蓉黄颗粒对非透析CKD-MBD肾虚湿热证患者血清FGF23的影响
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摘要
目的:观察非透析慢性肾脏病矿物质和骨代谢异常(CKD-MBD)且辨证为肾虚湿热证的患者血清成纤维细胞生长因子23(FGF23)水平的变化及蓉黄颗粒的干预作用。方法:将66例符合纳入标准的非透析CKD-MBD肾虚湿热证患者随机分为观察组与对照组各33例,最终实际完成62例,其中观察组32例,对照组30例,并设正常组20例。两组患者均给予西医常规治疗及中药保留灌肠,观察组加用蓉黄颗粒冲服,每日3次,每次1袋。疗程均8周。观察两组患者肾虚湿热证证候变化,检测两组患者治疗前后血清钙(Ca)、磷(P)、甲状旁腺激素(iPTH)和FGF23水平。结果:观察组疾病临床疗效显著优于对照组(P <0. 01)。两组患者证候积分值均随疗程增加而明显降低(P <0. 05或P <0. 01);观察组各个时间点疗效均显著优于对照组(P <0. 01)。治疗后,观察组血清Ca、P、iPTH均较治疗前显著改善(P <0. 05或P <0. 01);对照组除iPTH水平显著改善(P <0. 05)外,其余各项指标均无明显改善(P> 0. 05);治疗后观察组血清Ca、P、iPTH水平均显著优于对照组(P <0. 05)。治疗前,两组患者血清FGF23水平均显著高于正常组(P <0. 01);治疗后,观察组血清FGF23水平显著降低(P <0. 05);对照组血清FGF23水平无明显改善(P> 0. 05);观察组血清FGF23水平显著低于对照组(P <0. 05)。结论:蓉黄颗粒可改善非透析CKD-MBD肾虚湿热证患者的临床症状并纠正骨代谢紊乱。
Objective: To observe the changes of serum fibroblast growth factor 23( FGF23) levels in non-dialysis patients with chronic kidney disease mineral and bone metabolism disorder( CKD-MBD) and syndrome of kidney deficiency and damp heat and observe the therapeutic effect of these patients using Rong Huang Granule. Methods: 66 cases of non-dialysis CKD-MBD patients with syndrome of kidney deficiency and damp heat which met the inclusion criteria were randomly divided into observation group and control group. In the end,62 cases were actually completed,including 32 cases in the observation group and 30 cases in the control group. A normal group of 20 cases was set up. Two groups of patients were given the conventional therapy of western medicine and retention enema of traditional Chinese medicine. Rong Huang Granule was added to the observation group during the treatment. It was used three times a day,one bag each time. The course of treatment lasted 8 weeks. The changes of syndrome of kidney deficiency and damp heat in two groups of patients were observed. Serum calcium( Ca),phosphorus( P),intact parathyroid hormone( i PTH) and FGF23 in two groups of patients were tested before and after treatment. Results: The clinical efficacy of the observation group was significantly better than that of the control group( P < 0. 01). The scores of syndromes in the two groups were significantly decreased along with the increase of the course of treatment( P < 0. 05 or P < 0. 01). The efficacy of the observation group was significantly better than that of the control group at each time point( P < 0. 01). The serum levels of Ca,P and i PTH in the observation group were significantly improved after treatment( P < 0. 05 or P < 0. 01). In addition to the improvement in the level of i PTH in the control group( P < 0. 05),no other indicators had improved significantly. The serum levels of Ca,P and i PTH in the observation group were significantly better than those in the control group after treatment( P < 0. 05). The serum levels of FGF23 in the two groups were significantly higher than those in the normal group before treatment( P < 0. 01). The serum level of FGF23 in the observation group was significantly decreased after treatment( P <0. 05),while the serum level of FGF23 in control group was not significantly improved( P > 0. 05). The serum level of FGF23 in the observation group was significantly lower than that in the control group after treatment( P < 0. 05). Conclusion: Rong Huang Granule can improve the clinical symptoms of non-dialysis CKD-MBD patients with syndrome of kidney deficiency and damp heat and improve the disorder of bone metabolism.
Objective: To observe the changes of serum fibroblast growth factor 23( FGF23) levels in non-dialysis patients with chronic kidney disease mineral and bone metabolism disorder( CKD-MBD) and syndrome of kidney deficiency and damp heat and observe the therapeutic effect of these patients using Rong Huang Granule. Methods: 66 cases of non-dialysis CKD-MBD patients with syndrome of kidney deficiency and damp heat which met the inclusion criteria were randomly divided into observation group and control group. In the end,62 cases were actually completed,including 32 cases in the observation group and 30 cases in the control group. A normal group of 20 cases was set up. Two groups of patients were given the conventional therapy of western medicine and retention enema of traditional Chinese medicine. Rong Huang Granule was added to the observation group during the treatment. It was used three times a day,one bag each time. The course of treatment lasted 8 weeks. The changes of syndrome of kidney deficiency and damp heat in two groups of patients were observed. Serum calcium( Ca),phosphorus( P),intact parathyroid hormone( i PTH) and FGF23 in two groups of patients were tested before and after treatment. Results: The clinical efficacy of the observation group was significantly better than that of the control group( P < 0. 01). The scores of syndromes in the two groups were significantly decreased along with the increase of the course of treatment( P < 0. 05 or P < 0. 01). The efficacy of the observation group was significantly better than that of the control group at each time point( P < 0. 01). The serum levels of Ca,P and i PTH in the observation group were significantly improved after treatment( P < 0. 05 or P < 0. 01). In addition to the improvement in the level of i PTH in the control group( P < 0. 05),no other indicators had improved significantly. The serum levels of Ca,P and i PTH in the observation group were significantly better than those in the control group after treatment( P < 0. 05). The serum levels of FGF23 in the two groups were significantly higher than those in the normal group before treatment( P < 0. 01). The serum level of FGF23 in the observation group was significantly decreased after treatment( P <0. 05),while the serum level of FGF23 in control group was not significantly improved( P > 0. 05). The serum level of FGF23 in the observation group was significantly lower than that in the control group after treatment( P < 0. 05). Conclusion: Rong Huang Granule can improve the clinical symptoms of non-dialysis CKD-MBD patients with syndrome of kidney deficiency and damp heat and improve the disorder of bone metabolism.
引文
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[14]程叙扬,蔡美顺,崔太根,等.活性炭联合大黄类制剂协助控制慢性肾脏病高磷血症[J].中国血液净化,2011,10(3):119-124.Cheng XY,Cai MS,Cui TG,et al.Active carbon combined with rhubarb preparation to help control hyperphosphoremia in chronic kidney disease[J].Chin Blood Purification,2011,10(3):119-124.
[15]王凌芬,赵玮,王占启,等.肉苁蓉保护残余肾功能的临床观察[J].河北中医,2011,33(1):43-44.Wang LF,Zhao W,Wang ZQ,et al.Clinical observation on the preservation of residual renal function by Cistanche deserticola[J].Hebei Chin Med,2011,33(1):43-44.
[16]孙响波,于妮娜.六月雪治疗肾脏疾病探源[J].中医药导报,2013,19(10):127-128.Sun XB,Yu NN.June snow treatment of kidney disease[J].Chin Med Guide,2013,19(10):127-128.
[17]李小波,边壮,兰萍,等.桃仁对单侧输尿管梗阻大鼠肾小管上皮细胞转分化的影响[J].中国实验方剂学杂志,2011,17(13):189-191.Li XB,Bian Z,Lan P,et al.The effect of peach kernel on the transdifferentiation of renal tubular epithelial cells in rats with unilateral ureteral obstruction[J].Chin J Exp Prescriptions,2011,17(13):189-191.
[18]Voormolen N,Noordzij M,Grootendorst DC,et al.High plasma phosphate as a risk factor for decline in renal function and mortality in pre-dialysis patients[J].Nephrol Dialysis Transplant,2007,22(10):2909-2916.
[19]Shroff R.Phosphate is a vascular toxin[J].Pediat Nephrol,2013,28(4):583-593.
[20]Shroff RC,Mcnair R,Figg N,et al.Dialysis accelerates medial vascular calcification in part by triggering smooth muscle cell apoptosis[J].Circulation,2008,118(17):1748-1757.
[21]Martin KJ,González EA.Long-term management of CKD-mineral and bone disorder[J].Am J Kidney Dis,2012,60(2):308-315.
[22]刁宗礼,刘莎,刘文虎,等.慢性肾脏病继发性甲状旁腺功能亢进的发病机制研究进展[J].现代生物医学进展,2015,15(31):6186-6189.Diao ZL,Liu S,Liu WH,et al.Research progress in the pathogenesis of secondary hyperparathyroidism in chronic kidney disease[J].Modern Biomed Progress,2015,15(31):6186-6189.
[23]Liu M,Ius M,Kozlovskaia LV,et al.Significance of the morphogenetic proteins FGF-23 and Klotho as predictors of prognosis of chronic kidney disease[J].Terapevticheskii Arkhiv,2014,86(4):36-44.
[24]Pavik I,Jaeger P,Ebner L,et al.Secreted Klotho and FGF23 in chronic kidney disease Stage 1 to 5:a sequence suggested from a cross-sectional study[J].Nephrol Dialysis Transplant,2013,28(2):352-359.
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[2]王东,胡顺金,王亿平,等.蓉黄益肾解毒颗粒治疗非透析慢性肾衰竭肾虚湿热证临床观察[J].安徽中医药大学学报,2017,36(2):6-9.Wang D,Hu SJ,Wang YP,et al.Clinical observation of Rong Huang Yishen Jiedu Granule in treating non dialytic chronic renal failure with kidney deficiency and dampness heat syndrome[J].JAnhui Univ Tradit Chin Med,2017,36(2):6-9.
[3]赵振霞,赵振敏,赵成广.蓉黄益肾解毒汤治疗慢性肾脏病患者后血脂变化与血清骨保护素、甲状旁腺激素的关系研究[J].中药药理与临床,2016,32(5):102-105.Zhao ZX,Zhao ZM,Zhao CG.The relationship between blood lipid changes and serum osteoprotin and parathyroid hormone in patients with chronic kidney disease treated with Rong Huang Yishi Jiedu soup[J].Pharmacol Clin Med,2016,32(5):102-105.
[4]Levey AS,de Jong PE,Coresh J,et al.The definition,classification,and prognosis of chronic kidney disease:a KDIGO Controversies Conference report[J].Kidney Int,2011,80(1):17-28.
[5]王莉,李贵森,刘志红.中华医学会肾脏病学分会《慢性肾脏病矿物质和骨异常诊治指导》[J].肾脏病与透析肾移植杂志,2013,22(6):554-559.Wang L,Li GS,Liu ZH."Guidance on the diagnosis and treatment of mineral and bone abnormality of chronic kidney disease"branch of the Chinese Medical Association[J].Kidney Dis Dialysis Kidney Transplant,2013,22(6):554-559.
[6]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,2002:163-168.Zheng XY.Guiding principle of clinical research on new Chinese medicine(Trial)[M].Beijing:China Med Sci Technol Press,2002:163-168.
[7]马斌荣.医学统计学[J].第3版.北京:人民卫生出版社,2002:256.Ma BR.Medical Statistics[M].Third edition.Beijing:People's Medical Publishing House,2002:256.
[8]王海燕.肾脏病学[M].北京:人民卫生出版社,2008:1919-1931.Wang HY.Nephrology[M].Beijing:People's Medical Publishing House,2008:1919-1931.
[9]柳诗意,张宁,刘世巍,等.慢性肾脏病血管钙化机制研究进展及中医药研究概况[J].中国中西医结合肾病杂志,2015,16(4):352-355.Liu SY,Zhang N,Liu SW,et al.Research progress on the mechanism of vascular calcification in chronic kidney disease and a survey of Chinese medicine[J].Chin J Integrated Tradit Chin Western Med,2015,16(4):352-355.
[10]苏国斌,蔡寸,胡晓璇,等.黄春林治疗慢性肾脏病矿物质和骨代谢异常的中医思路[J].广州中医药大学学报,2014,31(1):130-132.Su GB,Cai C,Hu XX,et al.Traditional Chinese medicine for the treatment of abnormal minerals and bone metabolism in chronic kidney disease[J].J Guangzhou Univ Chin Med,2014,31(1):130-132.
[11]刘世巍,张宁,李同侠,等.补肾活血法干预长期维持性血液透析肾性骨病患者中医证候的研究[J].北京中医药大学学报,2012,35(11):786-790.Liu SW,Zhang N,Li TX,et al.Research on TCM Syndromes of long-term maintenance hemodialysis patients with renal osteopathy in maintenance hemodialysis[J].J Beijing Univ Chin Med,2012,35(11):786-790.
[12]胡振奋,黄蔚霞,吴睿轩,等.补肾泄浊法对慢性肾脏病3-5期患者中医证候及矿物质骨代谢的影响[J].中国中医急症,2017,26(11):2011-2014.Hu ZF,Huang WX,Wu RX,et al.Effect of tonifying kidney and turbidity method on TCM syndrome and mineral bone metabolism in 3-5 phase of chronic kidney disease(CKD)[J].Chin Med E-mergency,2017,26(11):2011-2014.
[13]汪天宇,骆阳阳,鲁科达.大黄素在慢性肾脏病中的作用机制[J].浙江实用医学,2017,22(2):154-156.Wang TY,Luo YY,Lu KD.Emodin in the mechanism of chronic kidney disease[J].Zhejiang Pract Med,2017,22(2):154-156.
[14]程叙扬,蔡美顺,崔太根,等.活性炭联合大黄类制剂协助控制慢性肾脏病高磷血症[J].中国血液净化,2011,10(3):119-124.Cheng XY,Cai MS,Cui TG,et al.Active carbon combined with rhubarb preparation to help control hyperphosphoremia in chronic kidney disease[J].Chin Blood Purification,2011,10(3):119-124.
[15]王凌芬,赵玮,王占启,等.肉苁蓉保护残余肾功能的临床观察[J].河北中医,2011,33(1):43-44.Wang LF,Zhao W,Wang ZQ,et al.Clinical observation on the preservation of residual renal function by Cistanche deserticola[J].Hebei Chin Med,2011,33(1):43-44.
[16]孙响波,于妮娜.六月雪治疗肾脏疾病探源[J].中医药导报,2013,19(10):127-128.Sun XB,Yu NN.June snow treatment of kidney disease[J].Chin Med Guide,2013,19(10):127-128.
[17]李小波,边壮,兰萍,等.桃仁对单侧输尿管梗阻大鼠肾小管上皮细胞转分化的影响[J].中国实验方剂学杂志,2011,17(13):189-191.Li XB,Bian Z,Lan P,et al.The effect of peach kernel on the transdifferentiation of renal tubular epithelial cells in rats with unilateral ureteral obstruction[J].Chin J Exp Prescriptions,2011,17(13):189-191.
[18]Voormolen N,Noordzij M,Grootendorst DC,et al.High plasma phosphate as a risk factor for decline in renal function and mortality in pre-dialysis patients[J].Nephrol Dialysis Transplant,2007,22(10):2909-2916.
[19]Shroff R.Phosphate is a vascular toxin[J].Pediat Nephrol,2013,28(4):583-593.
[20]Shroff RC,Mcnair R,Figg N,et al.Dialysis accelerates medial vascular calcification in part by triggering smooth muscle cell apoptosis[J].Circulation,2008,118(17):1748-1757.
[21]Martin KJ,González EA.Long-term management of CKD-mineral and bone disorder[J].Am J Kidney Dis,2012,60(2):308-315.
[22]刁宗礼,刘莎,刘文虎,等.慢性肾脏病继发性甲状旁腺功能亢进的发病机制研究进展[J].现代生物医学进展,2015,15(31):6186-6189.Diao ZL,Liu S,Liu WH,et al.Research progress in the pathogenesis of secondary hyperparathyroidism in chronic kidney disease[J].Modern Biomed Progress,2015,15(31):6186-6189.
[23]Liu M,Ius M,Kozlovskaia LV,et al.Significance of the morphogenetic proteins FGF-23 and Klotho as predictors of prognosis of chronic kidney disease[J].Terapevticheskii Arkhiv,2014,86(4):36-44.
[24]Pavik I,Jaeger P,Ebner L,et al.Secreted Klotho and FGF23 in chronic kidney disease Stage 1 to 5:a sequence suggested from a cross-sectional study[J].Nephrol Dialysis Transplant,2013,28(2):352-359.
[25]Gattineni J,Bates C,Twombley K,et al.FGF23 decrea-ses renal Na Pi-2a and Na Pi-2c expression and induces hy-pophosphatemia in vivo predominantly via FGF receptor 1[J].Am J Physiol Renal Physiol,2009,297(2):F282-F291.
[26]Takaiwa M,Aya K,Miyai T,et al.Fibroblast growth factor 23 concentrations in healthy term infants during the early postpartum period[J].Bone,2010,47(2):256-262.
[27]Canalejo R,Canalejo A,Martinezmoreno JM,et al.FGF23 fails to inhibit uremic parathyroid glands[J].J Am Society Nephrol Jasn,2010,21(7):1125-1135.
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