糖皮质激素治疗对原发性肾病综合征患者中医证候影响的规律探讨

Regularity discussion of the effect of glucocorticoids in treating patients with primary nephrotic syndrome on TCM syndrome

目的:应用中医证素辨证的方法分析原发性肾病综合征患者在糖皮质激素治疗过程中的证候特点,探讨原发性肾病综合征患者在糖皮质激素治疗中的中医证候动态变化规律,为中西医结合治疗原发性肾病综合征提供新的思路。方法:选择原发性肾病综合征并接受激素规范治疗患者190例,在激素治疗前、治疗3、6、9个月时,全面收集患者一般情况及四诊资料,填入临床观察表,收集的资料录入中医健康状态辨识与咨询系统并分析,同时检测各时间点患者的血清皮质醇。结果:①肾病综合征患者在激素治疗前、治疗3、6、9个月时最常见中医证型分别是脾肾阳虚、阴虚内热、气阴两虚、脾肾阳虚;标实则分别为湿、热、瘀血;病位证素主要集中在肾、脾、肺;②在治疗前,肾病综合征患者皮质醇较健康对照组低(P<0.05);与治疗前相比,血清皮质醇在激素治疗3个月时明显下降(P<0.01);在激素治疗9个月后,血清皮质醇较治疗后6个月时有所上升(P<0.05)。结论:肾病综合征患者在糖皮质激素治疗过程中中医证候存在动态的变化规律,主要表现为从阳虚→阴虚→气阴两虚→阴阳两虚,而激素治疗导致患者的血清皮质醇下降,并在减药至维持量时肾上腺皮质功能有所恢复,这一变化规律可以为临床中西医结合治疗肾病综合征提供思路。

Objective： To study the dynamic regular pattern of TCM syndrome of patients with primary nephrotic syndrome who were treated with glucocorticoids by TCM syndrome elements differentiation method. It could provide a new treatment thought of integrated western and Chinese medicine for patients with primary nephrotic syndrome. Methods： 190 patients who were diagnosed with primary nephrotic syndrome according to the nephrology （the third edition） and treated with glucocorticoids were enrolled in this study before and three, six and nine months after treatment. General state of health and information of four methods of examination were entirely recorded during the course of therapy. Results： The most frequent types of TCM syndrome of patients with PNS treated with glucocorticoids as follow： Spleen-kidney yang deficiency, yin asthenia generating intrinsic heat, qi-yin asthenia and spleen-kidney deficiency at the time of beginning, three months, six months and nine months respectively; And the excess of the symptoms of a disease were dampness, heat and blood stasis. The rate of syndrome dement of the disease location, kidney was the highest and spleen was the second. The serum corticosteroid of patients with primary nephrotic syndrome decreased before treatment （P〈0.05）. The serum corticosteroid of patients treated with glucocorticoids obviously decreased after three months of treatment（P〈0.01）. And compared with six months, it partly elevated by the time of nine months after treatment （P〈0.05）. Conclusion： The changing regularity of TCM syndrome elements of patients with primary nephrotic syndrome treated with glucocorticoids was certainly existing and manifested from yang deficiency to yin deficiency to qi asthenla to yin-yang concurrent deficiency, the serum corticosteroid of patients treated with glucocorticoids decreased, and adrenocortical function was restored with the drug reduced to maintenance dose, which can provide a instruction to clinical oractice.