Objective:To analyze the idiopathic effect of mycophenolate mofetil and cyclosporine A in combination with prednisone on idiopathic refractory nephrotic syndrome.Methods:A total of 76 patients with idiopathic refractory nephrotic syndrome treated in Zhumadian Central Hospital from January 2021 to January 2023 were selected, and they were randomly divided into study group and conventional group, with 38 cases in each group. The conventional group was treated with mycophenolate mofetil combined with prednisone, and the study group was treated with cyclosporine A combined with prednisone. The therapeutic effect, renal function, which was assessed by urinary protein (Pa), blood creatinine (Scr), uric acid (UA) and blood urea nitrogen (BUN), the levels of urinary renal injury molecule 1 (KIM-1), level of neutrophil gelatinase-associated lipocalin (NGAL), immune function assessed by cluster of differentiation 4 + (CD4 + ) and cluster of differentiation 8 + (CD8 + ), level of platelet activating factor hydrolase (PAF-AH), levels of platelet activating factor (PAF), and the incidence of adverse reactions were compared between the two groups. Results:The total effective rate of the study group was 94.74% (36/38), which was higher than the 76.32% (29/38) of the conventional group ( P<0.05). After treatment, the levels of Pa, Scr, UA, and BUN in the study group were lower than those in the conventional group ( P<0.05). After treatment, the levels of KIM-1 and NGAL in the study group were lower than those in the conventional group ( P<0.05). After treatment, the CD4 + level in the study group was lower than that in the conventional group ( P<0.05), while there was no significant difference in CD8 + level between the two groups ( P>0.05). After treatment, the level of PAF-AH in the study group was higher than that in the conventional group, while the level of PAF was lower than that in the conventional group ( P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P>0.05). Conclusions:Compared with mycophenolate mofetil combined with prednisone, the combination therapy of cyclosporine A with prednisone for idiopathic refractory nephrotic syndrome can improve the clinical efficacy, decrease the levels of KIM-1 and NGAL, regulate the levels of T lymphocyte subsets, PAF-AH and PAF. Moreover, it can significantly improve renal function, with safety.

目的:观察降糖益肾方联合西药治疗2型糖尿病肾病的疗效及对内皮功能及血液流变学的影响.方法:将100例2型糖尿病肾病患者采用随机数字表法随机分为对照组与观察组各50例.对照组予常规治疗,观察组在对照组基础上服用降糖益肾方治疗.比较2组临床疗效,比较2组治疗前后内皮功能及血液流变学.结果:治疗前,2组空腹血糖(FBG)、餐后2小时血糖(P2hBG)及糖化血红蛋白(HbA1c)水平比较,差异无统计学意义(P＞0.05);治疗后,2组FBG、P2hBG、HbA1c水平均降低(P＜0.05),且观察组低于对照组(P＜0.05).治疗前,2组24小时尿蛋白定量(24hPRO)、微量蛋白尿(mAlb)、β2-微球蛋白(β2-MG)及胱抑素C(CysC)水平比较,差异无统计学意义(P＞0.05);治疗后,2组24hPRO、mAlb、β2-MG、CysC水平均降低(P＜0.05),且观察组低于对照组(P＜0.05).治疗前,2组血清一氧化氮(NO)及内皮素-1(ET-1)水平比较,差异无统计学意义(P＞0.05);治疗后,2组血清NO水平升高(P＜0.05),ET-1水平下降(P＜0.05),且观察组血清NO水平高于对照组(P＜0.05),ET-1水平低于对照组(P＜0.05).治疗前,2组全血高切黏度(ηbH)、全血中切黏度(ηbM)、全血低切黏度(ηbL)、血浆黏度(ηP)、纤维蛋白原(FIB)水平比较,差异无统计学意义(P＞0.05);治疗后,2组ηbH、ηbM、ηbL、ηp、FIB水平均降低(P＜0.05),且观察组低于对照组(P＜0.05).结论:益肾降糖方在控制2型糖尿病肾病患者血糖水平、减少蛋白尿、保护肾功能等方面效果显著,机制可能与该方能有效调节2型糖尿病肾病患者血管内皮功能,保护血管内皮,改善患者血液流变学,降低血液高黏状态有关.

目的:探讨益肾化湿颗粒对2型糖尿病肾病大鼠肾功能的影响.方法:采取高糖脂饮食、小剂量链脲佐菌素(STZ,40 mg/kg)建立2型糖尿病肾病大鼠模型,随机均分为对照组、模型组、益肾化湿颗粒组(4.8 g/kg),阳性对照组(缬沙坦,10 mg/kg),连续干预8周.观察各组大鼠血糖、血脂、胰岛素抵抗以及肾功能变化,HE染色法观察大鼠肾脏病理变化,Western blot检测肾组织Nephrin、Podocin和PDGFRβ蛋白水平.结果:模型组干预后的FBG、TC、TG、HbA1c、FINS、HOMA-IR、肾质量/体质量、Scr、BUN、UAER均显著高于干预前(P<0.05)且足细胞密度显著低于干预前(P<0.05);益肾化湿颗粒组、阳性对照组干预后FBG、TC、TG、HbA1c、FINS、HOMA-IR、肾质量/体质量、Scr、BUN、UAER均显著低于干预前(P<0.05),足细胞密度、显著高于干预前(P<0.05).益肾化湿颗粒组、阳性对照组干预后的FBG、TC、TG、HbA1c、FINS、HOMA-IR、肾质量/体质量、Scr、BUN、UAER、PDGFRβ蛋白水平均显著低于模型组干预后(P<0.05),而足细胞密度、Neph-rin与Podocin蛋白水平显著高于模型组干预后(P<0.05).模型组肾脏组织肾小球增大、系膜增宽、毛细血管扩张,病变程度严重,益肾化湿颗粒组与阳性对照组部分肾小球增大与系膜增生.结论:益肾化湿颗粒对2型糖尿病肾病大鼠肾功能损伤有改善作用,可能与调节Nephrin、Podocin、PDGFRβ蛋白水平有关.

目的 探讨维持性血液透析患者红细胞分布宽度(RDW)与微炎症状态及心血管不良事件的关系.方法 选择2019年1月至2021年4月本院424例维持性血液透析患者,对患者追踪随访6个月,按患者是否发生心血管不良事件分为不良事件组(n=71)和对照组(n=353),比较两组红细胞参数及CRP水平差异,采用Logistic相关分析维持性血液透析患者发生心血管不良事件的危险因素,分析RDW与CRP的相关关系,绘制ROC曲线分析RDW及CRP对维持性血液透析患者心血管不良事件的预测价值.结果 不良事件组RBC、Hb、Hct、MHC低于对照组,差异有统计学意义(P<0.05),MCV、RDW及CRP高于对照组,差异有统计学意义(P<0.05),Logistic回归分析显示RDW及CRP是维持性血液透析患者发生心血管不良事件的危险因素(P<0.05).相关分析显示维持性血液透析患者RDW与CRP呈现正相关关系(γ=0.336,P<0.05).ROC曲线显示:RDW预测心血管不良事件的AUC值为0.762,截断值为18.6％,截断值预测心血管不良事件的敏感度为0.794,特异度为0.717,约登指数为0.501,CRP预测心血管不良事件的AUC值为0.794,截断值为12.4 mg/L,截断值预测心血管不良事件的敏感度为0.762,特异度为0.732,约登指数为0.494.结论 RDW与维持性血液透析患者微炎症状态及心血管不良事件的发生有关,检测RDW与CRP有助于预测近期心血管不良事件的发生风险.

目的 探讨贝那普利联合维持性血液透析(MHD)对终末期肾病(ESRD)患者的疗效及对胰岛素抵抗(IR)的影响.方法 选取2018年5月至2019年7月驻马店市中心医院收入院的ESRD患者210例,按照随机数字表法分为对照组和观察组,每组105例.对照组予以常规MHD治疗,观察组予以MHD联合贝那利普治疗.比较治疗前及治疗3个月后两组血生化指标[超敏C-反应蛋白(hsCRP)、血钙(Ca2+)、血磷(P)]、肾功能[血肌酐(Scr)、尿素氮(BUN)]、胰岛素抵抗指标[空腹血糖(FBG)、空腹胰岛素(FINS)、稳态模型胰岛素抵抗指数(HOMA-IR)]差异.结果 治疗3个月后,两组hsCRP、Ca2+、P、Scr、BUN、FBG、FINS、HOMA-IR值均较治疗前显著降低,且观察组显著低于同一时期对照组(P<0.05).结论 采用MHD联合贝那普利治疗方式有利于增强ESRD患者肾功能、控制血磷代谢紊乱,有效抑制胰岛素抵抗,提高MHD充分性.

目的 成功制备雷公藤甲素(3-丙羧基)三苯基溴化膦(TPP)-聚乙二醇-b-聚己内脂(PEG-PCL)脂质体(Tr@TPP/Lip),评价其靶向性及促肝肿瘤细胞凋亡效果.方法 采用正交试验优选Tr@TPP/Lip的制备工艺,再研究该载药系统的粒径、Zeta电位、载药量、包封率和多分散系数及透射电镜微观形态,评价Tr@TPP/Lip的稳定性、溶血性、释放情况;采用荧光试验,研究脂质体与肝肿瘤细胞的融合情况、线粒体靶向性和肝脏靶向性;在等剂量给药条件下,评价Tr@TPP/Lip促肝癌细胞凋亡效果.结果 正交试验优选的Tr@TPP/Lip粒径为(113.5±17.6)nm,Zeta电位(12.6±0.7)mV,包封率为(71.3±3.2)％,载药量为(3.9±1.1)％,多分散系数为0.12±0.04;透射电子显微镜图片显示Tr@TPP/Lip呈规则圆球形,该脂质体稳定性良好,具有较小的溶血率和良好的缓释药物性能;荧光试验结果显示,TPP阳离子能促进脂质体与肿瘤细胞的融合,并靶向线粒体,还能提高药物在肝肿瘤部位的靶向和滞留效果;细胞药效结果显示,Tr@TPP/Lip具有良好的促肝肿瘤细胞凋亡效果,能明显降低线粒体膜Zeta电位、增加细胞内活性氧水平和Caspase-3的释放,显著增加促凋亡蛋白Bcl-2、减少抗凋亡Bax蛋白的表达,这些细胞凋亡试验结果均明显优于雷公藤甲素普通脂质体和雷公藤甲素.结论 Tr@TPP/Lip具有较好的线粒体靶向功能,能增强药物促肝肿瘤细胞凋亡效果.

Objective:To investigate the effects of low calcium dialysate (LCD) on serum calcium-phosphorus metabolism, kidney injury molecule-1 (KIM-1), interleukin-18 (IL-18) and renal function in patients with chronic renal failure (CRF).Methods:The clinical data of 100 patients with CRF who were admitted and treated in Zhumadian Central Hospital from January 2014 to January 2017 were retrospectively analyzed. According to the concentrations of calcium ion, patients were divided into the standard calcium dialysate (SCD) group (calcium ion concentration of 1.75 mmol/L, n=48) and LCD group (calcium ion concentration of 1.25 mmol/L, n=52). Blood calcium, blood phosphorus, calcium-phosphorus product, intact parathyroid hormone (iPTH), standard-reaching rate of iPTH, KIM-1, IL-18, renal function assessed by blood urea nitrogen (BUN), serum creatinine (Scr), and uric acid (UA), 24 h urinary protein, albumin (ALB), and 3-year survival rate were compared between the two groups. Results:After treatment, blood calcium, blood phosphorus and calcium-phosphorus product in the LCD group were (2.10±0.85)mmol/L, (1.40±0.52)mmol/L, and (40.81±7.63)mg 2/dl 2, respectively, lower than the (2.54±1.17)mmol/L, (1.72±0.92)mmol/L and (50.12±9.67)mg 2/dl 2 in the SCD group ( P<0.05). The differences of iPTH level, standard-reaching rate of iPTH, KIM-1, IL-18, BUN, Scr, UA, 24 h urine protein and ALB levels between the two groups were not statistically significant before and after treatment ( P>0.05). There was no significant difference in 1-year and 2-year survival rates between the two groups ( P>0.05). The 3-year survival rate of the LCD group (94.23%, 49/52) was higher than that of the SCD group (81.25%, 39/48), P<0.05. Conclusions:LCD can improve calcium and phosphorus metabolism in patients with CRF, maintain serum PTH levels and stable parathyroid function, and improve quality of life of patients.

目的:观察黄葵胶囊联合阿卡波糖治疗糖尿病肾病的临床疗效及其对糖代谢、肾纤维化的影响.方法:将189例糖尿病肾病患者按随机数字表法分为研究组95例和对照组94例.所有患者均接受相同的基础治疗并控制血压,对照组给予口服阿卡波糖治疗,研究组在对照组的基础上加用黄葵胶囊治疗.2组均连续治疗8周,分析比较2组临床疗效,检测2组患者治疗前后空腹血糖值(FBG)、餐后2h血糖值(P2hBG)和糖化血红蛋白(HbA1c)等糖代谢指标水平,血肌酐(SCr)、血尿酸(UA)、血尿素氮(BUN)等肾功能指标水平,血清转化生长因子-β1 (TGF-β1)、基质金属蛋白酶抑制剂-1 (TIMP-1)等肾纤维化指标水平.结果:治疗后,研究组临床疗效优于对照组,经秩和检验,差异有统计学意义(P＜0.05).治疗前,2组FBG、P2hBG、HbA1c、SCr、UA、BUN、TGF-β1、TIMP-1水平比较,差异无统计学意义(P＞0.05);治疗后,2组上述指标均较治疗前降低(P＜0.05),且研究组各项指标均低于对照组(P＜0.05).结论:黄葵胶囊联合阿卡波糖对糖尿病肾病患者疗效肯定,可改善患者糖代谢及肾功能,有效下调肾脏纤维化指标.

目的 探讨银花泌炎灵片联合注射用头孢噻肟钠治疗急性肾盂肾炎的临床疗效.方法 选择2018年6月-2019年6月在驻马店市中心医院治疗的急性肾盂肾炎患者94例,根据用药的差别分为对照组(47例)和治疗组(47例).对照组患者静脉滴注注射用头孢噻肟钠,2.0 g加入生理盐水100mL,2次/d;治疗组在对照组的基础上口服银花泌炎灵片,4片/次,4次/d.两组患者均治疗14 d.观察两组患者临床疗效,同时比较治疗前后两组患者症候积分,血清转化生长因子β1(TGF-β1)、白细胞介素-6 (IL-6)、组织型-纤维蛋白溶解酶原激活剂(t-PA)、白细胞介素-17 (1L-17)、乙酰-β-D-葡萄糖苷酶(NAG)、β2-微球蛋白(β2-MG)水平,以及SF-36、PSQI和APACHEⅡ评分.结果 治疗后,对照组临床有效率为80.85％,显著低于治疗组的97.87％,两组比较差异有统计学意义(P＜0.05).经治疗,两组患者症候积分及SF-36、PSQI和APACHE Ⅱ评分均显著降低(P＜0.05),且治疗组患者比对照组降低更明显(P＜0.05).经治疗,两组患者血清β2-MG、IL-6、TGF-β1、IL-17、NAG水平均显著降低(P＜0.05),而t-PA水平均明显升高(P＜0.05),且治疗组比对照组改善更明显(P＜0.05).结论 银花泌炎灵片联合头孢噻肟治疗急性肾盂肾炎可有效改善患者临床症状,有利于患者生活质量的提高.

目的 探讨银杏达莫注射液联合血液透析对慢性肾衰竭(CRF)患者肾功能及血清炎症因子水平的影响.方法 选取2016年5月至2019年5月驻马店市中心医院收治的200例CRF患者,按随机数表法将患者分为对照组和观察组,每组100例.两组患者均接受基础治疗.对照组加用血液透析,每次4 h,每周3次.观察组患者在每次血液透析后,使用银杏达莫注射液治疗.两组患者均接受连续治疗4周.比较两组治疗前后肾功能[血尿素氮(BUN)、血肌酐(Scr)、β2微球蛋白(β2-MG)]和血清炎症因子[白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)].记录并比较两组患者不良反应发生率.结果 治疗后,两组BUN、Scr、β2-MG、IL-1、IL-6、TNF-α、CRP水平较治疗前降低,观察组BUN、Scr、β2-MG、IL-1、IL-6、TNF-α、CRP水平较对照组低(P<0.05).观察组不良反应发生率[5.00％(5/100)]较对照组[14.00％(14/100)]低(P<0.05).结论 银杏达莫注射液联合血液透析能够改善CRF患者的肾功能,抑制炎症因子,达到有效缓解病情的效果.

Objective:To investigate the effects of prednisone acetate combined with leflunomide on renal function and levels of serum creatinine (Scr) and blood urea nitrogen (BUN) in patients with immunoglobulin A (IgA) nephropathy.Methods:Sixty-four patients with IgA nephropathy admitted to Zhumadian Central Hospital from November 2013 to November 2018 were selected as research subjects. According to the random number table method, patients were divided into observation group and control group, with 32 cases in each group. Patients in control group were treated with prednisone acetate, and patients in observation group were treated with leflunomide on the basis of treatment of control group. And the two groups were treated for 6 months. The clinical efficacy of the two groups was compared. The renal function, assessed by human serum albumin (Alb), Scr, BUN, Cystatin C (CysC), levels of 24 h urine protein quantitation and serum transforming growth factor-β1 (TGF-β1), intercellular adhesion molecule-1 (ICAM-1) and monocyte chemoattractant protein-1 (MCP-1) were observed in the two groups before treatment and 6 months after treatment. And the incidence of adverse reactions (transaminase elevation, nausea and vomiting, lung infection, fatigue) of the two groups were recorded.Results:The total clinical effective rate in observation group (93.75%, 30/32) was significantly higher than that in control group (75.00%, 24/32), P<0.05. After 6 months of treatment, the levels of renal function indexes (Scr, BUN, CysC, 24 h urine protein quantitation) and serum TGF-β1, ICAM-1 and MCP-1 in the two groups were lower than those before treatment, and the levels of these indexes of observation group were lower than those of control group ( P<0.05). After treatment, the Alb levels in the two groups were higher than those before treatment, and the level in observation group was higher than that in control group ( P<0.05). There were no significant differences in the incidences of adverse reactions between the two groups ( P>0.05). Conclusions:Prednisone acetate combined with leflunomide has significant efficacy on patients with IgA nephropathy, and it can improve renal function, which is safe and reliable.

Objective: To explore the changes and clinical value of urinary monocyte chemotactic protein 1 (MCP-1), epidermal growth factor (EGF) and their ratio in patients with idiopathic membranous nephropathy (IMN). Methods: A total of 67 IMN patients were enrolled according to kidney biopsy in the Department of Nephrology of the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2018. The patients included 28 males and 39 females, with an average age of (47.6±14.2) years. Eighteen age-and sex-matched healthy controls were also enrolled. Clinical and pathological data, blood and urine samples of all subjects were collected. Urinary MCP-1 and EGF level were detected by enzyme-linked immunosorbent assay (ELISA). And then the levels of urinary MCP-1, EGF and the ratio of EGF/MCP-1 and their correlations with clinicopathology were analyzed. Results: There was no statistical difference of the urine EGF levels between the two groups [8.3(6.0,12.6) vs 8.4(6.5,10.2) ng/mg Cr, P=0.575]. The urine MCP-1 levels of IMN patients were 0.37 (0.21, 0.69) ng/mg Cr, which was statistical significantly higher than those of the control group [0.09 (0.02, 0.19) ng/mg Cr] (P<0.001), while the EGF/MCP-1 ratio was lower than that of the control group [22.2(15.1,36.6) vs 87.6(71.2,132.7), P<0.001]. Urine MCP-1 was negatively correlated with eGFR (r=-0.303, P=0.012), but positively correlated with the urinary ratio of albumin to creatinin (r=0.368, P=0.002). EGF was positively correlated with eGFR (r=0.722, P<0.001), but negatively correlated with the severity of interstitial fibrosis and renal tubular atrophy (IFTA) (r=-0.312, P=0.011). EGF/MCP-1 ratio was positively correlated with eGFR (r=0.693, P<0.001), but negatively correlated with the severity of the urinary ratio of albumin to creatinin and IFTA (r=-0.261, P=0.028 and r=-0.684, P<0.001, respectively). Further multivariate logistic regression analysis showed that EGF/MCP-1 was a protective factor for moderate-to-severe IFTA (OR=0.891, 95%CI: 0.844-0.949, P=0.008). Conclusion: Patients with IMN have elevated urine MCP-1 level and decreased EGF/MCP-1 ratio, which correlate with clinical indicators. In particular, EGF/MCP-1 ratio is independently related to moderate-severe IFTA, and may be a potential clinical biomarker for diagnosis of IMN.

目的 探讨缬沙坦联合黄葵胶囊治疗对慢性肾小球肾炎患者血清炎性因子及肾功能的影响.方法 选取2014年1月至2015年12月收治的84例慢性肾小球肾炎患者纳入研究对象,根据入院时间分为治疗组和对照组各42例.对照组采用缬沙坦口服,治疗组给予缬沙坦联合黄葵胶囊治疗,两组治疗疗程均为8周.治疗后观察两组临床疗效、血清炎性因子、肾功能等相关指标.结果 治疗后,治疗组患者有效率明显高于对照组,差异有统计学意义(P<0.05);治疗组血清C-反应蛋白(C-reactionprotein,CRP)、肿瘤坏死因子-α(Tumor Necrosis Factor-α,TNF-α)、白细胞介素-6(interleukin 6,IL-6)等炎性因子水平明显低于对照组(P<0.05);血肌酐(Serum creatinine,Scr)、尿素氮(blood urea nitrogen,BUN)、24 h尿蛋白含量等肾功能相关指标明显低于对照组,差异有统计学意义(P<0.05).结论 缬沙坦联合黄葵胶囊有助于缓解慢性肾小球肾炎患者炎性反应,改善肾功能,提高临床疗效.

目的:研究健脾补肾活血泄浊方联合杂合式血液净化疗法对慢性肾衰竭(CRF)患者肾功能及血清CD4+/CD8+水平的影响.方法:选取CRF患者96例,随机数字表法分为研究组和对照组各48例.对照组采用杂合式血液净化疗法治疗,研究组于对照组基础上加用健脾补肾活血泄浊方治疗.观察比较两组治疗效果、治疗前后肾功能指标[血尿素氮(BUN)、血清肌酐(Scr)、内生肌酐清除率(Ccr)]、血清T淋巴细胞亚群[CD4+、CD8+、CD4+/CD8+]、血清炎症因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)]水平及生活质量(SF-36评分).结果:研究组治疗总有效率高于对照组(P<0.05);治疗后研究组Scr、BUN水平低于对照组,Ccr水平高于对照组(P<0.05);治疗后研究组CD8+水平低于对照组,CD4+、CD4+/CD8+水平高于对照组(P<0.05);治疗后研究组IL-6、CRP、TNF-α水平低于对照组(P<0.05);治疗后研究组情感职能、躯体疼痛、社会职能、整体健康各项评分高于对照组(P<0.05).结论:健脾补肾活血泄浊方联合杂合式血液净化疗法治疗CRF,能显著提高治疗效果,有效改善患者肾功能,且能显著增强机体免疫功能,降低炎症因子水平,提高生活质量.

目的 探讨终末期肾脏病长期维持性血液透析患者认知功能障碍发生的特征及其影响因素.方法 对86例终末期肾脏病长期维持性血液透析患者的临床资料做回顾性分析,根据蒙特利尔认知评估量表评分分为认知功能障碍组和认知功能正常组.比较相关指标,分析影响患者认知功能障碍的危险因素.结果 本组认知功能正常者33例,认知功能障碍者53例,认知功能障碍发生率为61.6%.两组年龄、尿素清除指数、糖尿病病史、脑卒中病史、受教育年限比较差异有统计学意义(P<0.01);年龄大、有糖尿病病史、有脑卒中病史、受教育年限短是影响终末期肾脏病长期维持性血液透析患者认知功能障碍的独立危险因素,尿素清除指数是影响患者认知功能障碍的保护因素(P<0.01).结论 终末期肾脏病长期维持性血液透析患者认知功能障碍发生率较高,年龄大、有糖尿病病史、有脑卒中病史、受教育程度低是影响患者认知功能障碍的独立危险因素.

目的:探讨益气活血化湿方配合西医治疗慢性肾小球肾炎(CGN)的临床疗效.方法:选取CGN患者82例,按照随机数字表法分为对照组和观察组各41例,对照组仅予以西药治疗,观察组患者采用益气活血化湿方结合西医治疗.比较两组患者治疗效果、检测并对比治疗前后两组患者肾功能指标及不良反应.结果:治疗后观察组患者总有效率为95.12％,高于对照组的70.73％,差异有统计学意义(P＜0.05).治疗前两组患者血清BUN、SCr水平比较差异无统计学意义(P＞0.05);治疗后观察组血清BUN、SCr水平均较对照组低,差异有统计学意义(P＜0.05).观察组不良反应发生率为2.44％,低于对照组的19.51％,差异有统计学意义(P＜0.05).结论:益气活血化湿方配合西医治疗CGN,可有效改善患者肾功能,降低不良反应发生率,安全可行,值得临床推广应用.

Objective To investigate the clinical efficacy of Niaoduqing Granules combined with febuxostat in treatment of hyperuricemia. Methods Patients (140 cases) with hyperuricemia in Zhumadian Central Hospital from March 2014 to March 2016 were randomly divided into control (70 cases) and treatment (70 cases) groups. Patients in the control group were po administered with Febuxostat Tablets, 40 mg/time, once daily. Patients in the treatment group were po administered with Niaoduqing Granules on the basis of the control group, 5 g/time, four times daily. Patients in two groups were treated for 12 weeks. After treatment, the clinical efficacy was evaluated, and the serum XOD, BUA, Scr, BUN, serum inflammatory factors, serum NO and ET-1 levels in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 87.14％, which was significantly lower than 97.14％ in the treatment group, and there were differences between two groups (P < 0.05). After treatment, the XOD, BUA, Scr and BUN levels in two groups were significantly decreased (P < 0.05). And these indexes level in the treatment group decreased more significantly than that in the control group (P < 0.05). After treatment, the IL-1β, MPO, sICAM-1 and TNF-αlevels in two groups were significantly decreased (P < 0.05). And the serum inflammatory factors in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the serum NO level in two groups was significantly increased, but ET-1 level was significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And serum NO and ET-1 level in the treatment group was significantly better than that in the control group (P < 0.05). Conclusion Niaoduqing Granules combined with febuxostat in treatment of hyperuricemia can effectively reduce the inflammatory reaction and improve the vascular endothelial function, which has a certain clinical application value.

Objective: Observed the clinical efficacy of combination of Chinese and Western medicine in the treatment of diabetic nephropathy. Methods: 46 patients with diabetic nephropathy at stage Ⅳ were randomly divided into western medicine treatment group (control group) in 23 cases and western medicine plus Buyi Shenpi Huoxue Tongluo Lishui Shenshi prescription group (treatment group) in 23 cases. Blood albumin, urea nitrogen, serum creatinine, urinary albumin excretion, urinary protein quantification, fasting blood glucose, endogenous creatinine clearance and edema were observed before and after treatment. Results: The clearance rate of serum albumin and endogenous creatinine in each group after treatment was significantly higher than before treatment, and the urinary protein quantification and urinary albumin excretion rate were significantly lower than before treatment (P＜0. 01). Blood urea nitrogen and serum creatinine were significantly lower than before treatment (P＜0. 01, P＜0. 05), and edema was reduced. After treatment, the clearance of serum albumin and endogenous creatinine was significantly higher in the treatment group than in the control group (P＜0. 05). Urine albumin excretion rate and urine protein quantification were significantly lower than those in the control group (P＜0. 05). Blood urea nitrogen and serum creatinine were significantly lower than those in the control group (P＜0. 01), and edema was faster than the control group. Conclusion: The effect of integrated traditional Chinese and western medicine in the treatment of diabetic nephropathy in stage Ⅳ is more effective than that of western medicine alone.

目的 探讨桃核承气汤加减联合复方α-酮酸片对慢性肾衰竭(CRF)患者肾功能及尿TGF-β1、IV-C水平的影响.方法 选取2014年2月至2016年8月驻马店中心医院收治的84例CRF患者,按随机数表法分为对照组与观察组,各42例.对照组接受复方α-酮酸片治疗,给予观察组桃核承气汤加减联合复方α-酮酸片治疗,均治疗1个月.记录两组肾功能指标[内生肌酐清除率(Ccr)、血肌酐(Scr)、血清尿素氮(BUN)]、尿转化生长因子-β1(TGF-β1)及Ⅳ型胶原蛋白(IV-C)水平.结果 治疗后,观察组Scr、BUN水平低于对照组,Ccr水平高于对照组,TGF-β1、IV-C水平低于对照组,差异有统计学意义(P<0.05).结论 桃核承气汤加减与复方α-酮酸片联合治疗CRF,能缓解患者症状,有效改善肾功能.

Objective To investigate the clinical efficacy of Medicinal Charcoal Tablets combined with lanthanum carbonate in treatment of hyperphosphatemia in hemodialysis. Methods Patients (160 cases) with hyperphosphatemia in hemodialysis in Zhumadian Central Hospital from May 2014 to May 2016 were randomly divided into control (80 cases) and treatment (80 cases) groups. Patients in the control group were po administered with Lanthanum Carbonate Chewable Tablets, 1 g/time, three times daily. Patients in the treatment group were po administered with Medicinal Charcoal Tablets on the basis of the control group, 1.5 g/time, three times daily. Patients in two groups were treated for 12 weeks. After treatment, the clinical efficacy and serological indexes were evaluated. Results After treatment, the clinical efficacy in the control and treatment groups were 81.25％ and 93.75％, respectively, and there were differences between two groups (P < 0.05). After treatment, the blood phosphorus, blood calcium, PTH, hs-CRP, FGF-23, and calcium and phosphorus product levels in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And these serological indexes in the treatment group were more obviously lower than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Medicinal Charcoal Tablets combined with lanthanum carbonate can effectively improve the quality of life in treatment of hyperphosphatemia, which has a certain clinical application value.