摘要
报告1例辨证论治联合西药治疗重症系统性血管炎。女,68岁;腰酸乏力、纳差;乏力易倦,时有恶心、恶寒发热,肌肉关节酸痛隐隐,无腹胀腹痛、无头昏头痛、无胸闷气急,食纳不佳,小便量少约300mL/d;血红蛋白71g/L,白细胞:11.7×109/L,中性粒细胞百分比85.8%;肾功能:肌酐696umol/L、尿素氮25.8mmol/L;血沉:131mm/h;类风湿因子:377U/mL;尿常规:蛋白++,镜检红细胞++++/HP。抗中性粒细胞胞浆抗体(ANCA)回示后考虑显微镜下微血管炎可能性较大。甲泼尼龙0.5g×3d静滴,血浆置换3次。此后改口服激素40mg治疗,并加用CTX0.5×2d后MMF0.75bid治疗治疗直至症状缓解和炎症指标恢复正常。同时辨证予清肺化痰、益肾化瘀、和络泄浊等方药。初诊时为肺肾气虚、痰湿互结,补肺益肾、化痰清利,黄芪20g,党参、白术炒、仙灵脾、菟丝子各15g,法半夏12g,泽兰、泽泻、怀牛膝各15g,陈皮炒6g,淡子芩12g,玉桔梗6g,光杏仁12g。7剂后咳嗽、咯痰等明显好转,食欲渐好,针对水肿、口腔破溃、大便干结、贫血等,加用和络化瘀之品,石韦20g,车前草15g,益母草30g,茯苓、大黄制、当归炒15g等继续口服14剂,症状明显改善。出院后门诊继续服药,考虑正虚邪恋,调整方剂为参芪地黄汤加减,随访1年,患者肾功能稳定。大剂量使用激素患者常表现出气机郁滞、湿热蕴阻中焦之证候,见脘痞胀闷、肢体困重、舌苔厚腻,应疏滞化湿泄浊,选越鞠丸合黄连温胆汤;随激素撤减及长期使用免疫抑制剂,逐渐表现为正气受损,见乏力、舌质淡,应酌入扶正药物;"湿热"、"瘀血"病理贯穿于病程,故在辨证的基础上结合辨病清利和络之法也应贯穿始终。
This report one case of diagnosis and treatment combined with Western medicine treatment of severe systemic vasculitis effect. Female, aged 68 ; backache, fatigue, anorexia; fatigue easily tired, when there is nausea, chills, fever, muscle and joint aches faint, no bloating, abdominal pain, no dizziness, headache, chest tightness, shortness of breath, no, poor food satisfied, urinating less about 300mL / d; blood： hemoglobin 71g/L, WBC： 11.7× 109/L, neutrophil percentage of 85.8%; renal function： creatinine 696umol / L, urea nitrogen 25.8mmol / L; ESR： 131mm / h; class rheumatoid factor： 377U / mL; urine： protein ＋＋, microscopic red blood cell ＋＋＋＋ / HP. 0.5g x 3d intravenous methylprednisolone, plasmapheresis three times. After this change 40mg oral steroid therapy, and the addition of CTXO.5 × 2d after MMF0.75bid therapy treatment until symptoms and inflammatory markers returned to normal. In conjunction with clearing the lungs phlegm syndrome I, kidney circulation, and network Xiezhuo and other herbs. The beginning of the disease, syndrome of kidney deficiency, phlegm each node syndrome, treatment with lungs and kidney, clearing phlegm-based, Astragalus 20g, Codonopsis, Atractylodes fried, Epimedium, Dodder each 15g, France Pinellia 12g, Zeeland, Alisma, Achyranthes 15g, fried dried tangerine peel 6g, pale child skullcap 12g, jade bellflower 6g, light almond 12g. Decoction, 1 / d. 7 After the patient cough, expectoration and other symptoms significantly improved appetite getting better. For patients with edema, mouth ulceration, dry stool, anemia and other symptoms of other drugs adjustments, plus circulation of agents and networks, plus Pyrrosia 20g, plantain 15g, Motherwort 30g, Poria, rhubarb, fried angelica 15g and so continue oral 14. Clinical symptoms improved significantly. Outpatient continue medication after discharge, consider positive imaginary evil love, adjust prescriptions for Shenqidihuang decoction, followed up a year in patients with stable renal function.
出处
《实用中医内科杂志》
2014年第8期121-123,共3页
Journal of Practical Traditional Chinese Internal Medicine
关键词
重症系统性血管炎
甲泼尼龙
清肺化痰
益肾化瘀
和络泄浊
补肺益肾
化痰清利
病例报告
Severe systemic vasculitis
Methylprednisolone
Clearing the lungs phlegm
Kidneycirculation
Network Xiezhuo
Lungs and kidney
Phlegm clearing
Case Report
