成人肾病综合征激素治疗的中医症候证型分析

目的 :探讨成人原发性肾病综合征使用激素治疗期间的中医症侯、证型特征及变化规律。方法 :观察并分析 2 2 0例成人原发性肾病综合症患者使用激素治疗期间的临床症候 ,辨证类型的变化。结果 :成人原发性肾病综合征患者使用激素治疗期间 ,本证方面 ,在大剂量时 ,辨证属阴虚 (73% )比使用激素前 (12 % )明显增多 ,属阳虚 (9% )和阴阳两虚 (19% )比使用激素前 (5 8%和 30 % )明显减少 ;小剂量时 ,辨证属阴虚 (5 0 % ) ,虽减少却也占 1/ 2 ,属阳虚(10 % )与大剂量时 (9% )相近 ,而阴阳两虚 (40 % )明显增加 ;在维持量时 ,阴虚证明显减少 (16 % ) ,阳虚和阴阳两虚证有所增加 (2 6 %和 4 6 % )。标证方面 ,在大、小剂量时 ,属热毒 (6 1%和 35 % )、湿热 (49%和 4 5 % ) ,比使用激素前 (15 %和 13% )明显增多 ,在整个激素使用期间 ,属水湿比用药前明显减低 ,而血瘀、气滞均比用药前增加。结论 :治疗成人原发性肾病综合征使用激素后 ,中医症候、证型有明显变化 ,其变化有一定的特点 ,本证的变化规律由阳虚或阴阳两虚→阴虚→阴阳两虚或阳虚转化 ;标证发病率由高至低为水湿、湿热、热毒→热毒、湿热、血瘀、气滞→血瘀、气滞转化 ,这种变化与用药剂量有关 ,正确辨证论治 ,有助于提高激素效果 ,减少不良反应

Analysis Symptoms and Signs、Differential Diagnosis of Traditional Chinese Medicine about the Adult Idiopathic Nephrotic Syndrome Treated with Prednisone

Objective: To observe the regular pattern of TCM symptoms and signs,and characteristics and changing regulations of differential types for the patients with adult idiopathic nephrotic syndrome treated with prednisone.Methods:Observe and analyse the changes of TCM symptoms and signs and TCM differential types of 220 patients with adult idiopathic nephrotic syndrome treated with prednisone.Results: We studied the changes of TCM symptoms and signs and differentiation types on patients with adult idiopathic nephrotic syndrome who were treated with prednisone in three levels, large dosage, small dosage and maintaining dosage. In studying the primary symptoms, we found that 12% of patients were of Yin deficiency type, 58% of Yang deficiency and the remaining 30% of Yin and Yang deficiency.However,when diffevent dosages were used,these figures changed to 73%, 9% and 19% respectively with large dosage of predisone, and to 50%, 10% and 40% respectively after they took small dosage of prednisone, and to 16%, 26% and 46% after taking a maintaining dosage. Meanwhile, in studying the incidental symptoms,it was found that the patients of virulent heat-evil and dampness heat went up obviously from 15% to 61% and 13% to 49% respectively after they took a large dosage, then to 35% and to 45% after taking small dosage. During the entire course of prednisone-treating, patients of accumulated fluid dampness type reduced evidently while patients of blood stasis and qi-stagnation type increased.Conclusion: When the patients who suffered from adult idiopathic nephrotic syndrome are treated with predisone,there exists certain changing rules for TCM sings and symptoms as well as differential types,which are: for primary symptoms, charging from Yang deficiency or both Yin and Yang deficiency to Yin deficiency, then to both Yang and Yin deficiency or Yang deficiency; for incidental symptoms,changing from higher to lower the accumulated fluid dampness, wetness-heat and heat-toxin to heat-toxin, wetness-heat, blood stasis and qi-stagnation to blood stasis and qi-stagnation. These changes are closely related to the dosage of prednione. A correct syndrome differentiation is helpful to improve the curative effect of prednisone and can reduce harmful effect.