世界中医药

目的：探究防己黄芪汤加减对肾病综合征（NS）顽固性水肿患者肾功能、血清β2微球蛋白、凝血指标及炎性反应递质表达的影响。方法：选取2016年1月至2019年1月宝山区中西医结合医院收治NS顽固性水肿患者110例作为研究对象，按照就诊顺序编号随机分为对照组和观察组，每组55例。对照组常规西医治疗，观察组加用防己黄芪汤加减治疗，均治疗1个月。观察2组治疗前、治疗后肾功能、β2微球蛋白、凝血指标、炎性反应递质、血脂变化并比较；比较2组不良反应变化。结果：治疗后2组24 h尿蛋白（24 hU-pro）、尿素氮（BUN）、血肌酐（Scr）较治疗前显著下降，血白蛋白则显著升高，差异有统计学意义（P<0.05），治疗后观察组24 hU-pro、BUN、Scr显著低于对照组，白蛋白显著高于对照组，差异有统计学意义（P<0.05）。治疗后2组凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、前列腺素I2较治疗前显著升高，血栓素A2、血小板较治疗前显著下降，差异有统计学意义（P<0.05），治疗后观察组PT、APTT、前列腺素I2显著高于对照组，余显著低于对照组，差异有统计学意义（P<0.05）。治疗后2组白细胞介素-1β（IL-1β）、肿瘤坏死因子-α（TNF-α）、IL-6、IL-17较治疗前显著下降，差异有统计学意义（P<0.05），治疗后观察组以上指标显著低于对照组，差异有统计学意义（P<0.05）。治疗后2组血清β2微球蛋白、尿β2微球蛋白、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）较治疗前显著下降，差异有统计学意义（P<0.05），治疗后观察组以上指标显著低于对照组，差异有统计学意义（P<0.05）。治疗后观察组胃肠道反应、肌肉痉挛、头晕、电解质紊乱发生率显著低于对照组，差异有统计学意义（P<0.05）。结论：防己黄芪汤加减能改善NS顽固性水肿患者肾功能，抑制β2微球蛋白，改善凝血指标及炎性反应递质，降低血脂水平，且安全性高。

English Summary:

To explore the effects of Fangji Huangqi Decoction on renal function, serum β2 microglobulin, coagulation index and expression of inflammatory factors in patients with refractory edema of nephrotic syndrome(NS).Methods:A total of 110 patients with NS intractable edema who met the inclusion criteria were enrolled in Shanghai Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine from January 2016 to January 2019.They were randomly divided into a control group(55 cases)and an observation group(55 cases).The control group was treated with routine western medicine, while the observation group was treated with Fangji Huangqi Decoction for 1 month.The changes of renal function, beta 2 microglobulin, coagulation index, inflammatory factors and blood lipid were observed and compared before and after treatment in the 2 groups.And the changes of adverse reactions of the 2 groups were compared.Results:After treatment, 24-hour urinary protein(24 h U-pro), urea nitrogen(BUN), serum creatinine(Scr)in both groups decreased significantly, while albumin(Alb)increased significantly(P<0.05).After treatment, 24 h U-pro, BUN and Scr in the observation group were significantly lower than those in the control group, and Alb was significantly higher than those in the control group(P<0.05).2)After treatment, the prothrombin time(PT), activated partial prothrombin time(APTT)and prostaglandin I2 in the 2 groups were significantly increased than those before treatment, while thromboxane A2 and platelet were significantly decreased than those before treatment(P<0.05).After treatment, PT, APTT and prostaglandin I2 in the observation group were significantly higher than those in the control group, and the rest were significantly lower than those in the control group(P<0.05).3)After treatment, the levels of interleukin-1β(IL-1β), tumor necrosis factor-α(TNF-α), IL-6 and IL-17 in the 2 groups were significantly decreased than those before treatment(P<0.05), and the above indexes in the observation group were significantly lower than those in the control group(P<0.05).4)After treatment, serum β2 microglobulin, urinary β2 microglobulin, triglyceride(TG), total cholesterol(TC), low density lipoprotein cholesterol(LDL-C)of the 2 groups were significantly decreased than before treatment(P<0.05).After treatment, the above indexes of the observation group were significantly lower than those of the control group(P<0.05).5)The incidence of gastrointestinal reactions, muscle spasm, dizziness and electrolyte disturbance in the observation group were significantly lower than those in the control group after treatment, and the difference was statistically significant(P<0.05).Conclusion:Modified Fangji Huangqi Decoction can improve renal function, inhibit β2 microglobulin, improve coagulation index and inflammatory factors, reduce blood lipid level in patients with NS refractory edema, and has high safety.

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