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目的观察参芪地黄汤加味联合激素序贯疗法治疗难治性肾病综合征的临床疗效及对超敏C反应蛋白(hs-CRP)的影响。方法选取汕头市潮阳区大峰医院2015年1月—12月收治的84例符合入组标准的肾病综合征患者作为研究对象,按随机数字表分为观察组42例和对照组42例,对照组采用激素序贯疗法治疗,即地塞米松及环磷酰胺双冲击后配合中等量的醋酸泼尼松维持治疗,观察组在对照组的基础上再口服参芪地黄汤加味,维持治疗12个月,治疗结束后进行效果评价,空腹抽血进行hs-CRP、24 h尿蛋白定量、血清白蛋白、血脂、肾功能检测,记录不良反应发生情况,随访6个月,比较复发率差异。结果观察组的总缓解率为97.62%,明显高于对照组85.71%(χ2=13.013,P<0.05)。两组治疗后24 h尿蛋白定量、总胆固醇、甘油三酯、尿素氮、血肌酐、hs-CRP均明显下降(均P<0.05),血清白蛋白明显升高(P<0.05);与对照组比较,观察组上述指标变化更明显(P<0.05)。观察组随访3个月、6个月的复发率分别为0和7.14%,均明显低于对照组9.52%、26.19%(均P<0.05)。观察组柯兴综合征、肝功能损伤、激素撤减综合征发生率明显低于对照组(P<0.05)。结论参芪地黄汤加味联合激素序贯疗法治疗难治性肾病综合征的临床疗效确切,效果优于单纯激素序贯疗法,增强抗炎作用,减少疾病复发,降低不良反应发生率,值得临床推广使用。
Objective To observe the clinical effect of Shenqi Dihuang Decoction combined with sequential therapy of hormone on refractory nephrotic syndrome and its effect on hs-CRP. Methods A total of 84 patients with nephrotic syndrome who met the inclusion criteria from January 2015 to January 2012 in Chaoyang District, Shantou were selected as study subjects. According to the random number table, 42 patients in the observation group and 42 in the control group, Hormone sequential therapy was used, that dexamethasone and cyclophosphamide double impact with a moderate amount of prednisolone maintenance treatment, the observation group in the control group based on oral Shenqi Dihuang Decoction, maintenance treatment for 12 months , The effect was evaluated after the treatment, fasting blood hs-CRP, 24 h urinary protein, serum albumin, blood lipid, renal function test, record the incidence of adverse reactions, followed up for 6 months, the recurrence rate was compared. Results The total remission rate of the observation group was 97.62%, which was significantly higher than that of the control group (85.71%, χ2 = 13.013, P <0.05). Urine protein, total cholesterol, triglyceride, urea nitrogen, serum creatinine and hs-CRP were significantly decreased in both groups 24 h after treatment (both P <0.05) and serum albumin was significantly increased (P <0.05) Compared with the control group, the above indexes in the observation group changed more obviously (P <0.05). The observation group was followed up for 3 months. The recurrence rate at 6 months was 0 and 7.14% respectively, which were significantly lower than those in control group (9.52% and 26.19%, both P <0.05). The incidence of Cushing’s syndrome, liver injury, and hormone withdrawal syndrome in the observation group was significantly lower than that in the control group (P <0.05). Conclusion Shenqi Dihuang Decoction combined with hormone sequential therapy in the treatment of refractory nephrotic syndrome clinical curative effect is better than simple hormone sequential therapy to enhance anti-inflammatory effect, reduce disease recurrence and reduce the incidence of adverse reactions, is worthy of clinical promotion use.