中医综合疗法治疗早期慢性肾衰竭的疗效观察
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摘要
目的观察中医综合疗法治疗早期慢性肾衰竭的临床疗效。方法将160例早期慢性肾衰竭患者按照随机数字表法分为2组。治疗组80例在常规治疗基础上联合中药内服+灌肠+离子导入中医综合疗法治疗;对照组80例在常规治疗基础上联合包醛氧淀粉治疗。2组均治疗3个月后统计疗效,比较2组治疗前后中医症状疲倦乏力、腰膝痠软、纳差呕恶、夜尿清长、大便干结、脘腹胀满及水肿评分变化情况,比较2组治疗前及治疗1、2、3个月后血肌酐(Cr)、尿素氮(BUN)、尿酸(UA)、胱抑素C(Cys-C)、超敏C反应蛋白(hs-CRP)、转化生长因子-β_1(TGF-β_1)水平变化情况。结果治疗组总有效率85.00%,对照组总有效率58.75%,治疗组疗效优于对照组(P<0.05);2组治疗后中医症状疲倦乏力、腰膝痠软、纳差呕恶、夜尿清长、大便干结、脘腹胀满及水肿评分与本组治疗前比较均明显降低(P<0.05),且治疗组治疗后各中医症状评分均低于对照组(P<0.05);2组治疗1、2、3个月后Cr、BUN、UA、Cys-C、hs-CRP及TGF-β_1水平与本组治疗前比较均明显降低(P<0.05),且治疗组治疗后各指标均低于对照组同期水平(P<0.05)。结论在常规治疗基础上联合中药内服+灌肠+离子导入中医综合疗法治疗早期慢性肾衰竭可明显提高临床疗效,改善患者中医症状表现,改善患者肾功能,降低Cys-C、hs-CRP及TGF-β_1水平,延缓病情进展。
Objective To observe the clinical effects of traditional Chinese medicine comprehensive therapy on early chronic renal failure. Methods 160 patients with chronic renal failure were randomly divided into two groups. 80 cases in treatment group were treated by oral administration of Chinese medicine plus enema and iontophoresis on the basis of routine treatment. 80 cases in control group were treated by oxyamyli tectus aldehydum on the basis of routine treatment. The curative effect was evaluated after 3 months of treatment in both groups. The changes of TCM symptoms, such as fatigue, weakness of waist and knee, nausea and vomiting, clear and long night urine, dry stool, abdominal distention and edema scores before and after treatment were compared between the two groups. The levels of serum creatinine(Cr), urea nitrogen(BUN), uric acid(UA), cystatin C(Cys-C), hypersensitive C-reactive protein(hs-CRP) and transforming growth factor-β_1(TGF-β_1) were compared before treatment and 1, 2 and 3 months after treatment in the two groups. Results The total effective rate was 85.00% in the treatment group and 58.75% in the control group. The curative effect of the treatment group was better than that of the control group(P<0.05). After treatment, the TCM symptoms scores of fatigue, weakness of waist and knee, nausea and vomiting, clear and long night urine, dry stool, abdominal distension and edema in the two groups were significantly lower than those in the group before treatment(P<0.05), and the scores of TCM symptoms in the treatment group were lower than those in the control group(P<0.05). After 1, 2 and 3 months of treatment, the levels of Cr, BUN, UA, Cys-C, hs-CRP and TGF-β_1 in the two groups were significantly lower than those in the group before treatment(P<0.05), and the indexes in treatment group were lower than those in the control group at the same time(P<0.05). Conclusion On the basis of conventional treatment, combined with traditional Chinese medicine oral administration plus enema and iontophoresis in the treatment of early chronic renal failure can significantly improve clinical efficacy, improve the scores of TCM symptoms, improve renal function, and reduce the levels of Cys-C, hs-CRP and TGF-β_1, and delay the progress of the disease.
Objective To observe the clinical effects of traditional Chinese medicine comprehensive therapy on early chronic renal failure. Methods 160 patients with chronic renal failure were randomly divided into two groups. 80 cases in treatment group were treated by oral administration of Chinese medicine plus enema and iontophoresis on the basis of routine treatment. 80 cases in control group were treated by oxyamyli tectus aldehydum on the basis of routine treatment. The curative effect was evaluated after 3 months of treatment in both groups. The changes of TCM symptoms, such as fatigue, weakness of waist and knee, nausea and vomiting, clear and long night urine, dry stool, abdominal distention and edema scores before and after treatment were compared between the two groups. The levels of serum creatinine(Cr), urea nitrogen(BUN), uric acid(UA), cystatin C(Cys-C), hypersensitive C-reactive protein(hs-CRP) and transforming growth factor-β_1(TGF-β_1) were compared before treatment and 1, 2 and 3 months after treatment in the two groups. Results The total effective rate was 85.00% in the treatment group and 58.75% in the control group. The curative effect of the treatment group was better than that of the control group(P<0.05). After treatment, the TCM symptoms scores of fatigue, weakness of waist and knee, nausea and vomiting, clear and long night urine, dry stool, abdominal distension and edema in the two groups were significantly lower than those in the group before treatment(P<0.05), and the scores of TCM symptoms in the treatment group were lower than those in the control group(P<0.05). After 1, 2 and 3 months of treatment, the levels of Cr, BUN, UA, Cys-C, hs-CRP and TGF-β_1 in the two groups were significantly lower than those in the group before treatment(P<0.05), and the indexes in treatment group were lower than those in the control group at the same time(P<0.05). Conclusion On the basis of conventional treatment, combined with traditional Chinese medicine oral administration plus enema and iontophoresis in the treatment of early chronic renal failure can significantly improve clinical efficacy, improve the scores of TCM symptoms, improve renal function, and reduce the levels of Cys-C, hs-CRP and TGF-β_1, and delay the progress of the disease.
引文
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[19] 朱伟,王学美.大黄治疗慢性肾功能衰竭机制的研究进展[J].中国中西医结合杂志,2005,25(5):471-475.
[20] 王明星,张积银.中药离子导入治疗慢性肾衰竭45例临床观察[J].湖南中医杂志,2016,32(12):55-57.
[21] 饶晓明,李清萍,罗昭娜.中药外敷延缓慢性肾衰竭进程的临床价值及护理[J].中外医疗,2008,27(36):103-104.
[2] Cerqueira DP,Tavares JR,Machado RC.Predictive factors for renal failure and a control and treatment algorithm[J].Rev Lat Am Enfermagem,2014,22(2):211-217.
[3] 许筠,张军,翟晓丽,等.综合疗法治疗慢性肾衰竭临床观察[J].中国中西医结合肾病杂志,2002,3(10):596-597.
[4] 陈盛君.中药灌肠治疗慢性肾功能衰竭30例临床观察[J].云南中医中药杂志,2015,36(7):112-113.
[5] 关欣,郑红光,辛雨.中药高位结肠透析对慢性肾功能衰竭患者免疫功能的影响[J].中华中医药学刊,2014,32(12):3047-3049.
[6] 陈新昌.中药离子导入法治疗慢性肾功能衰竭74例临床观察[J].黑龙江中医药,2015,44(5):13-14.
[7] 上海慢性肾脏病早发现及规范化诊治与示范项目专家组.慢性肾脏病筛查诊断及防治指南[J].中国实用内科杂志,2017,37(1):28-34.
[8] 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.
[9] Druez A,Rahier JF,Hebuterne X.Methaemoglobinaemia and renal failure following mesalazine for treatment of inflammatory bowel disease[J].J Crohns Colitis,2014,8(8):900-901.
[10] 朱宣辑,牛丰,刘杨,等.2011例慢性肾衰竭住院患者的病因分析[J].中国实验诊断学,2014,18(11):1770-1772.
[11] 朱辟疆,赵华,周逊,等.结肠序贯透析加中药保留灌肠治疗中晚期慢性肾衰竭38例疗效分析[J].中国中西医结合急救杂志,2010,17(5):278-281.
[12] 刘付捷,陈贤,黄访英,等.中晚期慢性肾衰竭患者应用ACEI和AR1B有效性及安全性初探[J].中国中西医结合肾病杂志,2007,8(6):349-350.
[13] 杨渝伟,曾平,张林,等.慢性肾病患者基于血清胱抑素C与肌酐的肾小球滤过率估算方程的建立和评价[J].中华检验医学杂志,2013,36(4):352-359.
[14] 陈红.小儿急性肾炎患者治疗前后血清hs-CRP、TGF-β1和HGF检测的临床意义[J].放射免疫学杂志,2010,23(6):700-701.
[15] 陈红.小儿急性肾炎患者治疗前后血清hs-CRP、TGF-β1和HGF检测的临床意义[J].放射免疫学杂志,2010,23(6):700-701.
[16] 郑海生,王荣,刘凯.中医固脾肾结合灌肠法与包醛氧淀粉治疗慢性肾功能衰竭的meta分析[J].时珍国医国药,2013,24(4):998-1000.
[17] 何立群,张长明.活血化瘀法在慢性肾衰竭临床应用中研究进展[J].中国中西医结合肾病杂志,2012,13(7):565-567.
[18] 白志军.中药灌肠治疗慢性肾衰竭82例观察[J].山东中医杂志,2000,19(5):277-278.
[19] 朱伟,王学美.大黄治疗慢性肾功能衰竭机制的研究进展[J].中国中西医结合杂志,2005,25(5):471-475.
[20] 王明星,张积银.中药离子导入治疗慢性肾衰竭45例临床观察[J].湖南中医杂志,2016,32(12):55-57.
[21] 饶晓明,李清萍,罗昭娜.中药外敷延缓慢性肾衰竭进程的临床价值及护理[J].中外医疗,2008,27(36):103-104.