单中心原发性慢性肾小球肾炎治疗效果及其影响因素分析.pdfVIP

CGN临床表现多样，其中蛋白尿是主要的表现之一，也是作为临床疗效评价的重 要指标。本研究提示本中心尿蛋白治疗效果较好，且肾炎康复片、接受慢病管理以及 基线血肌酐和血清白蛋白水平是蛋白尿转阴的独立影响因素。肾炎康复片是临床验方 制成的中药，具有益气养阴、健脾益肾等功效，且与纳入患者的主要中医证型相对应。 这可能是肾炎康复片成为独立影响因素的重要原因，也提示中医药在CGN蛋白尿的治 疗方面确实具有重要的作用。血清肌酐升高与持续蛋白尿及肾脏结构损伤相关，故成 为影响蛋白尿转阴的危险因素。血清白蛋白低的患者可能更受医护人员关注，因此疗 效可能相对较好。本中心的中医慢病管理是医护人员通过与患者长期有效地沟通教 育，提高患者对CGN病情的认知度及治疗依从性，同时引导其尽可能进行中医特色的 饮食和运动，减少疾病危险因素，从而提高临床疗效。中医特色慢病管理对于CGN的 尿蛋白预后和终点预后都是独立保护因素，提示本中心的中医慢病管理方案在提高临 床疗效方面可能起一定的作用。中医慢病管理应该成为CGN常规治疗的重要组成部分。 但本研究结果还存在一些局限性，仍需要大样本量的、随访时间更长的前瞻性临床研 究来证实。 关键词： 慢性肾小球肾炎；蛋白尿；肾小球滤过率；影响因素；慢病管理 II A Retrospect i ve S i ng I e Center Study：Curat i Me Effect and I nf I uence Factor s of Pr i mary Chron i C G I omeru I onephr i t i S SpeciaIty：NephroIogy and TraditionaI Chinese MediCi Re Author：0IN Xin-dong Tutor：LIU Xu—sheng Abstract ObJect ive Primary chronic 910merularnephritis (CGN) is the leading cause of end—stage renal disease(ESRD)，which is insidious during onset and hard to be cured．Currently，western medicine treatment of CGN has been researched systematically，however，Chinese medicine treatment researches were still scattered，especially in long～term prognosis field．Meanwhile，there was no systematic and comprehensive research of chronic disease management on the influence on CGN prognosis．Therefore，this research is going to analyze data collection and collation of CGN cases from nephrology department of Guangdong Provincial Hospital of Chinese Medicine in the past five years．We observed the changing situation of proteinuria and estimating glomerular filtration rate(eGFR)to analyze various influence factors，in order to provide a reference for Cl i ni cal pract i ce and further research． Methods The subjects were those CGN patients with proteinuria and eGFR≥ 30ml／(rain·1．73m2)who regularly consul ted in nephrology department of Ouangdong Provincial Hospital of Chinese Medicine from 2010 to 2014，under the age of 14—80．Those participants whose cl inical data was incomplete or follow—up period was less than six months were exclu