摘要
[目的]通过对346例糖皮质激素治疗前后原发性肾病综合征患者其主症的观察,归纳辨证分型,客观论述其中医证型的演变规律。[方法]制定并使用统一的观察表,将患者的四诊信息真实地登录到观察表中,观察结束后四诊合参,使用统一的辨证标准进行中医证型判定,对原发性肾病综合征患者激素治疗前后中医证候演变的客观规律进行探索。[结果]（1）中医证候演变规律：在本虚证方面,在激素使用前,原发性肾病综合征患者以脾肾气虚及脾肾阳虚为主;在初始阶段的1~4周,以气阴两虚和脾肾气虚为主;在初始阶段的5~8周,以肝肾阴虚和气阴两虚为主;在撤减阶段,以气阴两虚为主;在维持阶段,以阴阳俱虚和脾肾阳虚为主。标实证的演变,在激素使用前,兼夹水湿、湿浊为主;使用激素1~4周后,以兼夹湿热、瘀血、湿浊为主;5~8周后,以兼夹湿热、瘀血、风动证为主;在撤减阶段,除水湿证外,其余各兼夹症均较明显;在维持阶段,以兼夹瘀血、湿热证为主。湿热、瘀血证在整个激素治疗过程中均较突出。（2）激素初始治疗阶段（1~8周）疗效与中医证型的关系：共入组130人,其中阴虚证组96人,非阴虚证组34人,结果表明,阴虚证组血清白蛋白及24小时尿蛋白定量疗效均优于非阴虚证组,具有统计学意义。[结论]激素在中医中被认为属纯阳之药,机体在纯阳药物作用下容易出现阴虚症状,则表明患者对药物的敏感性越高,而治疗的临床缓解率也越高。另外,可在临床运用激素的同时观察患者证候的变化,以期尽早判断患者对激素的敏感性。
[Objective]Based on 346 cases of PNS patients using glucocorticoids observed during treatment, the main symptoms, syndrome differentiation of syndrome type of traditional Chinese medicine（TCM） by induction, and discusses its the evolution regularity of TCM Syndromes.[Methods]Develop a unified observation table, then clinicians recorded symptoms, signs, tongue picture and type of pulse to log on to observe truthfully and un-mistakbly table, after the end of observation, comprehensive analysis by the four examination methods, using a unified standards for TCM syndrome type determination. Discussion after glucocorticoids treatment of patients with PNS TCM syndrome objective laws of evolution.[Result]First,TCM syndrome evolution： the results show that：before hormone treatment, Qi deficiency of spleen and kidney and Yang deficiency of spleen and kidney have become the most important type of syndrome;hormone use initial stages 1~4 weeks, Qi deficiency of spleen and kidney, deficiency of Qi and Yin, when the hormone used for 5~8 weeks. Yin deficiency of liver and kidney and deficiency of Qi and Yin occupied the main position; during the hormone withdrawal stage, the deficiency of Qi and Yin increased significantly; in the hormone maintain stage it was mostly deficiency of Yin and Yang and Yang deficiency of spleen and kidney. As for demonstration, in hormone therapy before a lot of patients suffering from retention of water and turbid damp; After the treatment of 1~4 weeks it was mostly humid heat,turbid damp and blood stasis; the accompanying symptoms were mostly humid heat, blood stasis and pathogenic factor of wind after the treatment of 5-8 weeks;Miscellaneous accompanying symptoms were very conspicuous except retention of water in the treatment of hormone withdrawal stage; In the hormone maintaining stage, the highest proportion of blood stasis compared with others. The use of hormone therapy, humid heat and blood stasis were more prominent than others. Second, after the hormone treatment（1~8weeks） the
出处
《浙江中医药大学学报》
CAS
2016年第9期669-676,共8页
Journal of Zhejiang Chinese Medical University
基金
江苏省临床医学科技专项--重点病种的规范化诊疗研究(BL2012032)~~
关键词
肾病综合征
糖皮质激素
证型
演变规律
阶段
阴虚证
PNS
glucocorticosteroid
syndromes
evolution regularity
stages
Yin deficiency syndrome
