养阴益肾颗粒干预激素治疗肾病综合征所致肾阴虚证的临床研究

A Clinical Study of Treating Kidney-yin Deficiency Syndrome Caused by Glucocorticoids in Nephrotic Syndrome with Yangyin Yishen Particles

目的:观察养阴益肾颗粒(滋阴补肾法)对糖皮质激素(glucocorticoids,GCs)治疗肾病综合征(nephrotic syndrome,NS)所致肾阴虚证的疗效。方法:将GCs治疗后出现肾阴虚证的360例NS患者随机分为治疗组、对照组和空白组,各120例。在基础治疗的同时,治疗组予养阴益肾颗粒(12 g/袋,每次12 g,每日3次,温水100 ml冲服),对照组予六味地黄丸(每次8粒,每日3次),空白组不予中药干预,共给药4周。观察各组治疗前后肾阴虚症状,促肾上腺皮质激素(adrenocorticotrophic hormone,ACTH)、皮质醇(cortisol,CORT)、24 h尿游离皮质醇(24 hour urine free cortisol,24 h UFC)、总胆固醇((total cholesterol,TC)、三酰甘油(triglyceride,TG)、高密度脂蛋白(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白(low density lipoprotein cholesterol,LDL-C)、载脂蛋白AⅠ(apolipoprotein AⅠ,Apo AⅠ)、载脂蛋白B(apolipoprotein B,Apo B)以及CD_3^+T、CD_4^+T和CD_8^+T淋巴细胞亚群等指标的变化。结果:与本组治疗前比较,治疗组肾阴虚症状积分、TG、LDL-C和Apo B降低(P<0.05,P<0.01),ACTH、CORT、24 h UFC、CD_3^+T和CD_4^+T均升高(P<0.05,P<0.01);对照组症状积分、TG、LDL-C和Apo B降低(P<0.05)。与空白组治疗后比较,对照组症状积分、TG、LDL-C和Apo B均降低(P<0.05),ACTH、CORT、24 h UFC、CD_3^+T和CD_4^+T均升高(P<0.05)。与对照组治疗后比较,治疗组症状积分和TG降低(P<0.05),CORT、24 h UFC和CD_4^+T均升高(P<0.05)。结论:养阴益肾颗粒能减轻激素治疗肾病综合征所致肾阴虚证的临床证候,升高血ACTH、CORT和24 h UFC浓度,降低血TG、LDL-C和Apo B水平,提高CD+3T和CD+4T淋巴细胞计数。

Objective：To observe the therapeutic effect of Yangyin Yishen Particles on kidney-yin deficiency syndrome caused by glucocorticoids in nephrotic syndrome. Methods：360 cases with kidney-yin deficiency syndrome caused by glucocorticoids therapy in nephrotic syndrome were randomly divided into treatment group,control group and blank group,120 in each group. With the same basic cure,patients in the treatment group received Yangyin Yishen Particles（ 12 g/bag,12 g each time,three times per day,take with 100 m L warm water）. Patient in the control group took Liuwi Dihuang pills（8 pills each time,3 times per day）. Patients in the blank group was not intervened by traditional Chinese Medicine. The therapeutic course for all was 4 weeks. Then the change of kidney-yin deficiency symptom scores,the level of adrenocorticotropic hormone（ ACTH）,cortisol（ CORT）,24 h urinary free cortisol（24 h UFC）,total cholesterol（ TC）,triglyceride（ TG）,high density lipoprotein（ HDL-C）,low density lipoprotein（LDL-C）,apolipoprotein AⅠ（Apo A I）,apolipoprotein B（Apo B）,CD3＋ T,CD4＋ T and CD8＋ T lymphocyte subsets were observed.Results：Compared with the before treatment,the kidney-yin deficiency syndrome symptom scores,TG,LDL-C and Apo B reduced（P 〈 0. 05,P 〈 0. 01）,ACTH,CORT,24 h UFC,CD3＋ T and CD4＋ T increased（ P 〈 0. 05,P 〈 0. 01） in the treatment group. The symptom scores,TG,LDL-C and Apo B reduced（ P 〈 0. 05） in the control group. Compared with the blank group after treatment,the symptom scores,TG,LDL-C and Apo B reduced（ P 〈 0. 05）,ACTH,CORT,24 h UFC,CD3＋ T and CD4＋ T increased（ P 〈0. 05） in the control group. Compared with the control group after treatment,the symptom scores,TG reduced（ P 〈 0. 05）,CORT,24 h UFC and CD＋4 T increased（ P 〈 0. 05）. Conclusion：Yangyin Yishen Particles can reduce the clinical syndrome of kidney-yin deficiency syndrome caused by GCs in nephrotic syndrome,elevate the blood concentration of ACTH,CORT and 24 h UFC,reduce the serum level of TG,LDL-C and Aop B,increase the count of CD3＋ T and CD4＋ T.