摘要：
目的:对吕仁和教授诊治慢性肾脏病慢性肾炎"肾络癥瘕"辨证方法的有效性及安全性进行验证.方法:选取2013年2月至2016年5月在东直门医院肾病科门诊和病房就诊的原发性慢性肾小球肾炎患者310例,采取前瞻性队列研究方法,依据治疗方法确定暴露因素,形成肾络癥瘕证队列(1组):吕仁和教授及其传承人根据肾络癥瘕证辨证论治予以口服汤药治疗,常规辨证队列(2组):非吕仁和教授继承人按照常规的辨证论治方法给予口服汤药治疗,每2～4周微调中药及剂量,至少就诊3个诊次,疗程至少为8周,8周后据情况给药,随访1年.结果:肾络癥瘕队列第8周和第12个月肾小球滤过率增高值和增高率均高于常规辨证队列,采用协方差分析提示第8周和第12个月组间差异有统计学意义( P＜0.001);肾络癥瘕队列中医证候积分呈下降趋势;肾络癥瘕辨证队列肌酐水平第8周比较,差异有统计学意义( P＝0.029, P＜0.05),第12个月比较,差异有统计学意义(P＝0.025,P＜0.05)均显著低于常规辨证队列.肾络癥瘕辨证队列尿素氮水平第8周(P＝0.04,P＜0.01)和第12个月(P＝0.028,P＜0.05)均显著低于常规辨证队列,差异有统计学意义(P＜0.05).肾络癥瘕辨证队列24 h尿蛋白定量第6个月显著低于常规辨证队列,差异有统计学意义(P＝0.005,P＜0.01).结论:吕仁和肾络癥瘕辨证方法对原发性慢性肾小球肾炎的疗效优于常规辨证方法.%Objective:To verify the efficacy and safety of the diagnosis and treatment of Lyu Renhe's renal collateral syndrome (RCC) in patients with chronic renal disease.Methods:This study adopted the method of prospective cohort study.A total of 310 with primary chronic glomerulonephritis who visited the Nephrology Clinic and Ward of Dongzhimen Hospital from February 2013 to May 2016 were selected.The exposure factor was formed based on the treatment method ,and formed renal collaterals remove lump queue,(group 1):Prof.Lyu Renhe and his inheritors treated patients with oral admonition of decoction based on syndrome differen －tiation of the renal collaterals remove lump ; conventional syndrome differentiation queue (group 2):not Prof.Lyu Renhe′s inheri－tors treated patients with oral admonition of decoction based on syndrome differentiation of the renal collaterals remove lump .The doses of Chinese herbal decoction were adjusted every 2－4 weeks with at least three clinical doctor visits.The course of treatment was at least eight weeks.Decoctions were given after 8 weeks according to the conditions with 1 year′s follow up.Results:The glo－merular filtration rate and increase rate of renal collaterals remove lump queue at 8 weeks and 12 months were higher than conven－tional syndrome differentiation queue.By using analysis of covariance tips ,the differences between 8 weeks and 12 months were ex－tremely significant (P＜0.001); The TCM syndrome scores of renal collaterals remove lump queue was decreasing .The creatinine level of renal collaterals remove lump queue at 8th week (P＝0.029,P＜0.05) and the 12th month (P＝0.025,P＜0.05) were significantly lower than that of conventional syndrome differentiation.The urea nitrogen of renal collaterals remove lump queue at the 8th week (P＝0.04,P＜0.01) and the 12th month (P＝0.028,P＜0.05) was significantly lower than that of conventional syndrome differentiation.The 24 h urine protein of renal collaterals remove lump queue at the 6th month (P＝0.005,P＜0.01) was significantly lower than the conventional syndrome differentiation.Conclusion:Lyu Renhe′s syndrome differential of renal col－laterals remove lump method is better than the conventional syndrome differentiation method for primary chronic glomerulonephritis.
