益肾降浊汤治疗慢的性肾功能衰竭的临床观察.doc

益肾降浊汤治疗慢性肾功能衰竭的临床观察 及对血清瘦素的影响 专业：中医内科 研究生：叶彬华 导师：阮诗玮 教授 主任医师 吴竞 副主任医师 摘 要 ABSTRACT 目的：观察益肾降浊汤治疗慢性肾功能衰竭（CRF）的临床疗效及治疗前后血清瘦素（leptin）水平的变化情况，并探讨瘦素与中医的病因之间的联系，为中西医结合治疗CRF提供理论依据和临床论证。 资料与方法：按中华内科杂志标准及全国中医肾衰研讨会标准，选择CRF患者40例，随机分治疗组20例，对照组20例。选择正常健康对照组20例。治疗组用益肾降浊汤治疗，对照组用单味大黄治疗，观察治疗前后尿素氮，肌酐，肌酐清除率，白蛋白，血红蛋白，瘦素等指标及临床症状的变化，观察CRF患者与正常人血清瘦素水平的区别。采用放射免疫法检测血清瘦素含量。 结果：（1）治疗组临床疗效优于对照组（P0.05）；（2）CRF患者血清Leptin水平显著高于正常健康对照组（P0.01）；（3）治疗组降低血清瘦素水平明显优于对照组（P0.01）；（4）患者血清瘦素与临床症状（食少纳呆）有显著正相关（P0.01）；（5）患者血清瘦素与肌酐清除率显著负相关、与血肌酐有显著正相关（P0.01）。 结论：（1）益肾降浊汤治疗慢性肾功能衰竭的临床疗效优于单味大黄；（2）CRF患者血清Leptin升高，是肾小球清除率下降的结果。（3）Leptin具有尿毒症毒素的特点，与食少纳呆症状呈正相关，可将瘦素归结为湿浊毒邪。（4）益肾降浊汤通过补益脾肾、降浊祛瘀的作用，对慢性肾功能衰竭辨证属脾肾气虚证为主者，起到显著改善症状，改善肾功能并能延缓慢性肾功能衰竭进展。（5）益肾降浊汤能降低CRF血清瘦素水平，可能是其获得疗效的机理之一。 主题词：肾功能衰竭，慢性/中医药疗法 补益脾肾 祛瘀 肾/病理生理学 瘦素/血液 @益肾降浊汤 Clinical effect of Yishenjiangzhuo Decoction for Chronic Renal Failure and effect to serum Leptin Major: Traditional Chinese Medicine Postgraduate: Yue Binhua Tutor: Prof. Ruan Shiwei Deputy Chief Physician. wu jing ABSTRACT Objectives: To observe the clinical result of Yishenjiangzhuo Decoction in patients with chronic renal failure (CRF) and the change of serum leptin level.To explore the relationship of leptin and the cause of disease of traditional Chinese medition. Materials and Methods: According to the standard in Chinese journal of internal medicine and national symposium of TCM, 40 patients with CRF were divided into treatment group and contrast group at random, treatment group is 20 case and contrast group is also 20 case ,20 healthy people were taken as the normal group, Patients of treatment group took the Yishenjingzhou decoction, Patients of contrast group took the Chinese Rhubarb.Observe the change of Blood urea nitrogen(BUN) 、serum creatinine (Scr) 、clearance of endogenous creatinine(Ccr)、Albumin、Hemoglobin、 serum Leptin levels and symptom in before and after therapy. Serum Leptin level were detected by