加味胃苓汤治疗湿热型原发性肾病综合征水肿期疗效及其对炎症因子的影响

Therapeutic Effect of Modified Weiling Decoction for Edema of Damp-heat Type of Primary Nephrotic Syndrome and Its Influence on Inflammatory Factors

【目的】观察加味胃苓汤治疗湿热型原发性肾病综合征水肿期疗效及其对炎症因子的影响。【方法】采用随机数字表法将70例湿热型原发性肾病综合征水肿期患者随机分为治疗组40例和对照组30例。治疗组失访4例,对照组失访5例,实际纳入病例为治疗组36例,对照组25例。2组均予常规西医治疗,治疗组加用加味胃苓汤,2组疗程均为4周。观察2组治疗前后临床症状积分、生化指标、利尿效果及炎症因子超敏C反应蛋白(hsCRP)、白细胞介素-18(IL-18)、白细胞介素-1β(IL-1β)等的变化情况。【结果】(1)治疗组总有效率为88.89%,对照组为80.00%,治疗组疗效有优于对照组趋势,但2组比较差异无统计学意义(P>0.05)。(2)治疗后,2组的血肌酐水平较治疗前略有好转,但差异无统计学意义(P>0.05);2组的血清白蛋白均显著升高,24 h尿蛋白定量显著降低,差异有统计学意义(P<0.05),且治疗组的改善优于对照组,差异有统计学意义(P<0.05);治疗后,2组的血脂指标总胆固醇均降至正常水平,与治疗前比较差异均有统计学意义(P<0.05),但2组治疗后比较差异无统计学意义(P>0.05)。(3)治疗后,2组的hsCRP、IL-18、IL-1β均显著降低,与治疗前比较差异均有统计学意义(P<0.05),且治疗组的降低作用优于对照组,差异有统计学意义(P<0.05)。(4)治疗组的全身水肿消退时间为(9.8±2.7)d,对照组为(11.9±3.7)d,治疗组的利尿效果优于对照组,2组比较差异有统计学意义(P<0.05)。【结论】在常规激素治疗基础上加用加味胃苓汤治疗原发性肾病综合征湿热证疗效确切。

Objective To investigate the therapeutic effect of modified Welling Decoction for the edema of damp- heat type of primary nephrotic syndrome, and to observe its influence on inflammatory factors. Methods Following the random number, 70 cases edema patients with damp-heat primary nephrotic syndrome were randomly divided into two groups. Control group had 30 cases, and finally left 25 for 5 cases lost during the follow-up. Treatment group had 40 cases, and finally left 36 for 4 cases lost during the follow-up. Both groups were treated with routine western medicine, and the treatment group was given modified Welling Decoction additionally. The treatment lasted 4 weeks, and the clinical symptoms scores, blood bio-chemical indexes, diuretic effect, and inflammation factors of hypersensitive C-reactive protein （hsCRP）, interleukin-18 （IL-18） and interleukin-1β （IL-1β） were observed before and after treatment. Results The total effective rate was 88.89% in the treatment group and was 80.00% in the control group, and the difference between the two groups was insignificant （P〉0.05）. After treatment, serum creatinine （SCr） in both groups showed a decreasing trend, but the difference was insignificant （P〉0.05）. Serum albumin was increased, 24-hour urine protein quantitation was decreased in both groups （P〈0.05 compared with those before treatment） , and the changes were more obvious in the treatment （P〈0.05）. Total cholesterol content was decreased to the normal level in both groups after treatment group （P〈0.05 compared with that before treatment）, but the difference between the two groups was insignificant （P〉0.05）. In the two groups, hsCRP, IL-18 and IL-1β were also reduced significantly （P〈 0.05 compared with those before treatment）, and the decrease was more obvious in the treatment group （P〈0.05）. The time for general dropsy disappearing was 9.8±2.7 days in the treatment group, and was 11.9±3.7 days in the control group, the difference being significant between the two groups （P〈0.05）. Conclusion Modified Welling Decoction combined with routine hormone therapy shows certain effect for the treatment of edema of damp-heat primary nephrotic syndrome.