世界中医药

目的：观察黄芪建中汤加减对慢性肾炎的临床疗效及其对患者免疫应答的影响。方法：选取2013年1月至2015年3月内蒙古自治区医院收治慢性肾炎患者80例，随机分为单纯西药组及中西医结合组，每组40例。2组患者均予内科基础治疗，单纯西药组在基础治疗上加用缬沙坦（160 mg/次，1次/d）联合阿托伐他汀（20 mg/次，1次/d），中西医结合组在单纯西药组治疗方案基础上加用黄芪建中汤，1剂/d，200 mL早晚温服。2组均接受为期6个月的治疗，检测并比较2组治疗前后24 h尿蛋白定量(24 h Upro)、尿β2-微球蛋白(Uβ2-MG)、血清肌酐(SCr)、尿素氮(BUN)、尿白蛋白排泄率(UAER)、总胆固醇（TC）、三酰甘油(TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、CD4+、CD8+、Th17细胞水平、IL-17水平的变化。结果：2组患者神疲气短、腰酸、浮肿、夜尿频多、纳少、便溏症候积分较治疗前减少（P<0.05），总症候积分亦较治疗前降低（P<0.05），其中中西医结合组降低得更明显（P<0.05）；2组治疗后24 h Upro、Uβ2-MG、SCr、BUN及UAER水平均低于治疗前（P<0.05），且中西医结合组低于单纯西药组。TC、LDL-C、TG治疗后水平低于治疗前（P<0.05），而HDL-C水平则高于治疗前（P<0.05），其中中西医结合组改善的趋势较单纯西药组明显（P<0.05）。2组CD4+、CD8+及CD4+/CD8+比值均高于治疗前（P<0.05），Th17与IL-17的水平低于治疗前（P<0.05），治疗后中西医结合组与单纯西药组差异有统计学意义（P<0.05）。结论：黄芪建中汤可有效治疗慢性肾炎，其作用机制可能与改善患者免疫功能有关。

English Summary:

To observe the clinical curative effect of Huangqi Jianzhong decoction on chronic nephritis and the impact on the immune response mechanism.Methods:A total of 80 cases of chronic nephritis who received and cured in our hospital during January 2013-March 2015 included into the research, were randomly divided into the simple western medicine group (WM group) and Integration of Traditional Chinese and Western Medicine group (ITCWM group), with 40 cases in each group.Two groups of patients were both given the medicine treatment.The WM group had valsartan (160 mg/times, 1 time/day) combined atorvastatin (20 mg/times, 1 times/day) on the basic treatment, and the ITCWM group had Huangqi Jianzhong decoction on the basic therapeutic schedule of WM group, 1 agent / day, 200 mL warm-taken in the morning and evening.Both of the two groups had 6 months for a period of treatment.24 h urine protein quantitative Upro (24 h Upro), urine beta globulin (Uβ2-MG),Serum creatinine (SCr), urea nitrogen (BUN), urinary albumin excretion rate (UAER), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C), CD4+, CD8+, Th17 cell content, the changes of the IL-17 concentration of the two groups before and after treatment were tested and compared.Results:1) Spiritlessness, soreness of waist, edema, night frequent micturition, eat less, loose stool symptom scores of two groups were less than before treatment (P<0.05), and the total symptom integrals also reduced than before treatment (P<0.05).The ITCWM group reduced more significantly (P<0.05); 2) After treatment, 24 h Upro, Uβ2-MG, SCr, BUN and UAER levels in the two groups were lower than before treatment (P<0.05), and ITCWM group were lower than the WM group.3) After treatment, the TC, LDL, TG levels were lower than before treatment (P<0.05), and HDL levels were higher than before treatment (P<0.05).The improving trend of ITCWM group were much obviously than the WM group (P<0.05).4) CD4+, CD8+ and CD4+ / CD8+ ratio of the two groups were higher than before treatment (P<0.05), and the contents of Th17 and IL-17 were lower than before treatment (P<0.05).After treatment, the differences between ITCWM group and WM group were statistically significant (P<0.05).Conclusion:Huangqi Jianzhong decoction can effectively treat chronic nephritis, and the mechanism may be related to the improvement of the immune function of the patients.

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