and the clinical total ef fective rate were calculated. Results The scores of TCM symptoms in both groups were decreased, the treatment group decreased significantly compared with the control group(P < 0.05). The level of α1-MG, RBP, β2-MG were significantly lower than those in the control group(P < 0.05). The level of TNF-α,IL-6 and IL-15 in the treatment group were significantly lower than those in the control group(P < 0.05). The 24-hour urinary protein quantitation and urinary red blood cell count in the treatment group decreased significantly than those in the control group(P < 0.05). The clinical total ef fective rate were 88.89% of the treatment group and 72.22%of the control group(P < 0.05). Conclusion The method of tonifying kidney, clearing heatand promoting diuresis can improve clinical symptoms and signs of IgA nephropathy patients with damp-heat of lower jiao and has a good therapeutic ef fect.
Objective To investigate the ef fect of tonifying kidney, clearing heatand promoting diuresis on TCM syndromes and serum inflammatory factors of IgA nephropathy patients with damp-heat in lower jiao. Methods 72 IgA nephropathy patients with damp-heat in lower jiao admitted to our hospital were selected and randomly divided into treatment group and control group with 36 cases in each group according to the table of random number. The control group was given routine treatment, while the treatment group was treated with the method of tonifying kidney, clearing heat and promoting diuresis on the basis of the control group, both groups of patients were treated for 3 months. The TCM symptom scores of damp-heat in lower jiao, the level of alpha 1-microglobulin(α1-MG),retinol binding protein(RBP), beta 2-microglobulin(β2-MG), and serum inflammatory factors, the changes of 24-hour urinary protein quantitation and urinary red blood cell count between the two groups were compared before and after treatment, and the clinical total ef fective rate were calculated. Results The scores of TCM symptoms in both groups were decreased, the treatment group decreased significantly compared with the control group(P < 0.05). The level of α1-MG, RBP, β2-MG were significantly lower than those in the control group(P < 0.05). The level of TNF-α,IL-6 and IL-15 in the treatment group were significantly lower than those in the control group(P < 0.05). The 24-hour urinary protein quantitation and urinary red blood cell count in the treatment group decreased significantly than those in the control group(P < 0.05). The clinical total ef fective rate were 88.89% of the treatment group and 72.22%of the control group(P < 0.05). Conclusion The method of tonifying kidney, clearing heatand promoting diuresis can improve clinical symptoms and signs of IgA nephropathy patients with damp-heat of lower jiao and has a good therapeutic ef fect.
引文
[1]闵璐琳,张敏芳,车霞静,等.来氟米特联合中小剂量激素治疗IgA肾病的疗效观察[J].中华肾脏病杂志, 2016,32(10):721-727.
[2]钟燕斌,周永恒,刘仕欣,等.三黄益肾胶囊联合糖皮质激素治疗IgA肾病的疗效观察及其对VEGF水平的影响[J].中国中医药科技, 2016, 23(5):523-525.
[3]陈香美,邓跃毅,谢院生. IgA肾病西医诊断和中医辨证分型的实践指南[J].中国中西医结合杂志, 2013, 33(5):583-585.
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[6]李六生,闫志群,周志华,等.不同剂量阿法骨化醇对IgA肾病患者血清TNF-α、IL-6、TGF-β1水平的影响[J].广东医学, 2016, 37(7):1067-1070.
[7]吴茸,王栋,张志刚,等.雷公藤甲素对炎症性肠病模型小鼠吻合口纤维化及肿瘤坏死因子-α/微小RNA-155轴的影响[J].中华实验外科杂志, 2015, 32(9):2182-2184.
[8]陈建军,寿迪文.黄葵胶囊对脾气虚型IgA肾病患者血清MCP-1、TNF-α及IL-6水平的影响[J].中国中医药科技,2015, 22(6):624-625, 637.
[9]董立君.中医辨证论治IgA肾病的疗效分析[J].临床医药文献杂志(电子版), 2016, 3(20):3953, 3955.
[10]刘永芳,陈帮明,胡修全,等.通络保肾方治疗IgA肾病的临床研究[J].中国中西医结合肾病杂志, 2016, 17(11):991-993.
[11]黄敏,杜珍芳,翟惟凯.益气养阴通络法治疗气阴两虚型IgA肾病疗效观察[J].陕西中医, 2014, 35(11):1507-1509.
[12]汪蕾,段昱方,赵文景,等.益气三仁汤治疗气虚湿热型IgA肾病临床观察[J].世界中西医结合杂志, 2015,10(10):1424-1426.
[13]黄迪,李雯雯,沈沛成,等.益气固本调免方治疗脾肾气虚型IgA肾病临床观察[J].上海中医药杂志, 2015, 49(3):54-56.
[14]杨俊,杨琴,吴嘉,等.雷公藤多苷片联合健脾益肾方治疗糖尿病肾病大量蛋白尿临床观察[J].新中医, 2013,45(10):87-89.
[15]张守琳,衣春光.补肾健脾,利湿化瘀法治疗慢性肾炎血尿的临床研究[J].吉林中医药, 2013, 33(2):161, 174.
[16]吴卿,李雯雯,姜健,等.固本通络方对IgA肾病患者血B细胞活化因子的影响[J].中国中西医结合肾病杂志,2017, 18(1):30-33.
[17]杨科朋,陈慕芝,谢志军,等.中西药合用治疗IgA肾病蛋白尿气阴两虚夹湿热型临床研究[J].实用中医药杂志,2017, 33(3):262-263.
[18]陈万佳,邓跃毅,倪兆慧,等.健脾补肾通络颗粒联合糖皮质激素治疗脾肾阳虚型重症IgA肾病随机、双盲、对照的多中心研究[J].中华肾病研究电子杂志, 2013,2(5):254-259.
[19]李翀,中医药防治IgA肾病的相关研究进展[J].湖南中医杂志, 2017, 33(7):194-197.
[20]王宏安,王银萍,张守琳.补肾健脾、解毒利咽中药治疗Ig A肾病29例临床观察[J].中医杂志, 2016, 57(5):413-415.
[2]钟燕斌,周永恒,刘仕欣,等.三黄益肾胶囊联合糖皮质激素治疗IgA肾病的疗效观察及其对VEGF水平的影响[J].中国中医药科技, 2016, 23(5):523-525.
[3]陈香美,邓跃毅,谢院生. IgA肾病西医诊断和中医辨证分型的实践指南[J].中国中西医结合杂志, 2013, 33(5):583-585.
[4]陈灏珠,林果为,王吉耀.实用内科学(下册)[M]. 14版.北京:人民卫生出版社, 2013:1337-1352.
[5]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社, 2002:295.
[6]李六生,闫志群,周志华,等.不同剂量阿法骨化醇对IgA肾病患者血清TNF-α、IL-6、TGF-β1水平的影响[J].广东医学, 2016, 37(7):1067-1070.
[7]吴茸,王栋,张志刚,等.雷公藤甲素对炎症性肠病模型小鼠吻合口纤维化及肿瘤坏死因子-α/微小RNA-155轴的影响[J].中华实验外科杂志, 2015, 32(9):2182-2184.
[8]陈建军,寿迪文.黄葵胶囊对脾气虚型IgA肾病患者血清MCP-1、TNF-α及IL-6水平的影响[J].中国中医药科技,2015, 22(6):624-625, 637.
[9]董立君.中医辨证论治IgA肾病的疗效分析[J].临床医药文献杂志(电子版), 2016, 3(20):3953, 3955.
[10]刘永芳,陈帮明,胡修全,等.通络保肾方治疗IgA肾病的临床研究[J].中国中西医结合肾病杂志, 2016, 17(11):991-993.
[11]黄敏,杜珍芳,翟惟凯.益气养阴通络法治疗气阴两虚型IgA肾病疗效观察[J].陕西中医, 2014, 35(11):1507-1509.
[12]汪蕾,段昱方,赵文景,等.益气三仁汤治疗气虚湿热型IgA肾病临床观察[J].世界中西医结合杂志, 2015,10(10):1424-1426.
[13]黄迪,李雯雯,沈沛成,等.益气固本调免方治疗脾肾气虚型IgA肾病临床观察[J].上海中医药杂志, 2015, 49(3):54-56.
[14]杨俊,杨琴,吴嘉,等.雷公藤多苷片联合健脾益肾方治疗糖尿病肾病大量蛋白尿临床观察[J].新中医, 2013,45(10):87-89.
[15]张守琳,衣春光.补肾健脾,利湿化瘀法治疗慢性肾炎血尿的临床研究[J].吉林中医药, 2013, 33(2):161, 174.
[16]吴卿,李雯雯,姜健,等.固本通络方对IgA肾病患者血B细胞活化因子的影响[J].中国中西医结合肾病杂志,2017, 18(1):30-33.
[17]杨科朋,陈慕芝,谢志军,等.中西药合用治疗IgA肾病蛋白尿气阴两虚夹湿热型临床研究[J].实用中医药杂志,2017, 33(3):262-263.
[18]陈万佳,邓跃毅,倪兆慧,等.健脾补肾通络颗粒联合糖皮质激素治疗脾肾阳虚型重症IgA肾病随机、双盲、对照的多中心研究[J].中华肾病研究电子杂志, 2013,2(5):254-259.
[19]李翀,中医药防治IgA肾病的相关研究进展[J].湖南中医杂志, 2017, 33(7):194-197.
[20]王宏安,王银萍,张守琳.补肾健脾、解毒利咽中药治疗Ig A肾病29例临床观察[J].中医杂志, 2016, 57(5):413-415.