芪苓通络方联合醋酸泼尼松对肾病综合征患者水肿、中医证候积分、生化指标及炎性因子的影响

Effects of Qiling Tongluo Decoction(芪苓通络方)and Prednisone Acetate on Edema,TCM Syndrome Score,Biochemical Indexes and Inflammatory Factors in Patients with Nephrotic Syndrome

目的探讨芪苓通络方辨证加减联合醋酸泼尼松片对肾病综合征患者水肿症状、中医证候积分、生化指标、炎性因子水平及临床总有效率的影响。方法选择2019年1月—2021年12月丹东市中医院收治明确诊断为肾病综合征患者118例,依据患者就诊时间将其分为对照组及观察组各59例,对入组患者均给予常规对症基础治疗,对照组在基础治疗前提下加用醋酸泼尼松片足量治疗,观察组在对照组基础上联合芪苓通络方辨证加减治疗,两组治疗周期均为4周,疗程结束后,观察两组患者治疗前后水肿情况、中医证候积分变化情况、生化指标[24 h尿蛋白定量、血清白蛋白(Alb)、血肌酐(Scr)]、炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、白细胞介素-18(IL-18)、转化生长因子-β(TGF-β)]水平,同时对两组患者临床总有效率进行对比。结果治疗后,两组患者平均24 h总尿量均比治疗前明显增加,且观察组患者尿量比对照组增加更明显;两组患者体质量均较治疗前明显下降,且观察组下降更明显;观察组患者水肿消退时间明显短于对照组;两组患者24 h尿蛋白定量、血清Scr值、TNF-α、IL-8、IL-18、TGF-β水平及疲惫乏力、浮肿、畏寒肢冷、纳呆少食等中医证候积分均明显低于治疗前,且观察组明显低于对照组;两组患者Alb指标均显著高于治疗前,且观察组较对照组升高更明显。观察组的总有效率显著优于对照组,均P<0.05,提示上述对比均有统计学意义。结论对症治疗基础上,应用足量激素治疗肾病综合征是经典的治疗方案,疗效确切,但在此基础上联合芪苓通络方辨证加减中药汤剂,疗效更显著,不论是水肿情况、中医证候积分还是对患者肾功能及炎性因子水平改善程度,均显著优于单纯激素治疗,因此建议临床治疗肾病综合征时,尤其是需足量激素治疗时,应优先考虑联合中药汤剂治疗。

Objective To investigate the effect of Qiling Tongluo Decoction(芪苓通络方)plus Prednisone Acetate Tablets on edema symptoms,TCM syndrome scores,biochemical indicators,levels of inflammatory factors and clinical total effective rate in patients with nephrotic syndrome.Methods From January 2019 to December 2021,118 patients with nephrotic syndrome who were definitely diagnosed in Dandong hospital of traditional Chinese medicine were selected.They were divided into control group and observation group with 59 patients each according to their visit time.All the patients in the group were treated with conventional symptomatic basic treatment.The control group was treated with prednisone acetate tablets in full amount on the premise of basic treatment.The observation group was treated with Qiling Tongluo Decoction on the basis of syndrome differentiation plus or minus on the basis of the control group,the treatment cycle of both groups was 4 weeks.After the treatment,to observe the edema,changes in TCM syndrome scores,biochemical indicators[24 h urine protein quantity,serum albumin(Alb),serum creatinine(Scr)],inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-8(IL-8),interleukin-18(IL-18),transforming growth factor-β(TGF-β)]of the patients in both groups before and after treatment.At the same time,the total clinical effective rate of the two groups was compared.Results After treatment,the average 24 h total urine volume of the patients in both groups increased significantly compared with that before treatment,and the urine volume of the patients in the observation group increased more significantly than that in the control group;The weight of patients in both groups decreased significantly compared with that before treatment,and the weight of patients in the observation group decreased more significantly;The time of edema regression in the observation group was significantly shorter than that in the control group;24 h urine protein quantity,serum Scr value,the level of TNF-α,IL-8,IL-18,TGF-βand TCM syndrome scores of fatigue,fatigue,edema,chilly limbs,and lack of food were significantly lower than before treatment,and the observation group was significantly lower than the control group;Alb index of patients in both groups was significantly higher than that before treatment,and the observation group was significantly higher than the control group.The total effective rate of the observation group was significantly better than that of the control group(P<0.05),indicating that the above comparison was statistically significant.Conclusion On the basis of symptomatic treatment,the treatment of nephrotic syndrome with adequate hormone is a classic treatment scheme with definite effect.However,on this basis,the combination of Qiling Tongluo Decoction and traditional Chinese medicine decoction based on syndrome differentiation has a more significant effect.No matter the edema situation,the score of traditional Chinese medicine syndromes,or the improvement of the patients'renal function and inflammatory factor level,it is significantly better than the simple hormone treatment.Therefore,it is recommended that when treating nephrotic syndrome in clinical,Especially when sufficient hormone treatment is needed,the combination of traditional Chinese medicine decoction should be given priority.