加味附子理中汤治疗马兜铃酸肾病疗效的临床观察

Clinical observation on efficacy of jiaweifuzilizhongtang used for treating aristolochic acid nephropathy

目的:观察加味附子理中汤对马兜铃酸肾病(AAN)患者肾功能及临床症状的影响。方法:对27例具有脾阳虚证候群的AAN患者应用加味附子理中汤进行治疗,每天1剂,水煎服,4周为1个疗程。第2疗程结束后3d内评估疗效,观察指标为尿素氮、血肌酐、内生肌酐清除率、血常规(红细胞、血红蛋白)、24h尿蛋白定量、尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、尿渗透压以及畏寒肢冷、倦怠乏力、食少纳呆、恶心欲吐、面色晄白、腰酸膝软等临床症状分级积分。结果:治疗后患者肾功能得到明显改善,血肌酐、尿素氮、24h尿蛋白定量、尿NAG酶下降,内生肌酐清除率、尿渗透压升高,与治疗前比较差异均有统计学意义(P<0.05)。同时临床症状得到缓解,症状分级积分均低于治疗前(P<0.05)。患者临床总有效率为74.07%。结论:加味附子理中汤对AAN有较好的治疗作用。

Objective： To observe the efficacy ofjiaweifuzilizhongtang on the renal function and clinical symptoms of patients with aristoloehic acid nephropathy （AAN）. Methods： Twenty-seven patients with AAN were treated withjiaweifuzilizhongtang. The observation indexes such as blood urea nitrogen（BUN）, serum creatinine（SCr）, endogenous creatinine clearance rate （CCr）, erythrocyte （RBC）,hemoglobin （Hb）, twenty-four-hour proteinuria quantitation （24 h Upro）, N-acety- β -D-glocosamidase （NAG）, Urine Osmole （Uosm）,were determined before and after treatment, and the score of patients＇ symptoms including aversion to cold, cold limbs, fatigue, weakness, anorexia, nausea, pale complexion and lassitude in loin and legs were also calculated. Results： Compared with that of pre-treatment, the renal function of patients after treatment was significantly improved （P〈0.05） according to the indexes of BUN, SCr, CCr, RBC and Hb, 24 h Upro, NAG, Uosm. Meanwhile, after treatment the score of clinical symptoms was obviously different （P〈 0.05） from that of pre-treatment, and the total clinical effective rate was 74.07%. Conclusion： Jiaweifuzilizhongtang is effective for treating the patients with aristoloehic acidnephropathy （AAN）.