肾灵汤辅助小剂量激素+环孢素A治疗原发性肾病综合征的疗效分析

Curative Effect Analysis of Small Doses Hormones and Cyclosporine A to Treat Primary Nephrotic Syndrome with Adjuvant Therapy of Shenling Decoction

目的:观察肾灵汤辅助小剂量激素+环孢素A治疗原发性肾病综合征的临床疗效及血液高凝状态的影响。方法:将肾病综合征患者85例随机按住院顺序分为对照组42例和观察组43例,两组均给予一般对症、支持治疗,对照组采用小剂量激素+环孢素A,观察组在对照组治疗的基础上加用肾灵汤辨证加减治疗。两组疗程均为6个月。检测治疗前后24 h尿蛋白定量,血浆白蛋白(ALB)水平,总胆固醇(TC)和甘油三脂(TG)水平;检测治疗前后血液流变指标;检测前后血清血栓素(TXB2)和6-酮-前列腺素F_(1a)(6-Keto-PGF_1a)水平;监测肝、肾功能,记录研究过程出现的不良反应。结果:观察组综合疗效总有效率为100%优于对照组的83.3%;治疗后观察组24 h尿蛋白定量、TC,TG均低于组(P<0.01),观察ALB水平高于对照组(P<0.01),观察组ALT和Cr水平低于对照组(P<0.01);治疗后观察组全血黏度(低切、高切)、红细胞聚集指数、血浆黏度、纤维蛋白原及全血还原黏度(低切、高切)的改善优于对照组(P<0.01);治疗后观察组TXB2低于对照组(P<0.01),治疗后观察组6-keto-PGF_1a高于对照组(P<0.01);观察组柯兴氏综合征、肝肾功能异常、感染及胃肠反应的发生率均低于对照组(P<0.05)。结论:肾灵汤辅助小剂量激素+环孢素A治疗原发性肾病综合征能起到增效减毒作用,并且能调节患者血脂代谢,促进血液循环,改善患者血高凝状态。

Objective：Observe the clinical effects and hypercoagulable state influence of small doses hormones and cyclosporine A to treat primary nephrotic syndrome with adjuvant therapy of Shenling decoction.Method：Eighty-five cases of patients with nephrotic syndrome were randomly divided into control group （42 cases） and observation group （43 cases） by the sequence of hospital.Both groups were treated with general symptomatic,supportive treatment.The patients in control group took small doses hormones and cyclosporine A.In observation group,patients added Shenling decoction by dialectical add and subtract treatment.Treatment courses for the two groups were six months.Detect urine protein quantitation of 24 hours,level of albumin （ALB）,total cholesterol （TC） and triglyceride （TG） before and after treatment.Test blood rheological index,level of serum thromboxane （TXB2） and 6-Ketone-prostaglandin F_（1a） （6-Keto-PGF_ 1 a） in pretherapy and post-treatment.Monitor function of liver and kidney.Record untoward effect at the research process.Result：The comprehensive total effective rate of observation group was 100％ superior to control group 83.3％.After treatment,urine protein quantitation of 24 hours,TC and TG of observation group were lower than control group （P ＜ 0.01）,the level of ALB of observation group was superior to control group （P ＜ 0.01）,the level of ALT and Cr of observation group were lower than control group （P ＜0.01）.the improvements of blood viscosity （low shear,high shear）,red cell assembling index,plasma viscosity,fibrinogen and whole blood reductive viscosity （low shear,high shear） of observation group were superior to control group （P ＜ 0.01）.TXB2 of observation group was lower than control group （P ＜ 0.01）,6-keto-PGF_ 1a of observation group was higher than control group （P ＜ 0.01）.the occurrence rates of Cushing＇s syndrome,abnormality of hepatorenal function,infection and gastrointestinal reaction of observation group were lower than control group （P ＜ 0.05）.Conclusion：It can improve the efficacy and reduce the toxicity when Shenling decoction with small doses hormones which combined with cyclosporin A used in primary nephrotic syndrome,and can adjust blood lipid metabolism of patients,promote blood circulation,improve the hypercoagulable state condition of patients.