黑地黄丸对慢性肾衰竭脾胃证候、营养状态和胃肠激素的影响
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摘要
目的:观察黑地黄丸对慢性肾衰竭(CRF)脾胃证候,营养状态和胃肠激素的影响。方法:慢性肾衰竭患者随机分为两组,59例观察组和59例对照组,在一般治疗的基础上,观察组给予黑地黄丸口服,9 g/次,3次/d。对照组给予尿毒清口服,9 g/次,3次/d。两组疗程均为8周。进行治疗前后中医脾胃证候评分,检测治疗前后血红蛋白(Hb),白蛋白(ALb),前白蛋白(PA),总胆固醇(TC),胃泌素(GAS),胃动素(MTL),生长抑素(SS),瘦素(Leptin)及神经肽Y(NPY)的变化。结果:脾胃证候观察组总有效率为81.35%,对照组总有效率为67.80%,观察组优于对照组(P<0.05);治疗后观察组Hb水平得到显著提升(P<0.05),观察组优于对照组(P<0.05);两组治疗后ALb和PA水平均有升高(P<0.05),观察组升高更为明显(P<0.05);治疗后两组血清GAS和MTL水平均下降(P<0.05);治疗后观察组血清SS水平显著升高(P<0.05),比对照组升高明显(P<0.05);治疗后观察组leptin,NPY水平比治疗前下降(P<0.05),且比对照组下降明显(P<0.05)。结论:黑地黄丸能较好地改善CRF患者中医脾胃证候和营养状态,其机制可能与调整胃肠激素紊乱有关,健脾(胃)法治疗慢性肾衰竭具有确切的近期疗效。
Objective: To observe the effect of Heidihuang Wan on spleen and stomach pattern,nutritive status and gastrointestinal hormone in chronic renal failure( CRF). Method: The CRF patients were randomly divided into two groups,59 cases in observation group and 59 cases in control group. On the basis of general treatment,the patients in observation group were also treated with Heidihuang Wan,9 g / time,3 times /day. The patients in control group were treated with Niaoduqing granules 9 g / time,3 times / day. The treatment course was 8 weeks in both groups. The scores of spleen and stomach pattern before and after treatment were graded; changes in the index of hemoglobin( Hb),albumin( ALb),prealbumi( PA),total cholesterol( TC),the level of gastrin( GAS),motilin( MTL),somatostatin( SS),Leptin and neuropeptide Y( NPY) before and after treatment were detected. Result: The total effective rate of spleen and stomach pattern in the observation group was 81. 35%,superior to 67. 80% in the control group( P < 0. 05). After treatment,the level of Hb was significantly higher( P < 0. 05),and the result in the observation group was better than that in the control group( P < 0. 05). After treatment,ALb and PA levels in both groups were increased obviously( P < 0. 05) and the increase in the observation group was more significant( P < 0. 05). After treatment,levels of GAS and MTL were decreased in both groups( P < 0. 05). After treatment,SS level was significantly increased in the observation group( P < 0. 05),which was more significant than that in the control group( P < 0. 05). After treatment,levels of Leptin and NPY were decreased in the observation group( P < 0. 05),which was more significant than that in the control group( P < 0. 05). Conclusion: Heidihuang Wan can well relieve TCM pattern of the spleen and stomach,and benefit the nutrient state of the patients with CRF. Its mechanism may be related to improving the gastrointestinal function disturbance. The methods of reinforcing spleen( stomach) has clear short-term effect in the treatment of CRF.
Objective: To observe the effect of Heidihuang Wan on spleen and stomach pattern,nutritive status and gastrointestinal hormone in chronic renal failure( CRF). Method: The CRF patients were randomly divided into two groups,59 cases in observation group and 59 cases in control group. On the basis of general treatment,the patients in observation group were also treated with Heidihuang Wan,9 g / time,3 times /day. The patients in control group were treated with Niaoduqing granules 9 g / time,3 times / day. The treatment course was 8 weeks in both groups. The scores of spleen and stomach pattern before and after treatment were graded; changes in the index of hemoglobin( Hb),albumin( ALb),prealbumi( PA),total cholesterol( TC),the level of gastrin( GAS),motilin( MTL),somatostatin( SS),Leptin and neuropeptide Y( NPY) before and after treatment were detected. Result: The total effective rate of spleen and stomach pattern in the observation group was 81. 35%,superior to 67. 80% in the control group( P < 0. 05). After treatment,the level of Hb was significantly higher( P < 0. 05),and the result in the observation group was better than that in the control group( P < 0. 05). After treatment,ALb and PA levels in both groups were increased obviously( P < 0. 05) and the increase in the observation group was more significant( P < 0. 05). After treatment,levels of GAS and MTL were decreased in both groups( P < 0. 05). After treatment,SS level was significantly increased in the observation group( P < 0. 05),which was more significant than that in the control group( P < 0. 05). After treatment,levels of Leptin and NPY were decreased in the observation group( P < 0. 05),which was more significant than that in the control group( P < 0. 05). Conclusion: Heidihuang Wan can well relieve TCM pattern of the spleen and stomach,and benefit the nutrient state of the patients with CRF. Its mechanism may be related to improving the gastrointestinal function disturbance. The methods of reinforcing spleen( stomach) has clear short-term effect in the treatment of CRF.
引文
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[10]王茂泓,高生.张小萍教授治慢性肾衰竭重在脾胃学术思想简介[J].新中医,2012,42(10):134-136.
[11]刘朵,章丹丹,卞卡.地黄药理药化及配伍研究[J].时珍国医国药,2012,23(3):748-750.
[12]刘芬,刘艳菊,田春漫.苍术提取物对实验性脾虚证大鼠胃肠动力及免疫功能的影响[J].吉林大学学报:医学版,2015,41(2):255-259.
[13]郭琳,苗明三.大枣现代研究分析[J].中医学报,2014,29(4):543-545.
[14]文跃强,贾波,刘兴隆,等.白术茯苓汤不同配比对脾虚型克罗恩病大鼠结肠VIP及其受体的影响[J].世界科学技术——中医药现代化,2014,16(5):1108-1113.
[15]刘宁,黄雯.尿毒症胃肠动力和胃肠激素水平变化[J].医学综述,2007,13(11):853-855.
[16]吴洋,马学琴,王洋,等.胃元宁对功能性消化不良小鼠胃肠运动及胃肠激素分泌的影响[J].中国实验方剂学杂志,2014,20(24):185-189.
[17]于俊生,杜雅静,庄文青,等.补肾排毒合剂治疗慢性肾衰竭营养不良59例临床观察[J].中国中西医结合肾病杂志,2006,7(7):395-397.
[18]蔺晓源,霍继荣,周应初,等.四磨汤对非胃肠术后患者胃肠功能及血清CCK,lepin的影响[J].中国实验方剂学杂志,2013,19(9):288-290.
[2]焦安钦.慢性肾衰竭脾胃证候分布规律初探[J].中国中医基础医学杂志,2011,9(9):947-949.
[3]李建英,于俊生,刘先英,等.中医药改善慢性肾衰竭营养不良研究近况[J].中华中医药学刊,2009,27(3):633-635.
[4]王宝安,吴金玉,龙韵,等.慢性肾衰竭的中医药治疗进展[J].中医学报,2011,26(7):854-855.
[5]王海燕.肾脏病学[M].2版.北京:人民卫生出版社,1996:1385.
[6]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2005:163-165.
[7]赵金铎.中医证候鉴别诊断学[M].北京:人民卫生出版社,1989:183-190.
[8]吴俊燕.张法荣教授应用黑地黄丸治疗慢性肾衰的经验[J].现代中医药,2013,33(3):9-10.
[9]张法荣,王芳,付海霞,等.黑地黄丸治疗慢性肾衰竭的临床观察[J].中国中西医结合肾病杂志,2009,10(2):156-157.
[10]王茂泓,高生.张小萍教授治慢性肾衰竭重在脾胃学术思想简介[J].新中医,2012,42(10):134-136.
[11]刘朵,章丹丹,卞卡.地黄药理药化及配伍研究[J].时珍国医国药,2012,23(3):748-750.
[12]刘芬,刘艳菊,田春漫.苍术提取物对实验性脾虚证大鼠胃肠动力及免疫功能的影响[J].吉林大学学报:医学版,2015,41(2):255-259.
[13]郭琳,苗明三.大枣现代研究分析[J].中医学报,2014,29(4):543-545.
[14]文跃强,贾波,刘兴隆,等.白术茯苓汤不同配比对脾虚型克罗恩病大鼠结肠VIP及其受体的影响[J].世界科学技术——中医药现代化,2014,16(5):1108-1113.
[15]刘宁,黄雯.尿毒症胃肠动力和胃肠激素水平变化[J].医学综述,2007,13(11):853-855.
[16]吴洋,马学琴,王洋,等.胃元宁对功能性消化不良小鼠胃肠运动及胃肠激素分泌的影响[J].中国实验方剂学杂志,2014,20(24):185-189.
[17]于俊生,杜雅静,庄文青,等.补肾排毒合剂治疗慢性肾衰竭营养不良59例临床观察[J].中国中西医结合肾病杂志,2006,7(7):395-397.
[18]蔺晓源,霍继荣,周应初,等.四磨汤对非胃肠术后患者胃肠功能及血清CCK,lepin的影响[J].中国实验方剂学杂志,2013,19(9):288-290.