肾衰Ⅱ号方联合西药对原发性慢性肾脏病3、4期患者肾功能及肾血流灌注的影响
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摘要
目的观察肾衰Ⅱ号方联合西药对原发性慢性肾脏病(CKD)3、4期脾肾气虚、湿浊瘀阻型患者的疗效。方法原发性CKD 3、4期脾肾气虚、湿浊瘀阻型患者88例随机分为治疗组和对照组各44例。两组患者均给予西医基础治疗,治疗组加用肾衰Ⅱ号方,对照组加用尿毒清颗粒,治疗6个月。治疗前后检测血肌酐(SCr)、血尿素氮(BUN)、血尿酸(UA)、24小时尿蛋白定量(24h Upro)、血红蛋白(Hb),肾脏超声造影检测右肾髓质、皮质到达时间(AT)、达峰时间(PT)、峰值强度(PI),上升支斜率(A)、曲线下面积(AUC),观察中医临床症状,治疗后评价中医症状疗效和临床疗效。结果治疗组临床疗效总有效率为82.92%,高于对照组的60.00%(P<0.05)。治疗组气短懒言、食少纳呆、脘腹胀满、肢体麻木、口中黏腻、倦怠乏力、腰膝酸软、恶心呕吐、腰痛、面色晦暗总有效率高于对照组(P<0.05或P<0.01)。与本组治疗前比较,治疗组治疗2、4、6个月SCr、BUN、UA、24h UPro均明显下降,2、4、6个月GFR及治疗4、6个月Hb均明显升高(P<0.05或P<0.01);对照组治疗6个月SCr、24h UPro均明显下降,治疗4、6个月GFR均明显升高(P<0.05或P<0.01),且治疗组治疗6个月BUN明显低于对照组,Hb明显高于对照组(P<0.05)。与治疗前比较,治疗组治疗后皮质和髓质肾血流灌注定量参数AT、PT、A、AUC降低,PI升高(P<0.01),对照组髓质PT、AUC降低(P<0.05);且治疗组治疗后皮质AT、PT、A,髓质AT、PT小于对照组(P<0.05或P<0.01)。结论肾衰Ⅱ号方联合西药治疗原发性CKD 3、4期脾肾气虚、湿浊瘀阻型患者临床疗效确切,能改善中医症状,减轻24小时蛋白尿定量,改善贫血,增加肾血流量。
Objective To observe the effect of Meliorated Renal Failure Decoction(肾衰Ⅱ号方,MRFD) combine with western medicine on primary chronic kidney disease(CKD) 3 or 4 stage patients with spleen and kidney qi deficiency,dampness retention and stasis obstruction syndrome. Methods A total of 88 cases of primary CKD 3 or4 stage of spleen and kidney qi deficiency and dampness retention and stasis obstruction syndrome were randomly divided into treatment group of 44 cases and control group of 44 cases. Patients in both groups were given long term western medicine treatment,respectively add MRFD to treatment group,and uremic clearance granules to control group for continuous 6 months. Serum creatinine(SCr),blood urea nitrogen(BUN),uric acid(UA),24-hour urinary protein quantity(24 h Upro),and hemoglobin(Hb) were detected before and after the treatment. Ultrasonic detection and measurement was used to detect radiography of right renal medulla(AT,PT,PI,A,AUC,TIC).Clinical symptoms of traditional Chinese medicine were observed to evaluate the symptoms of traditional Chinese medicine and clinical efficacy after treatment. Results The total effective rate of the treatment group was 82. 92%,which was higher than 60. 00% of the control group(P < 0. 05). In the treatment group,the total effective rate of shortness of breath,laziness to speak,little intake of food,poor appetite,abdominal distension,limb numbness,greasy and sticky mouth,fatigue,weakness waist and knees,nausea and vomiting,low back pain,dull complexion were higher than the control group(P < 0. 05 or P < 0. 01). Compared with before treatment,SCr,BUN,UA and24 h UPro were significantly decreased in the treatment group at 2,4,and 6 months,and GFR and Hb after 4 and 6 months' treatment were significantly increased(P < 0. 05 or P < 0. 01). The control group had a significant decrease in SCr and 24 h UPro at 6 months of treatment,and the GFR was significantly increased at 4 and 6 months of treatment(P < 0. 05 or P < 0. 01),and the BUN in the treatment group was significantly lower than that in the control group at6 months,and Hb was significantly higher than the control group(P < 0. 05). Compared with before treatment,the cortex and medullary renal blood perfusion quantitative parameters AT,PT,A,AUC of treatment group were decreased after treatment,and PI increased(P < 0. 01). The medullary PT,AUC of control group decreased(P <0. 05). And the cortex AT,PT,A,medullary AT,PT of treatment group was smaller than the control group after treatment(P < 0. 05 or P < 0. 01). Conclusion Meliorated Renal Failure Decoction combined with western medicine in the treatment of primary CKD 3 or 4 stage patients with spleen and kidney qi deficiency and dampness and phlegm obstruction syndrome is effective,which can improve the symptoms of traditional Chinese medicine,reduce the 24-hour proteinuria quantification,improve anemia and increase renal blood flow.
Objective To observe the effect of Meliorated Renal Failure Decoction(肾衰Ⅱ号方,MRFD) combine with western medicine on primary chronic kidney disease(CKD) 3 or 4 stage patients with spleen and kidney qi deficiency,dampness retention and stasis obstruction syndrome. Methods A total of 88 cases of primary CKD 3 or4 stage of spleen and kidney qi deficiency and dampness retention and stasis obstruction syndrome were randomly divided into treatment group of 44 cases and control group of 44 cases. Patients in both groups were given long term western medicine treatment,respectively add MRFD to treatment group,and uremic clearance granules to control group for continuous 6 months. Serum creatinine(SCr),blood urea nitrogen(BUN),uric acid(UA),24-hour urinary protein quantity(24 h Upro),and hemoglobin(Hb) were detected before and after the treatment. Ultrasonic detection and measurement was used to detect radiography of right renal medulla(AT,PT,PI,A,AUC,TIC).Clinical symptoms of traditional Chinese medicine were observed to evaluate the symptoms of traditional Chinese medicine and clinical efficacy after treatment. Results The total effective rate of the treatment group was 82. 92%,which was higher than 60. 00% of the control group(P < 0. 05). In the treatment group,the total effective rate of shortness of breath,laziness to speak,little intake of food,poor appetite,abdominal distension,limb numbness,greasy and sticky mouth,fatigue,weakness waist and knees,nausea and vomiting,low back pain,dull complexion were higher than the control group(P < 0. 05 or P < 0. 01). Compared with before treatment,SCr,BUN,UA and24 h UPro were significantly decreased in the treatment group at 2,4,and 6 months,and GFR and Hb after 4 and 6 months' treatment were significantly increased(P < 0. 05 or P < 0. 01). The control group had a significant decrease in SCr and 24 h UPro at 6 months of treatment,and the GFR was significantly increased at 4 and 6 months of treatment(P < 0. 05 or P < 0. 01),and the BUN in the treatment group was significantly lower than that in the control group at6 months,and Hb was significantly higher than the control group(P < 0. 05). Compared with before treatment,the cortex and medullary renal blood perfusion quantitative parameters AT,PT,A,AUC of treatment group were decreased after treatment,and PI increased(P < 0. 01). The medullary PT,AUC of control group decreased(P <0. 05). And the cortex AT,PT,A,medullary AT,PT of treatment group was smaller than the control group after treatment(P < 0. 05 or P < 0. 01). Conclusion Meliorated Renal Failure Decoction combined with western medicine in the treatment of primary CKD 3 or 4 stage patients with spleen and kidney qi deficiency and dampness and phlegm obstruction syndrome is effective,which can improve the symptoms of traditional Chinese medicine,reduce the 24-hour proteinuria quantification,improve anemia and increase renal blood flow.
引文
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[12]李建华,冯蕾,孙淡,等.超声造影评估慢性肾功能不全患者肾血流灌注的研究[J].中国医学影像学杂志,2012,20(7):520-523.
[2]ECKARDT KU,ROSENBERGER C,JRGENSEN JS,et al.Role of hypoxia in the pathogenesis of renal disease[J].Blood Purif,2003,21(3):253-257.
[3]韩海燕,王琛,郑平东.肾衰2号方抑制残余肾TGF-β1与CTGF mRNA的过度表达[J].中国中西医结合肾病杂志,2008,9(2):114-117.
[4]秦军燕,王琛,邵命海,等.肾衰Ⅱ号方对肾衰大鼠肾组织AngⅡ和n NOS蛋白表达的影响[J].中国中西医结合杂志,2012,32(9):1280-1284.
[5]秦军燕,王琛,杨婧,等.AngⅡ抑制剂对HIF-1α在慢性肾衰大鼠肾组织中表达的影响[J].第二军医大学学报,2012,33(9):965-968.
[6]KDOQI.KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease[J].Am J Kidney Dis,2007,49(2 Suppl 2):S12-S154.
[7]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:233-236.
[8]STANGHELLINI V,GHIFINI C,MACEARINI MR,et al.Fasting and postprandial gastrointestinal motility in ulcer and non-ulcer dyspepsia[J].Gut,1992,33(1):184-190.
[9]TIAN S,LI C,RAN R,et al.Surfactant protein A deficiency exacerbates renal interstitial fibrosis following obstructive injury in mice[J].Biochim Biophys Acta,2017,1863(2):509-517.
[10]SUN CY,CHERNG WJ,JIAN HZ,et al.Aliskiren reduced renal fibrosis in mice with chronic ischemic kidney injury-beyond the direct renin inhibition[J].Hypertens Res,2012,35(3):304-311.
[11]STOCK E,VANDERPERREN K,HAERS H,et al.Quantitative differences between the first and second injection of contrast agent in contrast-enhanced ultrasonography of feline kidneys and spleen[J].Ultrasound Med Biol,2017,43(2):500-504.
[12]李建华,冯蕾,孙淡,等.超声造影评估慢性肾功能不全患者肾血流灌注的研究[J].中国医学影像学杂志,2012,20(7):520-523.