CAJ | 학술논문

目的：观察右归丸对激素抵抗型肾病综合征（ SRNS）脾肾阳虚型患者的增敏作用及其机制。方法：将40例SRNS患者随机分为对照组和治疗组，对照组20例，治疗组20例，对照组采用常规西医治疗，治疗组在西医常规治疗的基础上加右归丸。分别观察两组患者治疗1月后、治疗2月后的水肿消退时间、尿蛋白转阴时间、中医症状总积分并检测外周静脉血液中单个核细胞（PBMC）MDR1、P-gp170以及GRα、GRβ的变化。结果：（1）经治疗2月后，治疗组临床疗效总有效率为100．00%，对照组则为60．00%，差异有统计学意义（ P<0．05）。（2）治疗后，治疗组的水肿消退时间、尿蛋白转阴时间、中医症状总积分，与对照组相比较，差异均有统计学意义（ P<0．05）。（3）耐药基因方面：经治疗后，治疗组外周静脉血液中PBMC MDR1、P-gp170的表达量减少，而GRα的表达量增加，GRβ的表达量无明显改变。MDR1、P-gp170及GRα治疗组与治疗前、同期对照组相比较差异有统计学意义（ P<0．05）；而GRβ表达量两组前后变化差值比较差异无统计学意义（ P>0．05）。结论：右归丸对SRNS有一定的增敏作用，其机制可能与降低 PBMC MDR1、P-gp170的表达及上调 GRα表达量有关。
목적：관찰우귀환대격소저항형신병종합정（ SRNS）비신양허형환자적증민작용급기궤제。방법：장40례SRNS환자수궤분위대조조화치료조，대조조20례，치료조20례，대조조채용상규서의치료，치료조재서의상규치료적기출상가우귀환。분별관찰량조환자치료1월후、치료2월후적수종소퇴시간、뇨단백전음시간、중의증상총적분병검측외주정맥혈액중단개핵세포（PBMC）MDR1、P-gp170이급GRα、GRβ적변화。결과：（1）경치료2월후，치료조림상료효총유효솔위100．00%，대조조칙위60．00%，차이유통계학의의（ P<0．05）。（2）치료후，치료조적수종소퇴시간、뇨단백전음시간、중의증상총적분，여대조조상비교，차이균유통계학의의（ P<0．05）。（3）내약기인방면：경치료후，치료조외주정맥혈액중PBMC MDR1、P-gp170적표체량감소，이GRα적표체량증가，GRβ적표체량무명현개변。MDR1、P-gp170급GRα치료조여치료전、동기대조조상비교차이유통계학의의（ P<0．05）；이GRβ표체량량조전후변화차치비교차이무통계학의의（ P>0．05）。결론：우귀환대SRNS유일정적증민작용，기궤제가능여강저 PBMC MDR1、P-gp170적표체급상조 GRα표체량유관。
Objective:To observe the effect and mechanism of Yougui Pill’s sensibilization in steroid resistant nephritic syndrome( SRNS)patients,which the patients belong to PiShenYangXu type according to the treatment based on syndrome differentia-tion. Methods:To select 40 yangxu tape SRNS patients,which were divided into two groups,the number of Control Group is 20,and the treatment group is 20. The control group used Glucocorticoid( GC)and Western medicine conventional therapy,the treatment group used Yougui Pill on the basis of the control group medication. Drawing their peripheral venous blood in 1 month,2 month after treatment at 2 time points,to detect the expression of MDR1、P-gp170 and GRα、GRβin blood mononuclear cells( PBMC),and re-cord their clinical symptoms and signs of traditional Chinese medicine,the change of urine protein in the urine routine at the same time. Results:(1)After 2 months’treatment,the total effect rate of the treatment group is 100%,meanwhile,the control group is 60%(P<0. 05).(2)After treatment,compared with the control group,the time of edema extinction,proteinuria turn to negative and the score of T. C. M syndrome is much more better than the control group.(3)Resistance Genes:After treatment,the expression of PBMC MDR1、P-gp170 in treatment group is dereased(P<0. 05). However,the expression of PBMC GRα is increased(P<0. 05),meanwhile,the expression of PBMC GRβhas little change after treatment(P>0. 05). Conclusion:Yougui Pill has a positive effect on SRNS patients,the mechanism may be related to the decrease of PBMC MDR1、P-gp170 and the increase of the GRα.