辩证论治对慢性肾衰竭患者微炎症状态的影响
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摘要
目的探讨中医辨证论治对非透析慢性肾衰竭患者微炎症状态的影响。方法30例符合纳入标准的慢性肾衰竭患者进行辩证分型后,给予对应方药治疗,在此基础上,针对患者不同情况加用改善肾脏循环,纠正电解质、酸碱平衡紊乱,降压,纠正贫血等常规西医对症处理对症治疗,试验时间长度为4周,试验前后抽取晨起空腹静脉血,测定超敏C反应蛋白(Hs-CRP),肌酐(CREA),血清白蛋白(ALB),血红蛋白(Hb)等,并采用SPSS11.5对结果进行统计分析。结果(1)通过相关分析,治疗前及治疗后Hs-CRP与CREA值均呈强正线性相关关系(P＜0.01),Hs-CRP与ALB在治疗前呈负线性相关关系(P＜0.01);(2)试验结束时,30例患者的Hs-CRP、CREA水平明显降低,ALB、Hb水平明显升高,经过配对检验,差异均具有显著统计学意义(P＜0.05)。结论(1)慢性肾衰竭患者普遍存在微炎症状态,且与肾功能、营养状况等因素密切相关。(2)辩证诊治是中医治疗慢性肾衰竭患者微炎症状态的主要方法。(3)根据中医辨证论治方法治疗慢性肾衰竭患者,可一定程度上降低慢性肾衰竭患者Hs-CRP、CREA浓度,升高ALB、Hb浓度,改善患者贫血和营养不良状况,改善并延缓肾功能的进展和恶化,从而改善患者的微炎症状态。
Objective: To study the effects of treatment based on differentiation of syndromes(TDS) in non-dialysis chronic renal failure(CRF) patients with microinflammation state.
Methods Thirty non-dialysis CRF patients in our center were enrolled. First we differentiated of patients' syndromes, then patients were given the corresponding traditional Chinese medicine prescription treatment at the base of differentiation of syndromes , on the other hand , for different circumstances, patients were given medicine to improve kidney cycle, correct electrolyte and acid-base balance disorder, improve anemia, and other conventional Western medicine symptomatic treatment at the same time, the treatment time lasted 4-weeks totally. At last, we tested the serum levels of High-sensitivity C-reactive protein(Hs-CRP),creatinine(CREA),albumin(ALB) and hemoglobin(Hb) in CRF patients before and after TDS. Finally analyzed the results.
Results (1)According to correlation analysis, Hs-CRP and CREA values showed strong positive linear relationship before and after TDS (P<0. 01) while Hs-CRP and serum ALB showed negative linear relationship before TDS (P<0.01); (2)At the end of trial, the level of Hs-CRP and CREA were significantly lowered, ALB and Hb level were increased. With matching test, the differences are statistically significant significance (P<0.05).
Conclusion (1) Microinflammatory state exist in CRF patients extensively and there is a close correlations with renal function, nutritional status and other factors are closely related. (2) TDS is one of important treatment ways to CRF patients with microinflammation state. (3) TDS can reduce serum levels of Hs-CRP, CREA and increase ALB, Hb concentration, and can improve the situation in patients with anemia and malnutrition, and delay the progress and deterioration of renal function , thus improving patients with microinflammation state.
Objective: To study the effects of treatment based on differentiation of syndromes(TDS) in non-dialysis chronic renal failure(CRF) patients with microinflammation state.
Methods Thirty non-dialysis CRF patients in our center were enrolled. First we differentiated of patients' syndromes, then patients were given the corresponding traditional Chinese medicine prescription treatment at the base of differentiation of syndromes , on the other hand , for different circumstances, patients were given medicine to improve kidney cycle, correct electrolyte and acid-base balance disorder, improve anemia, and other conventional Western medicine symptomatic treatment at the same time, the treatment time lasted 4-weeks totally. At last, we tested the serum levels of High-sensitivity C-reactive protein(Hs-CRP),creatinine(CREA),albumin(ALB) and hemoglobin(Hb) in CRF patients before and after TDS. Finally analyzed the results.
Results (1)According to correlation analysis, Hs-CRP and CREA values showed strong positive linear relationship before and after TDS (P<0. 01) while Hs-CRP and serum ALB showed negative linear relationship before TDS (P<0.01); (2)At the end of trial, the level of Hs-CRP and CREA were significantly lowered, ALB and Hb level were increased. With matching test, the differences are statistically significant significance (P<0.05).
Conclusion (1) Microinflammatory state exist in CRF patients extensively and there is a close correlations with renal function, nutritional status and other factors are closely related. (2) TDS is one of important treatment ways to CRF patients with microinflammation state. (3) TDS can reduce serum levels of Hs-CRP, CREA and increase ALB, Hb concentration, and can improve the situation in patients with anemia and malnutrition, and delay the progress and deterioration of renal function , thus improving patients with microinflammation state.
引文
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[6]Stenvinkel P,Wanner C,Metzger T,et al.Inflammation and outcome in end-stage renal failure:does female gender constitute a survival advantage [J].Kidney Int,2002;62(5):1791-1798.
[7]王剑青,邓安国,戴勇.维持性血液透析患者微炎症状态相关因子的变化.临床内科杂志,2005;22(7):451-454.
[8]丁德良,郑国俊,李环波,等.慢性肾衰竭患者微炎症状态与脂蛋白(a)及动脉粥样硬化的关系,实用全科医学,2006;4(5):531-532.
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[10]杨海波,谢恺庆,周红卫,等.尿毒症非透析患者的微炎症状态及对脂蛋白(a)的影响.临床荟萃,2005;20(2):73-75.
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[12]Miyata T,Ueda Y,Hoire,et al.Interleukin-8 in chronic renal failure and dialysis patients[J].Kidney Int,1998;53:416-422.
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[14]Mimic-Oka J,Simic T,Djukanovic L,et al.Plasma levels of IL-1 beta,TNF alpha and their specific inhibitors in undialyzed chronic renal failure, CAPD and hemodialysis patients[J].Clin Nephoro],1999:51:233-241.
[15]钟春梅,陈明.慢性肾衰竭肾功能衰竭期患者微炎症状态与血脂关系的探讨.泸州医学院学报,2005;28(4):354-355.
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[17]Memoli B,Minutolo R,Bisesti V,et al.Paired filration dialysis:studies on efficiency,flow dynamics and hydraulie properties of the system[J].Am Kidney Dis,2002:39:266-273.
[18]Schiffl H,Lang SM,Stratakis D,et al.Effects of ultrapure dialysis fluid on nutritional status and inflammatory parameters[J].Nephrol Dial Transplant,2001:16:1863-1869.
[19]Cheung AK,RoccoMV,Yah G,et al.Serum beta-2 microglobulin levels predict mortality in dialysis patients:results of the HEMO study[J].J Am Soc Nephrol,2006:17(2):546-555.
[20]闭闵,李家燕,肖华秀,等.超净水与超净透析液对血液透析患者微炎症的影响.广西医科大学学报,2004;21(6):878-879.
[21]Boenisch O,Ehmke KD,Heddergott A,et al.C-reactive protein and cytokine,plasma levels in hemodialysis patiar P,el al.Significance of high C-reactive protein levels in predients[J].J Am Soc Nephrol,2002;15:547-551.
[22]李海坚,韩小彤,冯家伍,等.维持性透析患者幽门螺杆菌感染与微炎症状态关系的初步探讨.中国综合临床,2003;19(5):425-426.
[23]鲁维维,袁伟杰,苏红,等.静脉补铁对维持性血液透析患者微炎症及氧化应激状态的影响.中华肾脏病杂志,2005;11(5):295-299.
[24]于秀峙,朱丽娟,陆石,等.静脉补铁对维持性血液透析患者的贫血及微炎症状态的影响.实用诊断与治疗杂志,2006;20(8):556-558.
[25]陈江华,何强,徐莹.维持性血液透析患者微炎症状态的认识与防治.中华肾脏病杂志,2005;21(2):117-118.
[26]Owen WF,Lowrie EG.Plasms C-reactive protein in hemodialysis:A cross-sectional and longitudinal survey[M].Kidney Int,1998:54:627-636.
[27]Chang JW,Yang WS,Min WK,et al.Malnutrition,cardiac disease,and mortality:an integrated point of view[J].Am J Kidney Dis,2002:39:1213-1217.
[28]刘建,李友芸,刘琦.慢性肾功能衰竭患者C反应蛋白测定的意义.临床肾脏病杂志,2004;4(3):115-116.
[29]Panichi V,Migliori M,Pietro De,et al.Plasma C reactive protein in hemodialysis patents:a cross-sectional,longitudinal clinical survey[J].J Blood Purif,2000:18:30-36.
[30]Usui H,Shikata K,Matsuda M,et al.HMC-CoA reductase inhibitor ameliorates diabetic nephropathy by its pleiotropic effects in rats[J].Nephrol Dial Transplant.2003:18(2):265-272.
[31]李长红,王振,刘中柱.他汀改善维持性血透患者微炎症状态从而降低促红细胞生成素抵抗.黑龙江医药科学,2006;29(3):81-82.
[32]陆红,解汝娟,王明霁.辛伐他汀对尿毒症患者微炎症状态的影响.中国血液净化,2006;5(1):19-26.
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