摘要
作为慢性肾脏疾病的主要临床表现之一蛋白尿,有着极其重要的临床意义,更是对肾脏疾病患者进入肾功能衰竭终末期的时间有着重要的影响。科研工作者与临床医生均在积极探求减少尿蛋白的有效方法。中医中药可以有效的减少尿蛋白,抑制其复发、稳定病情以及减少其他药物的副作用等作用。
目的：观察原发性慢性肾小球疾病患者,寻找各年龄组证候学特点。并根据不同年龄分组确立不同的中医治法,采用中药治疗3个月,观察与对照组的疗效差别,从而为肾脏病的治疗提供新的思路。
方法：第一部分共收集552例原发性慢性肾小球疾病患者的临床资料进行观察,探讨年龄与证候类型的关系。第二部分选择120例原发性慢性肾小球疾病患者,按年龄不同,分为0-20岁(A组)、21-60岁(B组)、61岁以上(C组)年龄段患者各40例。每组患者随机分为治疗组与对照组各20例,对照组予基础治疗,治疗组在对照组基础上A组加服自拟健脾益肾方、B组加服自拟理气益肾方、C组加服自拟活血益肾方,随证加减药物不超过3味。治疗3个月观察疗效。
结果：
1.在以蛋白尿为主要临床表现的慢性肾小球疾病的临床辨证中,本虚标实证为多见,无论是单纯本虚证、单纯标实证还是本虚标实诸证,均非临床尿蛋白定量多少的明确影响因子。而标实证与本虚证之间亦无明显影响或从属关系。
2.在以蛋白尿为主要临床表现的慢性肾小球疾病的临床辨证中,20岁以下的患者以脾肾虚弱证型为主；21～60岁患者气滞证较为突出；60岁以上患者血瘀证较为突出。以上证候类型在各自族群中的数据统计均有统计学意义。
3.3组患者治疗前后中医证候积分对比均有统计学意义。治疗组证候积分降低均明显高于对照组(P<0.05)。
4.3组患者治疗前,治疗组和对照组比较,24h尿蛋白定量对比均无统计学意义。治疗后各组24h尿蛋白定量减少,较治疗前对比均有统计学意义(P<0.05)
结论：
1.不同年龄慢性肾小球疾病患者存在不同的证候学特点。20岁以下的患者以脾肾虚弱证型为主；21～60岁患者以气滞证为主；60岁以上患者以血瘀证为主。
2.按年龄不同分别采用健脾益肾方、理气益肾方、活血益肾方治疗,治疗前后中医证候积分对比均有统计学意义,治疗后各组24h尿蛋白定量减少,较治疗前对比均有统计学意义。提示因岁治宜治疗蛋白尿具有临床指导意义。
Proteinuria is a main clinical manifestation in chronic renal disease.It has vital clinical significance, and has important effect on the length of time which patients with kidney disease enter the end stage renal failure. Science researchers and clinicians are actively seeking the effective ways of reducing protein in the urine. Chinese medicine treatment can reduce proteinuria, inhibit recurrence, stabilise symptoms and reduce the side effects of other drugs
Objective:To observe the patients with primary chronic glomerular disease and to find the symptoms characteristics in each age groups. We established diffident therapeutic methods in TCM according to the different age groups, treated patients with traditional Chinese medicine for3months in order to observe the curative effect difference with the control groups.
Methods:Test1included552patients with primary chronic glomerular disease. Clinical data was collected to explore the relationship between age and syndrome type. Test2included120patients with primary chronic glomerular disease, divided into three groups. A group includes patients from0to20years of age, B group includes patients from21to60years, C group includes patients over61years old. Each group includes40patients. These patients were randomly divideded into treating group and control group. Both groups were given basic treatment and the treatment group was given Chinese herbs at the same time. A treatment group was given the decoction of invigorating spleen and kidney. B treatment group was given the decoction of regulating Qi and invigorating kidney. C treatment group was given the decoction of activating blood and invigorating kidney. Therapeutic effect was observed at3months.
Results:
1The syndrome of asthenia in origin and asthenia in superficiality is more obvious ly in cl inic syndrome di f ferent iat ion among the pat ients with proteinuria as the main clinical manifestation of chronic glomerular disease.
2Among the patients with proteinuria as the main clinical manifestation of chronic glomerular disease, weak spleen and kidney syndrome is the main cl inical type in the pat ients under the age of20. Weak spleen and kidney syndrome is the main clinical type in the patients under the age of20. Syndrome of qi stagnation is the main clinical type in the patients between the age from21to60. Syndrome of blood stasis is the main clinical type in the patients over the age of61.
3Compaired with treating group and control group, integral of syndrome of Traditional Chinese Medicine descented obviously in three groups(P<0.05).
4Compaired wi th treat ing group and control group,24h urine protein quant i ty is not statistically significant before receiving the treatment.24h urine protein quantitative decrease after treatment in each group, the result is statistically significant (P<0.05)
Conclusion:
1. There are different syndrome characteristics in different age patients with primary chronic glomerular disease. Weak spleen and kidney syndrome is the main cl inical type in the pat ients under theage of20. Syndrome of qi stagnation is the main clinical type in the patients between the age from21to60. Syndrome of blood stasis is the main clinical type in the patients over the age of61.
2. Patients were divided into three groups according to ages. Three groups were treated the decoction of invigorating spleen and kidney, the decoction of regulating Qi and invigorating kidney, and the decoction of activating blood and invigorating kidney Compaired with treating group and control group, integral of syndrome of Traditional Chinese Medicine descented obviously in three groups(P<0.05),24h urine protein quantitative decrease after treatment in each group (P<0.05). It suggests that treatment individualized according to age have clinical significance in the treatment of proteinuria.
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