藤草胜湿汤治疗脾肾阳虚兼风湿内扰型特发性膜性肾病的临床疗效及安全性观察  

Effect and safety of Tengcao Shengshi Decoction on Idiopathic Membranous Nephropathy of spleen-kidney yang deficiency and rheumatism internal disturbance type

作　　者：王刚 董叶朋 武晓妹 张宇 李宁[3] 胡金焕 WANG Gang;DONG Yepeng;WU Xiaomei;ZHANG Yu;LI Ning;HU Jinhuan(First Department of Nephrology,The First Affiliated Hospital of Hebei University of Chinese Medicine,Shijiazhuang,Hebei 050011;Graduate School of Hebei University of Chinese Medicine,Shijiazhuang,Hebei 050091;Department of Nephrology,Hebei Chest Hospital,Shijiazhuang,Hebei 050041;First Department of Oncology,The First Affiliated Hospital of Hebei University of Chinese Medicine,Shijiazhuang,Hebei 050011)

机构地区：[1]河北中医学院第一附属医院肾病一科,河北石家庄050011 [2]河北中医学院研究生学院,河北石家庄050091 [3]河北省胸科医院肾内科,河北石家庄050041 [4]河北中医学院第一附属医院肿瘤一科,河北石家庄050011

出　　处：《河北中医》2022年第9期1453-1457,共5页Hebei Journal of Traditional Chinese Medicine

基　　金：河北省中医药管理局2017年度中医药类科研计划课题(编号:2017031)。

摘　　要：目的 观察藤草胜湿汤治疗脾肾阳虚兼风湿内扰型特发性膜性肾病(IMN)的临床疗效及安全性。方法 将96例脾肾阳虚兼风湿内扰型IMN患者按照随机数字表法分为2组,均予基础治疗,对照组49例加用醋酸泼尼松片、雷公藤多苷片治疗,治疗组47例加用藤草胜湿汤治疗。2组均治疗6个月。比较2组疗效;比较2组治疗前后中医证候评分变化;比较2组治疗前后24 h尿蛋白定量、血清白蛋白(ALB)水平变化;比较2组治疗前后肝、肾功能指标变化;观察2组不良反应发生情况。结果 治疗组总缓解率66.0%(31/47),对照组总缓解率65.3%(32/49),2组疗效比较差异无统计学意义(P>0.05)。2组治疗后中医证候各项评分及总评分均较本组治疗前降低(P<0.05),治疗后治疗组倦怠乏力、腰膝痠软、食少纳呆、小便泡沫多、肢体痠楚疼痛评分及总评分均低于对照组(P<0.05)。2组治疗后24 h尿蛋白定量均较本组治疗前降低(P<0.05),血清ALB较本组治疗前升高(P<0.05)。2组治疗后24 h尿蛋白定量、血清ALB比较差异均无统计学意义(P>0.05)。2组治疗前后血肌酐(Cr)、估算肾小球滤过率(eGFR)比较差异均无统计学意义(P>0.05)。2组治疗前后天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)比较差异均无统计学意义(P>0.05)。治疗组不良反应发生率4.3%(2/47),对照组不良反应发生率18.4%(9/49),治疗组不良发应发生率低于对照组(P<0.05)。结论 藤草胜湿汤治疗脾肾阳虚兼风湿内扰型IMN,可有效降低患者尿蛋白,提高血清ALB水平,缓解患者临床症状,且对肝、肾功能无影响,无明显毒副作用。Objective To observe the clinical efficacy and safety of Tengcao Shengshi Decoction in the treatment of idiopathic membranous nephropathy(IMN)of spleen-kidney yang deficiency and rheumatism internal disturbance type.Methods Totally 96 IMN patients(spleen-kidney yang deficiency and rheumatism internal disturbance)were randomly divided into 2 groups,on the basis of conventional treatment,the control group(n=49)were additionally treated with prednisone acetate tablets+tripterygium wilfordii tablets,and the treatment group(n=47)additionally with Tengcao Shengshi Decoction.A 6-month treatment was performed,aiming to compare the curative effects,traditional Chinese medicine(TCM)syndrome scores,24-hour urinary protein quantification,as well as serum albumin(ALB)levels.Results There was no difference in the curative effect between the treatment group and the control group(66.0%[31/47]vs 65.3%[32/49],P>0.05,respectively).After treatment,TCM syndromes scores in the two groups were all lower(P<0.05).TCM syndromes scores(lassitude,weakness of waist and knees,poor appetite,more urine foam,limb pain)in the treatment group were lower than those in the control group(P<0.05).The lower 24-hour urinary protein quantification and the higher serum ALB was detected in the both groups(all P<0.05),but no difference had statistical significance in the above indexes between groups after treatment(P>0.05).The intergroup difference was not statistical significance in serum creatinine(SCr)and Epidermal growth factor receptor(eGFR),aspartate aminotransferase(AST)and alanine aminotransferase(ALT)before and after treatment(all P>0.05).The adverse incidence was lower in the treatment group than that the control group(4.3%[2/47]vs 18.4%[9/49],(P<0.05),respectively).Conclusion For IMN patients(spleen-kidney yang deficiency and rheumatism internal disturbance),Tengcao Shengshi Decoction can effectively reduce urinary protein,increase serum ALB level,relieve clinical symptoms,without obvious side effects for liver and kidney functions.

关 键 词：肾小球肾炎 膜性 中药疗法 

分 类 号：R692.31[医药卫生—泌尿科学] R289.6[医药卫生—外科学]