中药排石汤联合体外震波碎石术对肾结石患者肾功能、尿液代谢的影响
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摘要
目的:探讨中药排石汤联合体外震波碎石术(ESWL)对肾结石患者肾功能、尿液代谢的影响。方法:选取2014年5月至2017年2月成都市龙泉驿区中医医院收治的肾结石患者138例为研究对象,按照随机数字表法分为观察组和对照组,每组69例,2组均行ESWL治疗,术后对照组采用常规药物治疗,观察组在对照组的基础上采用中药排石汤治疗,2组治疗时间均为2周。比较2组患者临床疗效及中医证候改善情况;统计手术前后2组患者肾功能及尿液代谢状况。结果:术后观察组总有效率为94. 20%,显著高于对照组的78. 26%(P <0. 05);与术前比较,2组患者中医证候积分均下降,且观察组低于对照组(P <0. 05);与术前比较,术后3～14 d 2组血清血肌酐(SCr)、尿素氮(BUN)、半胱氨酸蛋白酶抑制剂(Cys-C)、中性粒细胞明胶酶相关载脂蛋白(NGAL)水平均呈先升高后降低趋势,且各时间点观察组均低于对照组(P <0. 05);术后14 d观察组与术前比较,差异无统计学意义(P> 0. 05),对照组仍高于术前(P <0. 05);与术前比较,术后2周内2组患者高尿钙症、高草酸尿症、高尿酸尿症、低尿量及低镁尿症等尿液代谢异常发生率下降(P <0. 05),且观察组低于对照组(P <0. 05)。结论:中药排石汤联合ESWL治疗肾结石可保护患者肾功能,降低尿液代谢异常状况发生率,临床疗效显著。
Objective: To explore the influence of Chinese medicine Paishi Decoction combined with extracorporeal shock wave lithotripsy (ESWL) on the renal function and urine metabolism of patients with renal calculus. Methods: A total of 138 cases of patients with renal calculus from May 2014 to February 2017 were selected as study objects and were randomly divided into observation group (n = 69) and control group (n = 69). The 2 groups were treated with ESWL,control group was treated with routine drugs,and the observation group was treated with Paishi Decoction on the basis of control group. The 2 groups were treated for 2 weeks. The clinical efficacy and the improvement of Traditional Chinese Medicine syndrome of 2 groups were compared; the renal function index and urine metabolism condition of 2 groups were detected before and after operation. Results: The total effective rate of observation group reached up to 94. 20% after operation,which was higher than that 78. 26% of control group (P < 0. 01);Compared with before operation,the Traditional Chinese Medicine syndrome integral of 2 groups decreased after operation,and observation group were lower than control group (P < 0. 01); Compared with before operation,the levels of serum SCr,BUN,NGAL,Cys-C of 2 groups from 3 days to 14 days after operation increased firstly and then decreased,and observation group was lower than control group at each time point (P < 0. 01); There was no difference between 14 days after operation and before operation of observation group (P > 0. 05),but the control group was higher than those before operation (P < 0. 01). Compared with before operation,the incidence of urinary metabolic abnormalities such as high urinary calcium,phenylketonuria,hyperuricemia,low urine output and low magnesium decreased within 2 weeks after operation (P < 0. 05 or P < 0. 01),and observation group were lower than control group (P < 0. 01). Conclusion: Chinese medicine Paishi Decoction combined with ESWL in the treatment of renal calculus can protect the renal function of patients,reduce the incidence of urinary metabolic abnormalities,the clinical efficacy is remarkable.
Objective: To explore the influence of Chinese medicine Paishi Decoction combined with extracorporeal shock wave lithotripsy (ESWL) on the renal function and urine metabolism of patients with renal calculus. Methods: A total of 138 cases of patients with renal calculus from May 2014 to February 2017 were selected as study objects and were randomly divided into observation group (n = 69) and control group (n = 69). The 2 groups were treated with ESWL,control group was treated with routine drugs,and the observation group was treated with Paishi Decoction on the basis of control group. The 2 groups were treated for 2 weeks. The clinical efficacy and the improvement of Traditional Chinese Medicine syndrome of 2 groups were compared; the renal function index and urine metabolism condition of 2 groups were detected before and after operation. Results: The total effective rate of observation group reached up to 94. 20% after operation,which was higher than that 78. 26% of control group (P < 0. 01);Compared with before operation,the Traditional Chinese Medicine syndrome integral of 2 groups decreased after operation,and observation group were lower than control group (P < 0. 01); Compared with before operation,the levels of serum SCr,BUN,NGAL,Cys-C of 2 groups from 3 days to 14 days after operation increased firstly and then decreased,and observation group was lower than control group at each time point (P < 0. 01); There was no difference between 14 days after operation and before operation of observation group (P > 0. 05),but the control group was higher than those before operation (P < 0. 01). Compared with before operation,the incidence of urinary metabolic abnormalities such as high urinary calcium,phenylketonuria,hyperuricemia,low urine output and low magnesium decreased within 2 weeks after operation (P < 0. 05 or P < 0. 01),and observation group were lower than control group (P < 0. 01). Conclusion: Chinese medicine Paishi Decoction combined with ESWL in the treatment of renal calculus can protect the renal function of patients,reduce the incidence of urinary metabolic abnormalities,the clinical efficacy is remarkable.
引文
[1]姚林亚.坦索罗辛联合中药排石汤剂对于促进输尿管上段结石ESWL术后排石的疗效研究[D].苏州:苏州大学,2012.
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[13]潘建林,蔡新建,吴春梅,等.中药排石Ⅰ号联合坦洛新辅助体外震波碎石术治疗草酸钙输尿管结石患者疗效观察[J].浙江中医药大学学报,2012,36(9):1003-1005.
[14]刘国歧.肾结石体外震波碎石术后应用中药排石汤治疗效果[J].内蒙古中医药,2017,36(2):88.
[15]杨成.中药联合体外震波碎石治疗肾结石疗效观察[J].亚太传统医药,2013,9(6):144-145.
[16]何强,杨昱.两种取石术治疗肾结石对患者血清NGAL,Cys-C及尿KIM-1水平的影响比较[J].中国医学创新,2016,13(15):59-61,62.
[17]朱红,马丽娜,杨伟,等.血清NGAL和Cys-C对老年冠心病患者早期肾损害的诊断价值[J].心血管康复医学杂志,2014,23(2):170-174.
[18]詹颉,张华,闫福堂,等.血清NGAL与Cr,BUN,RBP,Cys-C联合检测在糖尿病肾病早期诊断中的应用[J].现代检验医学杂志,2016,31(4):100-103.
[19]朱永生,粟宏伟,邓青富.输尿管软镜治疗肾结石的临床效果及对肾功能的影响[J].四川医学,2014,35(10):1304-1306.
[20]洪志明,温志鹏,陈德宁,等.导滞排石汤对气滞血瘀和湿热下注型肾结石患者尿液代谢的影响[J].中国实验方剂学杂志,2016,22(19):131-134.
[21]许金梅,唐莹莹,郭敏,等.尿酸性肾结石发病机制的研究进展[J].中国医药导报,2015,11(1):165-168.
[2]李梓林,李芙蓉.体外震波碎石配合自拟中药排石汤治疗输尿管结石240例体会[J].云南中医中药杂志,2010,31(4):27-27.
[3]侯春华.体外冲击波碎石联合排石汤治疗泌尿系结石临床观察[J].湖北中医杂志,2011,33(7):59-60.
[4]那彦群.中国泌尿外科疾病诊断治疗指南[S].北京:人民卫生出版社,2013:54.
[5]布兰迪.泌尿外科学[M].济南:山东科学技术出版社,2014:15.
[6]国家药品食品局.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:23.
[7]高社全,文红壮,高庆亮,等.复杂性肾结石微创治疗与结石分析预防复发的研究[J].世界中医药,2015,8(A02):1510-1511.
[8]Cui X,Ji F,Yan H,et al.Comparison between extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy for treating large proximal ureteral stones:a meta-analysis[J].Urology,2015,85(4):748-56.
[9]隆自菊.体外震波碎石配合三金排石汤治疗上尿路结石疗效观察[J].基层医学论坛,2013,17(13):1727-1728.
[10]陈晓鹏.用泌尿排石汤对行体外冲击波碎石术的泌尿系统结石患者进行术后治疗的效果观察[J].当代医药论丛,2015,13(22):279-280.
[11]高荣芳.益气排石汤对体外冲击波碎石术后促进排石的临床观察[D].广州:广州中医药大学,2016.
[12]刘亚玮,李建坤,赵春艳,等.体外震波碎石术后应用中药排石汤治疗肾结石患者的疗效观察[J].中国药房,2016,27(8):1110-1112.
[13]潘建林,蔡新建,吴春梅,等.中药排石Ⅰ号联合坦洛新辅助体外震波碎石术治疗草酸钙输尿管结石患者疗效观察[J].浙江中医药大学学报,2012,36(9):1003-1005.
[14]刘国歧.肾结石体外震波碎石术后应用中药排石汤治疗效果[J].内蒙古中医药,2017,36(2):88.
[15]杨成.中药联合体外震波碎石治疗肾结石疗效观察[J].亚太传统医药,2013,9(6):144-145.
[16]何强,杨昱.两种取石术治疗肾结石对患者血清NGAL,Cys-C及尿KIM-1水平的影响比较[J].中国医学创新,2016,13(15):59-61,62.
[17]朱红,马丽娜,杨伟,等.血清NGAL和Cys-C对老年冠心病患者早期肾损害的诊断价值[J].心血管康复医学杂志,2014,23(2):170-174.
[18]詹颉,张华,闫福堂,等.血清NGAL与Cr,BUN,RBP,Cys-C联合检测在糖尿病肾病早期诊断中的应用[J].现代检验医学杂志,2016,31(4):100-103.
[19]朱永生,粟宏伟,邓青富.输尿管软镜治疗肾结石的临床效果及对肾功能的影响[J].四川医学,2014,35(10):1304-1306.
[20]洪志明,温志鹏,陈德宁,等.导滞排石汤对气滞血瘀和湿热下注型肾结石患者尿液代谢的影响[J].中国实验方剂学杂志,2016,22(19):131-134.
[21]许金梅,唐莹莹,郭敏,等.尿酸性肾结石发病机制的研究进展[J].中国医药导报,2015,11(1):165-168.