八味肾气丸合八正散加减对中老年反复发作性尿路感染的调节作用  

Regulation Effect of Syndrome Differentiation and Treatment of Bawei Shenqi Wan Combined with Bazhengsan in Patients with Recurrent Urinary Tract Infection and Old Age

作　　者：严旭东 黄超 杨玲[2] YAN Xu-dong;HUANG Chao;YANG Ling(The Affiliated Hospital of Dazhou Vocational and Technical College,Dazhou 635000,China;The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610072,China)

机构地区：[1]达州职业技术学院附属医院,四川达州635000 [2]成都中医药大学附属医院,成都610072

出　　处：《中国实验方剂学杂志》2018年第17期195-200,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：四川卫生厅科技计划项目(130458)

摘　　要：目的：观察八味肾气丸合八正散加减治疗中老年反复发作性尿路感染（RUTI）的临床疗效及对免疫功能和炎症因子的影响。方法：将140例患者，按区组随机分为观察组和对照组各70例。对照组口服盐酸左氧氟沙星片，0．2g／次，2次／d。连续治疗2周，尿培养阴性后采用头孢氨苄甲氧苄啶胶囊，0．25g·d-1，睡前服用。观察组在对照组治疗的基础上加用八味肾气丸合八正散加减内服，1剂／d。两组疗程均连续治疗12周。进行治疗前后主要临床症状和生活质量评分；记录6个月内的复发情况；检测治疗前后d，-微球蛋白（oL，-MG）和卢：-微球蛋白（卢：-MG），尿N-乙酰印-氨基葡萄糖苷酶（NAG）水平；检测治疗前后T细胞亚群（CD3’，CD4’，CD8‘，CD4’／CD8’）和尿液分泌型免疫球蛋白A（SIgA）水平；检测治疗前后肿瘤坏死因子-a（TNF．ot），白细胞介素-6（IL-6），IL-8和降钙素原（PCT）等炎症因子水平。结果：经秩和检验，观察组患者临床疗效优于对照组（P〈0．05）；观察组各症状评分和总分均低于对照组（P〈0．01）；治疗后观察组d，-MG，卢：-MG和NAG水平均低于对照组（P〈0．01）；观察组CD4’，CD4’／CD8’和SIgA均高于对照组（P〈0．05），CD8’低于对照组（P〈0．05）；观察组TNF—d，IL-6，IL-8和PCT水平均低于对照组（P〈0．01）；观察组患者生理职能、活力、情感职能和精神健康4个维度评分均高于对照组（P〈0．05）；观察组在6个月随访中平均复发次数少于对照组（P〈0．01），观察组复发率为37．74％，低于对照组的60．98％（z。=5．003，P〈0．05）。结论：八味肾气丸合八正散加减治疗肾虚湿热型RUTI中老年患者可减轻临床症状、减少复发，提高生活质量，保护肾功能，并具有调节免疫和抗炎效应，近期和远期疗效均优于单纯西医治疗。[ Abstract] Objective： To observe the clinical efficacy of syndrome differentiation and treatment of Bawei Shenqi Wan combined with Bazhengsan to recurrent urinary tract infections （RUTI） in the middle and old age, and investigate its effects on immunity and inflammatory factors. Method： One hundred and forty eligible patients were randomly divided into control group （70 cases） and observation group （70 cases） by using SAS software. Patients in the control group got levofloxacin tablets by oral administration, 0. 2 g/time, 2 times/days, for continuous 2weeks. And cefalexin and trimethoprim capsules were given at 0.25 g/day when urine culture showed negative results. Based on the treatment in control group, the patients in observation group additionally got Bawei Shenqi Wan combined with Bazhengsan, 1 dose/day. The treatment course was 12 weeks in both groups. Before and after treatment, scores of the main symptoms and quality of life were graded. Relapse within 6 months was recorded. And the levels of al-microglobulin （a^-MG） and fl2-micr^gl^bulin （fl2-MG） , N-acetyl-fl-D-glucosaminidase （NAG）, T cell subgroup （CD3 ＋ , CDd ~ , CD8 ~ , CD4~/CD8 ~ ）, urine secretory immunoglobulin A （SIgA）, tumor necrosis factor-a （TNF-a）, interleukin （IL-6） and calcitonin （PCT） were detected. Result： As analyzed by rank sum test, the clinical efficacy in observation group was superior to that in the control group （P 〈 0.05 ）. Scores of symptoms and the total score were all lower than those in control group （P 〈0.01）. After treatment, levels of %-MG, fl2-MG, ＂NAG, TNF-a, IL-6, IL-8 and PCT were all lower than those in control group （P 〈 0.01）. Levels of CDd＋, CD4＋/CD8 ~ and SIgA in the observation group were higher than those in the control group （P〈0.05）, while level of CD8 ~was lower than that in the control group （P 〈0.05）. The scores of physiological function, vitality, emotional function and mental health in the observation group were highe

关 键 词：反复发作性尿路感染 肾虚湿热证 八味肾气丸 八正散 免疫功能 肾损伤 炎症因子 

分 类 号：R25[医药卫生—中医内科学] R256[医药卫生—中医学]