加味补肾利湿汤配合虫类药治疗慢性肾炎蛋白尿的临床观察

Clinical observation of Modified Tonifying-kidney and Eliminating-dampness Decoction combined with medicinal insects on treatment of proteinuria in chronic nephritis

目的观察虫类药配合张炳厚教授经验方加味补肾利湿汤治疗慢性肾小球肾炎蛋白尿的疗效及安全性。方法按照随机分组原则,将64例慢性肾炎蛋白尿患者分为对照组和治疗组各32例,对照组仅予加味补肾利湿汤辨证治疗;治疗组在对照组治疗基础上加龟甲、蝉蜕、僵蚕、水蛭、全蝎、地龙、穿山甲,2组均治疗8周后观察中医证候积分、24 h尿蛋白定量及肝肾功能等变化。结果 2组治疗后中医证候积分均较治疗前下降,差异有统计学意义(P<0.01),但2组间比较差异无统计学意义。2组治疗后24 h尿蛋白定量均较治疗前下降,差异有统计学意义(P<0.01);治疗组下降较对照组更为明显,差异有统计学意义(P<0.01)。治疗过程中,2组患者生命体征平稳,复查血、尿、便常规及肝肾功能稳定,心电图及腹部超声较治疗前无明显动态变化。结论加味补肾利湿汤能够明显改善慢性肾炎蛋白尿患者症状,配合虫类药可更为有效地减少蛋白尿,安全性好。

Objective To observe the efficacy and safety of Professor ZHANG Bing-hou＇ s experienced prescription Modified Tonifying-kidney and Eliminating-dampness Decoction （MTED） combined with medicinal insects on treatment of proteinuria in chronic nephritis. Methods According to randomized principle, 64 cases of chronic nephritis with proteinuria were assigned into a control group and a treatment group, 32 cases in each one. The control group was treated with MTED. Based on the treatment in the control group, Carapax et plastrum testudinis, Periostracum cicada, Bombyx batryticatus, Hirudo, Scorpio, Lumbricus and Squama Manis were additionally applied. After 8-week treatment in two groups, TCM symptom score, 24-hour urine protein and liver-kidney function were observed. Results After the treatment, the TCM symptom scores were lowered in two groups （P 〈0. 01 ）, which were not significantly different between the groups. Compared before the treatment, the 24-hour urine protein was decreased after the treatment in both groups （P 〈 0.01 ）, which was more significant in the treatment group （P 〈 0. 01 ）. During the treatment, the vital signs were stable in two groups without any obvious dynamic change on routine test of blood, urine and stool as well as liver and kidney function, electrocardiogram and abdomen ultrasound. Conclusion The MTED could effectively improve proteinuria in chronic nephritis, which could be more effective and safe in combination of medicinal insects.