健脾益肾祛湿化瘀法治疗肾劳骨痿的临床观察
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摘要
目的:通过观察健脾益肾、祛湿化瘀法对肾劳骨痿病患者相关的实验室指标及患者临床症状的变化情况,探讨健脾益肾、祛湿化瘀法对肾劳骨痿患者的影响,为临床治疗提供客观依据。
方法:临床纳入脾肾阳虚、浊瘀阻滞证患者60例,按就诊顺序开放分为治疗组30例,对照组30例。在对慢性肾衰竭基础治疗并同时加用罗盖全的基础上上,对照组应用尿毒清口服,治疗组服用健脾益肾、祛湿化瘀法指导下的中药汤剂—补骨生髓泄浊汤,以3个月为1个疗程,观察指标为:对治疗前后两组的临床症状,尿素氮,血清肌酐,全段甲状旁腺激素,血磷,血钙,钙磷乘积进行前后观察对比。
结果:1.在降低中医证候积分方面,治疗组及对照组在治疗前后均有显著性差异(P＜0.05)。组间比较有显著性差异(P＜0.05),治疗组优于对照组。(2)在改善肾功方面,治疗组在治疗前后有显著性差异(P＜0.01),对照组在治疗前后也有显著性差异(P＜0.05),组间比较有显著性差异,治疗组疗效优于对照组(p＜0.05)。(3)在改善临床化验方面,治疗组与对照组在治疗前后血清甲状旁腺激素,血磷,钙磷乘积均有显著性差异(P＜0.05),组间比较有显著性差异,治疗组疗效优于对照组(p＜0.05),对血钙,碱性磷酸酶影响不显著,治疗组与对照组无显著性差异(P＞0.05)。
结论:通过临床研究发现:1.健脾益肾、祛湿化瘀法能有效地治疗慢性肾衰竭脾肾阳虚、浊瘀阻滞证,临床症状改善明显。2.健脾益肾、祛湿化瘀法能明显改善肾劳骨痿患者钙磷代谢异常及延缓慢性肾衰竭病程的进展,保护健存肾单位。3.健脾益肾、祛湿化瘀法对于改善临床症状、化验指标方面的作用优于尿毒清组。为治疗肾劳骨痿病提供新思路。
Objects: Through observing the methods of invigorating spleen> tonifying kidney、dissipating dampness and resolving blood stasis on the change of the relevant laboratory's values and clinical symptom on the patients who are bone wilting due to kidney taxation , we discuss the effect of this methods on bone wilting due to kidney taxation.
Methods: we select 60 cases of yang deficiency of spleen and kidney with turbidity stasis stagnancy, and divided them into two groups at random, the therapy group and the control group. On the basic therapy, the control group is given VD3, and the therapy group is given herbal decoction which follows the principle of invigorating spleen、tonifying kidney, resolving dampness and dissipating blood stasis—Gugu decoction. After one period of treatment with three months, we observe the laboratory's values, such as clinical symptom, BUN, Scr, iPTH, P, Ca, CaXP, to compare the two groups before and after therapy.
Result : (1)In reducing the accumulating grade of TCM syndrome there was significant difference in both groups before and after theraphy(p<0.05), and between the groups(p<0.05) the therapy group is better than the normal group .(2)On the aspect of improving the renal function, before and after therapy there was significant difference both the two groups (p<0.01 or p<0.05), and between the two groups(p<0.05).(3) On the aspect of improving clinical tests, before and after therapy there were significant difference on PTH, P and the product of P and Ca both the two groups (p<0.05). There was significant difference between the two groups, and the therapy group is better than normal group(p<0.05). There is no significant difference on the P and AKP in serum between the two groups(p>0.05). Conclusions: 1. The methods of invigorating spleen, tonifying kidney, dissipating dampness and resolving blood stasis can treat the syndrome of yang deficiency of spleen and kidney with turbidity stasis stagnancy on CRF, and the symptom can be improved significantly.2. The methods of invigorating spleen、tonifying kidney、dissipating dampness and resolving blood stasis can improve the the abnormal of Ca、P in blood serum, retard the progression of CRF, protect the renal units.3. The methods of invigorating spleen、tonifying kidney、dissipating dampness and resolving blood stasis is better than the normal group on the aspect of improving the clinical symptom and test index. This methods may be a new idea on treating bone wilting due to kidney taxation
方法:临床纳入脾肾阳虚、浊瘀阻滞证患者60例,按就诊顺序开放分为治疗组30例,对照组30例。在对慢性肾衰竭基础治疗并同时加用罗盖全的基础上上,对照组应用尿毒清口服,治疗组服用健脾益肾、祛湿化瘀法指导下的中药汤剂—补骨生髓泄浊汤,以3个月为1个疗程,观察指标为:对治疗前后两组的临床症状,尿素氮,血清肌酐,全段甲状旁腺激素,血磷,血钙,钙磷乘积进行前后观察对比。
结果:1.在降低中医证候积分方面,治疗组及对照组在治疗前后均有显著性差异(P＜0.05)。组间比较有显著性差异(P＜0.05),治疗组优于对照组。(2)在改善肾功方面,治疗组在治疗前后有显著性差异(P＜0.01),对照组在治疗前后也有显著性差异(P＜0.05),组间比较有显著性差异,治疗组疗效优于对照组(p＜0.05)。(3)在改善临床化验方面,治疗组与对照组在治疗前后血清甲状旁腺激素,血磷,钙磷乘积均有显著性差异(P＜0.05),组间比较有显著性差异,治疗组疗效优于对照组(p＜0.05),对血钙,碱性磷酸酶影响不显著,治疗组与对照组无显著性差异(P＞0.05)。
结论:通过临床研究发现:1.健脾益肾、祛湿化瘀法能有效地治疗慢性肾衰竭脾肾阳虚、浊瘀阻滞证,临床症状改善明显。2.健脾益肾、祛湿化瘀法能明显改善肾劳骨痿患者钙磷代谢异常及延缓慢性肾衰竭病程的进展,保护健存肾单位。3.健脾益肾、祛湿化瘀法对于改善临床症状、化验指标方面的作用优于尿毒清组。为治疗肾劳骨痿病提供新思路。
Objects: Through observing the methods of invigorating spleen> tonifying kidney、dissipating dampness and resolving blood stasis on the change of the relevant laboratory's values and clinical symptom on the patients who are bone wilting due to kidney taxation , we discuss the effect of this methods on bone wilting due to kidney taxation.
Methods: we select 60 cases of yang deficiency of spleen and kidney with turbidity stasis stagnancy, and divided them into two groups at random, the therapy group and the control group. On the basic therapy, the control group is given VD3, and the therapy group is given herbal decoction which follows the principle of invigorating spleen、tonifying kidney, resolving dampness and dissipating blood stasis—Gugu decoction. After one period of treatment with three months, we observe the laboratory's values, such as clinical symptom, BUN, Scr, iPTH, P, Ca, CaXP, to compare the two groups before and after therapy.
Result : (1)In reducing the accumulating grade of TCM syndrome there was significant difference in both groups before and after theraphy(p<0.05), and between the groups(p<0.05) the therapy group is better than the normal group .(2)On the aspect of improving the renal function, before and after therapy there was significant difference both the two groups (p<0.01 or p<0.05), and between the two groups(p<0.05).(3) On the aspect of improving clinical tests, before and after therapy there were significant difference on PTH, P and the product of P and Ca both the two groups (p<0.05). There was significant difference between the two groups, and the therapy group is better than normal group(p<0.05). There is no significant difference on the P and AKP in serum between the two groups(p>0.05). Conclusions: 1. The methods of invigorating spleen, tonifying kidney, dissipating dampness and resolving blood stasis can treat the syndrome of yang deficiency of spleen and kidney with turbidity stasis stagnancy on CRF, and the symptom can be improved significantly.2. The methods of invigorating spleen、tonifying kidney、dissipating dampness and resolving blood stasis can improve the the abnormal of Ca、P in blood serum, retard the progression of CRF, protect the renal units.3. The methods of invigorating spleen、tonifying kidney、dissipating dampness and resolving blood stasis is better than the normal group on the aspect of improving the clinical symptom and test index. This methods may be a new idea on treating bone wilting due to kidney taxation
引文
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[2]张宁,刘世巍.补肾活血法对肾性骨病患者全段甲状旁腺素与骨特异性碱性磷酸酶的影响,北京中医药大学学报[J],2005,12(14):1-3
[3]安海燕,任可。补骨汤治疗肾性骨病的临床观察,中国中西医结合肾病杂志[J],2004,12(5):718-719
[4]赵玉庸,孙中成,尹雷董等。中药复方治疗肾性骨营养不良大鼠的实验研究,河北中医药学报[J],2001,16(3):14-15
[5]张庆怡,牟姗。慢性肾衰竭与肾性骨病,中国中西医结合肾病杂志[J],2003,4(3):125-127。
[6]朱鹏飞,李冬华。肾主骨理论的现代理解与补肾法的研究[J]。上海中医药杂志,2003,37(6):9。
[7]刘连升,胡岗。海螵蛸对尿毒症血透患者血磷和甲状旁腺素作用的研究,实用中西医结合临床[J]2005,(5)5:5-6
[8]刘毅,张英,管竞环。根据中药钙磷比值辨证组方治疗慢性肾功能衰竭的实验研究,中国中医基础医学杂志[J],2000,6(6):36-40
[9]刘旭生,尹国良。中药配合口服西药治疗透析患者骨病临床观察,中医杂志[J],1999,2(2):100-101
[10]杨收平。肾主骨生髓学说的现代理解,中西医结合肾病杂志[J],2002,3(8):17-18
[11]Dony DC Renal bone diseases Proceedings of 4~(th)Asian Pacific Congress of Nephrology Dzakarta:International Academic Publishers,1991:86.
[12]Cohen-sol.al ME,Augry F,Mauras Y.et al,fluoride and strontium.accumulation in bone does not correlate with osteoid tissue in dialysis patients.Nephrol Dial Transplant.2002,17(3):449-454
[13]Cohen-Solal ME,Augry F,Mauras Y,et al.Fluoride and strontium Aeeum load on parathyroid hormone synthesis.Nephrol Dial Transplant,2002,17(3):449-454,
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