【作者】 李云；

【导师】 司国民；

【作者基本信息】 山东大学 ， 中西医结合临床， 2007， 硕士

【摘要】 目的：通过临床与实验研究，阐明参芪解毒汤的部分作用机理，验证其疗效，为临床应用提供科学的理论和实践依据，并以方现法，用本方来体现益气活血，解毒泻浊，温阳固肾之法治疗慢性肾衰竭的作用。方法：（一）临床研究按照随机对照原则，将64例慢性肾衰竭病人分为治疗组（常规西药对症治疗加用参芪解毒汤）36例；对照组（常规西药对症治疗加科索亚）28例，4周为1疗程，共2疗程。重点观察治疗前后患者的症状评分以及血肌酐（SCr）、尿素氮（BUN）、肌酐清除率（Ccr）、血红蛋白（Hb）、血清白蛋白（ALB）、甘油三脂（TG）、胆固醇（CHO）。（二）实验研究采用腺嘌呤制作大鼠CRF模型，分为5组：正常组、模型组、科索亚组及参芪解毒汤高、低剂量组，治疗8周后，测量各组SCr、BUN、ALB、TG、CHO；放射免疫法测CRF大鼠血清瘦素（Leptin）水平，观察各组大鼠肾脏组织病理结果以及免疫组化法观察转化生长因子TGF-β₁在肾组织的表达。结果：（一）临床研究，治疗组总有效率为83.33％，对照组总有效率为60.71％，两组疗效比较有统计学意义（p＜0.05）。各项结果观察表明，两组均能改善患者临床症状，降低SCr、BUN，升高Ccr、Hb、ALB，且两组比较，在升高ALB两组疗效相当（p＞0.05），降低SCr、BUN，升高Ccr、Hb疗效治疗组优于对照组（P＜0.05）。（二）实验研究，参芪解毒汤高、低剂量组、科索亚组治疗后SCr、BUN、Leptin水平均低于模型组，ALB高于模型组，差别有统计学意义（p＜0.05）。病理结果表明治疗后参芪解毒汤高、低剂量组、科索亚组大鼠的肾组织病理损伤要明显轻于模型组，高剂量组损伤最轻：免疫组化结果显示各用药组TGF-β₁的在肾组织的表达均明显低于模型组（p＜0.05），治疗组参芪解毒汤高、低剂量组、科索亚组各组之间差别无统计学意义（p＞0.05）。结论：参芪解毒汤在治疗慢性肾衰竭的过程中，能有效改善肾衰患者临床症状，有效降低SCr、BUN、Leptin水平，升高Ccr、Hb、ALB，并能减轻大鼠的肾组织的损伤，减少TGF-β₁在肾组织的表达，延缓肾功能恶化。因此根据益气活血，解毒泻浊，温阳固肾法组成的参芪解毒汤是治疗慢性肾衰竭及改善其病理基础的有效途径。更多还原

【Abstract】 Objective: To investigate the effect and partly mechanisms of Shenqi Jiedu Decoction in treating chronic renal failure（CRF）. In addition, this decoction can embody the effect of Yiqihuoxue Jieduxiezhuo Wenyanggushen therapeutics for chronic renal failure.Methods: （1） clinical study: 64 cases of CRF were randomly divided into therapy group （treated with Shenqi Jiedu Decoction and general western medicine ） （n=36） and controlled group （using general western medicine and losartan ） （n=28）. Each treatment period was 4 weeks and there were two periods. The changes of total effective rate, serum creatinine （SCr）,blood urea nitrogen（BUN）, creatinine clearance rate（Ccr）,hemoglobin（Hb）,plasma albumin（ALB）,triglyceride（TG） and cholesterol （CHO）in two groups were compared after treatment. （2） animal experimental study: The rat model of CRF was established by feeding Adenine, All animals were randomly divided into five groups: the normal group, the model group, the high dose group,the low dose group and losartan group, After 8 weeks of treatment, the levels of SCr, BUN, TG, CHO, ALB, Leptin were tested in the five groups.In addition, the results of pathology and the expression of TGF-β₁ were observed .Results: （1） clinical study: The total effective rate of the treating group was 83.33 percent,while the control group was 60.17percent, The comparison of the rapeutic effect in two groups were significant（P<0.05）. Two groups both could decrease SCr ,BUN, and increase Ccr, Hb, ALB .The decrease of SCr ,BUN, and increase of Ccr, Hb in the treated group was more significant than in the control group （P<0.05）. （2） experimental study: Compared with the model group, the levels of SCr,BUN and Leptin in Shenqi Jiedu Decoction groups and losartan group were lower, while the levels of ALB were higher （P<0.05）,And pathology also proved that the results of Shenqi Jiedu Decoction groups and losartan group were better than he model group,and the high dose group was the best. Compared with the model group,the expression of TGF-β₁ in Shenqi Jiedu Decoction groups and losartan group were lower.Conclusion: For chronic renal failure, Shenqi Jiedu Decoction can ameliorate the syndromes of CRF,decrease the levels of SCr ,BUN and Leptin,increase the levels of A Ccr, Hb, ALB, reduce pathology injury and the expression of TGF-β₁, postpone the aggravation of renal function.更多还原