IgA肾病宏观与微观结合辨证治疗研究

Study on the combination of macro and micro syndrome differentiation treatment in IgA nephropathy

目的:观察宏观与微观结合辨证治疗IgA肾病的疗效,探讨微观指标对该病中医证候诊断的价值。方法:将入选的156例患者随机分为微观辨证治疗组和对照组各78例,对照组应用西药常规疗法,治疗组在对照组治疗基础上采用宏观资料与微观指标相结合法进行中医辨证治疗,观察期3个月。结果:治疗组气虚证21例,气阴两虚30例,肝肾阴虚15例,脾肾阳虚12例。治疗3个月后治疗组完全缓解率和总有效率明显高于对照组(P<0.05,P<0.01);治疗组尿蛋白(Upro)、血白蛋白(ALB)、血肌酐(Scr)、估计肾小球滤过率(e GFR)、血胆固醇(TC)及甘油三酯(TG)较治疗前有显著改善(P<0.01,P<0.05),对照组Upro、ALB及TG治疗前后比较有显著改善(P<0.01,P<0.05),治疗组Upro及ALB较对照组改善更明显(P<0.01,P<0.05)。治疗组气虚证完全缓解率和总有效率最高,其次为气阴两虚证;完全缓解和总有效患者中,各证型分布差异有统计学意义(P<0.01,P<0.05),其中气虚证占比最高,脾肾阳虚证最低。结论:宏观与微观结合辨证、中西药结合治疗可以显著提高Ig A肾病临床疗效。

Objective： To observe the curative effect of syndrome differentiation treatment in IgA nephropathy by combination with macro and micro method to explore the diagnostic value of microscopic indexes in syndrome differentiation of IgA nephropathy. Methods： One hundred and fifty-six patients with IgA nephropathy were randomly divided into two groups, the 78 patients in the control group treated with conventional western medicine therapy, and the other 78 patients in the treated group given the TCM syndrome differentiation treatment with combination of macro information and microscopic indexes on the basis of the control group. All patients were treated for 3 months. Results： There were four TCM syndrome types in treated group, including 21 patients with syndrome of qi deficiency, thirty patients with syndrome of deficiency of both qi and yin, fifteen patients with syndrome of yin deficiency of liver and kidney and 12 patients with syndrome of yang deficiency of spleen and kidney. After 3 months treatment, the complete remission rate and total effective rate of the treatment group were significantly higher than those of the control group（P〈0.05, P〈0.01）. Although the total urinary protein（Upro）, blood albumin（ALB）, serum creatinine（Scr）, e GFR, serum cholesterol（TC） and triglyceride（TG） were all significantly improved in treated group and the level of Upro, ALB, TG were improved in control group（P〈0.01, P〈0.05）, the lower level of Upro and ALB were showed in treatment group comparing with control group（P〈0.01, P〈0.05）. The patients with complete remission and total efficiency in treatment group mainly belonged to the syndrome of qi deficiency, followed by the syndrome of deficiency of both qi and yin. The significant result was showed in the distribution of four syndrome types with complete remission and total efficiency in patients（P〈0.01, P〈0.05）, in which the highest proportion is syndrome of qi deficiency, the lowest is syndrome of yang deficiency of spleen and kidney. Conclusion： Integration of traditional Chinese and western medicine treatment of IgA nephropathy in combination with micro and macro syndrome differentiation can significantly improve the clinical curative effect.