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报告1例桃红四物汤联合激素治疗多发性骨髓瘤管型肾病,症状改善。女,56岁。食欲不振1月余,血肌酐升高半月余。1月前无明显诱因出现食欲不振,恶心,无腹痛,腹泻及其他症状,未予重视。半月前,症状加重。肌酐:334.0umol/L,尿素氮:11.50mmol/L;红细胞:2.79×10~(12)/L,血红蛋白:88g/L,血小板:92×10~9/L;尿蛋白:trace;肌酐:369umol/L,尿素氮:11.20mmol/L,白蛋白:40.1g/L,钙:2.87mmol/L;血常规:血红蛋白:84g/L,血小板:114×10~9/L;微量白蛋白:51.9mg/L,β_2微球蛋白:74.1mg/L,α1微球蛋白:94.9mg/L;免疫球蛋白+补体:Ig A:0.26g/L,Ig G:2.64g/L,Ig M:<0.169g/L,C3:0.86g/L;ANA谱3及ANCA均(-);泌尿系彩超示:双肾弥漫性损害,大小正常。甲强龙40mg/次,1次/d,静滴,及对症治疗。院外激素改为美卓乐40mg/次,1次/d,口服。桃红四物汤:制半夏12g,陈皮9g,藿香15g,桃仁9g,红花、熟地各15g,川芎12g,川牛膝15g,赤芍、佩兰各9g,白扁豆15g,山药30g,水煎100m L,1剂/d,早晚温服。出院后不便化疗,地塞米松20mg/次,1次/d,及桃红四物汤加减继续治疗,症状改善。
Report 1 cases of Taohong Siwu Decoction combined with hormone treatment of multiple myeloma tubular nephropathy, symptoms improved. Female, 56 years old. Loss of appetite more than 1 month, serum creatinine increased more than half a month. 1 month ago, no obvious incentive to loss of appetite, nausea, no abdominal pain, diarrhea and other symptoms, no attention. Half a month ago, the symptoms worsened. Creatinine: 334.0umol / L; urea nitrogen: 11.50mmol / L; erythrocyte: 2.79 × 10-12 / L; hemoglobin: 88g / L; platelet: 92 × 10-9 / 369umol / L, urea nitrogen: 11.20mmol / L, albumin: 40.1g / L, calcium: 2.87mmol / L; blood: hemoglobin: 84g / L, platelet: 114 × 10 ~ 9 / L; microalbumin: 51.9 mg / L, β 2 microglobulin: 74.1 mg / L, α1 microglobulin: 94.9 mg / L; immunoglobulin + complement: Ig A: 0.26 g / L, Ig G: <0.169g / L, C3: 0.86g / L; ANA spectrum 3 and ANCA (-); urinary color Doppler showed: diffuse bilateral renal damage, the size of normal. A strong dragon 40mg / time, 1 / d, intravenous infusion, and symptomatic treatment. Hospital hormone replaced Metsole 40mg / time, 1 / d, orally. Peach rhubarb soup 12g, dried tangerine peel 9g, Agastache 15g, peach kernel 9g, safflower, Rehmannia 15g, Chuanxiong 12g, Achyranthes 15g, red peony, Perrin 9g, white beans 15g, yam 30g, water Fried 100m L, 1 / d, morning and evening warm clothes. Inconvenient chemotherapy after discharge, dexamethasone 20mg / time, 1 / d, and Taohong Siwu Decoction continued treatment, the symptoms improved.