玉屏风散合真武汤加减治疗难治性肾病综合征47例

Curative effect of Yupingfeng powder combined with Zhenwu decoction on refractory nephrotic syndrome

目的探讨玉屏风散合真武汤加减对难治性肾病综合征的临床疗效。方法选取2016年5月至2018年1月首都医科大学附属北京地坛医院收治的难治性肾病综合征病人94例,采用随机数字表法分为常规组与联合组,各47例。常规组给予西医常规治疗,联合组在常规组基础上另给予玉屏风散合真武汤加减治疗。对比治疗前后中医证候积分、肾功能相关指标[血尿素氮(BUN)、血肌酐(Scr)、24 h尿蛋白定量]、血脂水平[三酰甘油(TG)、总胆固醇(TC)]及血清白蛋白(ALB)变化情况,另比较临床疗效及用药安全性,且随访1年,观察疾病复发情况。结果两组治疗后中医证候积分均低于治疗前,联合组治疗后低于常规组[(7.85±1.24)分比(10.74±2.65)分],均差异有统计学意义(P<0.05);两组治疗后BUN、Scr、24 h尿蛋白定量、TG、TC均低于治疗前,联合组治疗后低于常规组,均差异有统计学意义(P<0.05);两组治疗后ALB均高于治疗前,联合组治疗后高于常规组[(35.94±4.36)g/L比(30.21±4.08)g/L],均差异有统计学意义(P<0.05);两组临床疗效等级分布比较,差异有统计学意义(P<0.05),联合组总有效率高于常规组,差异有统计学意义(95.74%比80.85%,P<0.05);两组总不良反应发生率比较,差异无统计学意义(34.04%比27.66%,P>0.05);联合组随访1年的疾病复发率低于常规组,差异有统计学意义(0.00%比30.00%,P<0.05)。结论在西医常规治疗基础上,对难治性肾病综合征病人采用玉屏风散合真武汤加减治疗,可明显减轻临床症状,改善肾功能及ALB水平,促进血脂水平降低,提升临床疗效,减少疾病复发,且具有一定安全性。

Objective To explore the clinical effect of Yupingfeng powder combined with Zhenwu decoction on refractory nephrotic syndrome.Methods 94 patients with refractory nephrotic syndrome,admitted from May 2016 to January 2018 to Beijing Ditan Hospital Affiliated to Capital Medical University,were selected and randomly assigned into routine group and combined group,with 47 cases in each group.The routine group was treated with routine western medicine,while the combined group was treated with Yupingfeng powder combined with Zhenwu decoction on the basis of the therapy in routine group.The changes of traditional Chinese medicine(TCM)syndrome,renal function related indicators[blood urea nitrogen(BUN),serum creatinine(Scr),24 h urinary protein quantification],blood lipid level[triglyceride(TG),total cholesterol(TC)]and serum albumin(ALB)were compared before and after treatment,and the clinical efficacy and the safety of medication were compared,then follow-up was conducted for 1 year to observe the recurrence of the disease.Results The scores of TCM syndromes in the two groups after treatment were lower than those before treatment,and the scores in the combined group after treatment was lower than those in the routine group[(7.85±1.24)points vs.(10.74±2.65)points];all differences were statistically significant(P<0.05).The levels of BUN,Scr,24 h urinary protein,TG and TC in the two groups after treatment were lower than those before treatment,which in the combined group after treatment were lower than those in the routine group;all differences were statistically significant(P<0.05).The levels of ALB in the 2 groups after treatment were higher than those before treatment,which in the combined group after treatment was higher than that in the routine group[(35.94±4.36)g/L vs.(30.21±4.08)g/L],and the differences were statistically significant(P<0.05).There was a significant difference in the clinical efficacy grade distribution between the 2 groups(P<0.05),and the total effective rate of the combined group was higher than that of the routine group;the difference was statistically significant(95.74%vs.80.85%,P<0.05).There was no significant difference in the incidence of total adverse reactions between the two groups(34.04%vs.27.66%,P>0.05).The recurrence rate of disease of the combined group was lower than that of the routine group after one-year follow-up,and the difference was statistically significant(0.00%vs.30.00%,P<0.05).Conclusion On the basis of routine treatment of western medicine,the treatment of refractory nephrotic syndrome patients with Yupingfeng powder combined with Zhenwu decoction can obviously relieve clinical symptoms,improve renal function and ALB level,promote the reduction of blood lipid level,improve clinical efficacy and reduce disease recurrence,which has a certain degree of safety.