中药分期联合西药治疗肾病综合征随机平行对照研究

Nephrotic Nyndrome Combined with Western Medicine Treatment Staging Randomized Controlled Study

[目的]观察中药分期联合西药治疗肾病综合征疗效。[方法]使用随机平行对照方法,将60例住院患者按掷骰子法简单随机分为两组。对照组30例高热量、低盐（〈3g/d）、优质蛋白饮食126-148k J/kg;利尿消肿不宜过快,可造成血容量过低,加重血液黏稠,诱发血栓等;氢氯噻嗪,25mg/次,3次/d;呋塞米,20-120mg/次,1次/d,预防低钠、低钾、低氯血症性碱中毒;泼尼松,1mg/kg,初始剂量要足、减药慢、长时间服用,晨起顿服,最大剂量〈80mg/d;每7-14d减至原来10%,最小剂量（10mg/d）。治疗组30例中药分期：激素开始阶段（生黄芪40g,生地20g,黄柏12g,旱莲草、女贞子各15g,丹皮12g,知母15g,甘草6g）;激素减量阶段（白术-炒、生地各20g,生黄芪40g,太子参30g,补骨脂15g）;激素维持阶段（生黄芪40g,白术-炒20g,何首乌、菟丝子各15g,猪苓10g,淫羊藿15g,茯苓10g）;辅以活血化瘀（丹参10g,当归、益母草各15g,水蛭、怀牛膝各10g）,1剂/d,水煎400m L,早晚口服,200m L/次;西药治疗同对照组。连续治疗56d为1疗程。观测临床症状、24h尿蛋白量、TP、ALB、不良反应。治疗1疗程,判定疗效。[结果]治疗组显效17例,有效10例,无效3例,总有效率90.00%。对照组显效10例,有效8例,无效12例,总有效率60.00%。治疗组疗效优于对照组（P〈0.01）。血液指标两组均有改善（P〈0.05）,治疗组改善优于对照组（P〈0.01）。[结论]中药分期联合西药治疗肾病综合征疗效满意,无严重不良反应,值得推广。

[Objective]To observe the effect of staging combined with western medicine nephrotic syndrome.[Methods]Randomized parallel controlled method,60 cases of hospitalized patients were randomly divided into two groups craps method is simple.The control group 30 cases of high-calorie,low salinity（3g/d）,high-protein diet 126-148KJ/kg;swelling diuretic can not be too fast,otherwise it may cause hypovolemia,leading to worse blood viscosity,induce thrombosis disease;thiazide diuretic hydrochlorothiazide,25mg/time,3 times/d,attention hyperkalemia;loop diuretics furosemide,20-120mg/times,1 times/d,prevent hyponatremia,hypokalemia,low chlorine hyperlipidemia alkalosis;glucocorticoid prednisone,1mg·kg^-1,the initial dose should be sufficient,reduce the dosage slowly,taking a long time; prednisone, 1mg·kg^-1, early morning serving Dayton, the maximum dose80mg/d;reduced the original 10 percent every 7-14d,the lowest dose（10mg/d）. Chinese medicine treatment group, 30 cases of stage： beginning hormone（Shenghuangqi 40 g, Shengdi 20 g, Huangbai 12 g, Hanlaincao, Nvzhenzi 15 g, Danpi 12 g, Zhimu 15 g, Gancao 6g）;hormone reduction stage（Baizhu,Shengdi 20 g, Shenghuangqi 40 g, Taizishen 30 g, Buguzhi 15g）; maintenance phase（Shenghaungqi 40 g,Baizhu 20 g, Heshouwu,Tusizi 15 g, Zhuling 10 g,Yinyanghuo 15 g, Fuling 10g）; auxiliary blood circulation（Danshen 10 g,Danggui,yimucao15 g, Shuizhi, Huainiuxi 10g）,1 ji/d,decoction 400 m L, sooner or later, oral, 200 m L/second;western medicine with the control group.56 d for a course of continuous treatment. Observation of clinical symptoms,24 h urine protein,TP,ALB,adverse reactions. One course of treatment,to determine efficacy. [Results] The treatment group 17 cases,10 cases,3 cases,the total efficiency of 90.00%.The control group 10 cases markedly effective in 8 cases,12 cases,the total efficiency 60.00%.Treatment group than the control group（P〈0.01）. Two blood indicators have improved（P〈0.05）,the treatment group than the control group improved（P〈0.01）. [Conclusion] TCM combined with Western medicine treatment stage nephropathy syndrome satisfied, no serious adverse reactions,is worth promoting.