郑剑 孙妲男 李勇 乔伟

〔摘要〕 目的 探討温阳补肾汤对慢性肾小球肾炎（chronic glomerulonephritis， CGN）脾肾阳虚证患者尿液半胱氨酸蛋白酶抑制剂C（cystatin C， Cys C）、α1-微球蛋白（α1-microglobulin， α1-MG）表达及T淋巴细胞亚群的影响。方法 纳入98例CGN脾肾阳虚证患者，随机分为对照组和观察组各49例。对照组应用常规西药治疗，观察组在对照组基础上加用温阳补肾汤治疗。比较两组临床疗效、中医证候积分疗效，肾功能指标、尿液Cys C、α1-MG水平及T淋巴细胞亚群水平和用药安全性。结果 用药治疗后，观察组临床疗效有效率为87.50%较对照组的68.75%高（P<0.05），中医证候积分疗效有效率为91.67%较对照组的68.75%高（P<0.05）;两组24 h尿蛋白定量、血清肌酐及尿素氮水平与治疗前相比均降低（P<0.05），且观察组均较对照组低（P<0.05）;两组尿液Cys C、α1-MG与治疗前相比均降低（P<0.05），且观察组均较对照组低（P<0.05）;两组CD3+、CD4+、CD4+/CD8+水平与治疗前相比均增高（P<0.05），CD8+水平与治疗前相比降低（P<0.05），且观察组CD3+、CD4+、CD4+/CD8+水平较对照组高（P<0.05），CD8+水平较对照组低（P<0.05）;两组治疗过程中无严重不良反应出现。结论 应用温阳补肾汤对CGN脾肾阳虚证患者进行治疗的效果显著，可明显改善患者肾功能，有效下调尿液Cys C、α1-MG表达水平，并大大增强免疫功能。

〔关键词〕 慢性肾小球肾炎;脾肾阳虚证;温阳补肾汤;半胱氨酸蛋白酶抑制剂C;α1-微球蛋白;T淋巴细胞亚群

〔中图分类号〕R2       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.07.025

〔Abstract〕 Objective To investigate the effects of Wenyang Bushen Decoction on the expression of urinary cystatin C （Cys C）， α1-microglobulin （α1-MG） and T lymphocyte subsets in patients with chronic glomerulonephritis （CGN） of spleen and kidney Yang deficiency. Methods 98 patients with CGN of spleen and kidney Yang deficiency were enrolled and randomly divided into control group and observation group， with 49 cases in each group. The control group was treated with conventional western medicine， and the observation group was treated with Wenyang Bushen Decoction on the basis of the control group. The clinical efficacy， the efficacy of traditional Chinese medicine （TCM） syndrome score， renal function indexes， urine Cys C， α1-MG levels， T lymphocyte subgroup levels， and medication safety were compared between the two groups. Results After medication， the clinical efficacy rate of the observation group was 87.50%， higher than that of the control group's 68.75% （P<0.05）， and the efficacy rate of TCM syndrome score of the observation group was 91.67%， higher than the control group's 68.75% （P<0.05）; the levels of 24-hour urinary protein quanlitation， serum creatinine and urea nitrogen in the two groups were lower than those in before treatment （P<0.05）， and observation group was lower than control group （P<0.05）; the Cys C and α1-MG in the two groups were lower than those before treatment （P<0.05）， and observation group were lower than those in the control group （P<0.05）; the levels of CD3+， CD4+， CD4+/CD8+ in the two groups were higher than those before treatment （P<0.05）， the levels of CD3+， CD4+， CD4+/CD8+ in the observation group were higher than those in the control group （P<0.05）， and the level of CD8+ was lower than that in the control group （P<0.05）; there were no serious adverse reactions in the two groups. Conclusion The application of Wenyang Bushen Decoction in the treatment of CGN patients with spleen and kidney Yang deficiency has significant effect， it can significantly improve the renal function of patients， effectively reduce the expression levels of urinary Cys C and α1-MG， and greatly enhance the immune function.

〔Keywords〕 chronic glomerulonephritis; spleen and kidney Yang deficiency; Wenyang Bushen Decoction; cystatin C; α1-microglobulin; T lymphocyte subsets

慢性肾小球肾炎（chronic glomerulonephritis， CGN）是一种免疫介导性肾脏病，临床上除存在浮肿、血尿、血压升高等症状表现外，还伴随蛋白尿、肾功能减退等病理表现。此病起病隐匿，呈缓慢进行性发展，迁延不愈，末期可演化为慢性肾衰竭，致生命健康受到重大威胁[1]。目前，西医以对症治疗为主，包括使用血管紧张素转化酶抑制药（angiotensin converting enzyme inhibitors， ACEI）等降压药、降脂药、利尿剂以及抗血小板药物等，可减轻患者病症，但无法有效抑制肾功能减退[2]。近年来，中医药疗法愈来愈受到肾内科治疗领域关注。中医学认为，本病属于“水肿”“血尿”范畴，其发生和肾阳亏虚有关[3]。而运用中医药，通过作用于与疾病有关的多个靶点，从而可达到更理想的疗效。本研究观察了温阳补肾汤运用于CGN脾肾阳虚证治疗中的作用，以期为CGN的中医治疗提供参考依据。……