从络论治膜性肾病低危患者临床研究

Clinical Observation of Treating Low-risk Patients of Idiopathic Membranous Nephropathy under the Guidance of the Theory of Collateral Disease

目的：以＂肾络瘀阻＂为病机,益气化瘀通络为治法,观察中医及中西医结合方案治疗特发性膜性肾病低危患者的临床疗效。方法：采用随机、对照的临床研究方法,将96例患者随机分为西药组、中西医结合治疗组和中药组。西药组给予缬沙坦,结合组在西药组基础上予中药汤剂芪苓通络方治疗,中药组予芪苓通络方,比较3组患者治疗前后临床疗效、中医症状积分、24 h尿蛋白定量、血浆白蛋白、肾功能指标的变化。结果：中药组、结合组治疗效果优于西药组（P〈0.05,P〈0.05）;治疗后24 h尿蛋白定量均下降,血浆白蛋白（ALB）升高,与西药组比较差别有统计学意义（P〈0.05,P〈0.05）;中药组、结合组各项指标差别无统计学意义（P〉0.05）;血肌酐（Scr）、尿素氮（BUN）均有下降,与西药组比较差别无统计学意义（P〉0.05）。结论：中医、中西医结合方案治疗特发性膜性肾病低危患者均可减轻患者临床症状、减少尿蛋白、保护肾功能,而中医方案更经济安全。

Objective： ＂Kidney collateral stasis＂is the pathogenesis of IMN. Adopting the method of benefiting Qi,resolving stasis and dredging collaterals,we observe the curative effect of the traditional Chinese medicine,Chinese and Western medicine program treating low-risk patients of IMN. Methods： By a randomized and comparative research methods,totally 96 patients were randomly dividedas the Western medicine group,Traditional Chinese medicine group and Chinese and Western medicine group. The Western medicine group was treated by Trochisci Levamisoli Hydrochloridi.Chinese and Western medicine group was treated by Trochisci Levamisoli Hydrochloridi and Qiling Tongluo Decoction.Traditional Chinese medicine group was treated by Qiling Tongluo Decoction. The effects,symptom scores in Chinese medicine,24 h urinary protein,plasma albumin and renal function were observed before and after the treatment. Result：Traditional Chinese medicine group and Chinese and Western medicine group was better than the Western medicine group after treatment（ P〈 0. 05,P 〈0. 05）. 24 h urinary protein was decreased and ALB level was increased after treatment.There were significant differences as compared with the Western medicine group（ P〈 0. 05,P 〈0. 05）. There were no significant differences between two groups（ P 〉0. 05）. Urea nitrogen and serum creatinine declined. There were no significant differences in three groups（ P〉 0. 05）. Conclusion： Solutions of traditional Chinese medicine and Chinese and Western medicine group can improve the symptom,reduce urine protein and protect renal function. The traditional Chinese medicine program is more economical,safe and effective.