辨证分期治疗联合中药足浴治疗慢性尿酸性肾病临床研究

Clinical Study on Syndrome Differentiation and Stage Treatment Combined with Traditional Chinese Medicine Foot Bath in Treating Chronic Uric Acid Nephropathy

目的:观察辨证分期治疗联合中药足浴在慢性尿酸性肾病患者及预防远期复发的效果,总结其临床应用价值。方法:选择2016年6月~2017年8月我院确诊治疗的慢性尿酸性肾病患者96例纳入分析,将受试患者分为观察组和对照组,对照组接受常规中长程疗法,包括低嘌呤饮食,大量饮水,口服或静滴NaHCO3碱化尿液,同时避免使用抑制尿酸排泄的药物治疗;观察组在对照组基础上,辨证分期治疗联合中药足浴。收集患者治疗前后(治疗后6周)免疫功能指标,包含血清免疫球蛋白IgA、IgM以及IgG,并对预后进行评估(包括临床症状评估及生活质量评估两个部分)。本研究随访12个月,观察复发率等综合分析评价。结果:治疗前观察组与对照组组间血清IgA、IgM、IgG水平差别无统计学意义(P>0.05),治疗后差别有统计学意义(P<0.05),并且观察组治疗前后IgA、IgM、IgG水平差别有统计学意义(P<0.05),而对照组疗前后三项指标虽有一定变化,但差异无统计学意义(P>0.05)。对照组关节炎、痛风结节、水肿、夜尿、躯体功能、情绪功能评分与观察组比较,差异有统计学意义(P<0.05)。随访发现,两组不良反应发生率差异有统计学意义。研究中观察组在3~6个月,6~12个月以及12~18个月不同时间段的复发率均较对照组低,且差别有统计学意义(P<0.05)。结论:辨证分期治疗联合中药足浴治疗慢性尿酸性肾病,疗效显著,可临床推广应用。

Objective: To observe the effect of syndrome differentiation and stage treatment combined with traditional Chinese medicine foot bath on patients with chronic uric acid nephropathy and prevent long-term recurrence,and to summarize its clinical application value.Methods: Ninety-six patients with chronic uric acid nephropathy admitted to our hospital from June 2016 to August 2017 were enrolled in the observation group and the controlled group according to the treatment plan.The study group would be observed in the observation group and the controlled group.The controlled group received routine long-term and long-term therapy,including low-grade diet,plenty of drinking water,oral or intravenous NaHCO3 alkalized urine,while avoiding the use of drugs that inhibit uric acid excretion.The observation group was based on the controlled group.Syndrome differentiation and stage treatment combined with traditional Chinese medicine foot bath was treated by Chinese medicine dialectical staging.The immune function indicators(immunoglobulin IgA,IgM,IgG) were measured before and 6 weeks after treatment.The prognostic evaluation included two parts: clinical symptom assessment and quality of life assessment.The scores of each sub-item were given by subjective scoring system.(Between 1-5 points in the division,the lower the score,the less ideal the prognosis).The clinical symptoms assessment includes: arthritis,gout nodules,edema,nocturia,low back pain,hematuria,frequent urination,urgency,dysuria and fever;specific quality of life assessment includes: physical function,emotional function,cognitive function,social function.The patients were followed up for 12 months and the recurrence rate was observed.Results: There were no significant differences in serum IgA,IgM and IgG levels between the two groups before treatment,P > 0.05.There were significant differences in serum IgA,IgM and IgG levels between the two groups after treatment(P < 0.05).There were significant differences in serum IgA,IgM and IgG levels between the observation group and the controlled group before and after treatment(P < 0.05).There were some changes in serum IgA,IgM and IgG levels before and after treatment in the controlled group,but the difference was not statistically significant,P > 0.05.Arthritis,gout nodules,edema,nocturia,physical function,and emotional function scores in the controlled group were lower than those in the observation group,and the difference was statistically significant(P < 0.05).During the 12 months follow-up,the incidence of adverse reactions was significantly different between the two groups,P < 0.05.The recurrence rate of the observation group was significantly lower than that of the controlled group at 3 to 6 months,6 to 12 months,and 12 to 18 months.The difference was statistically significant(P < 0.05).Conclusion: Syndrome differentiation and stage treatment combined with traditional Chinese medicine foot bath is effective in patients with chronic uric acid nephropathy.Clinical promotion can be considered.