补肾活血颗粒缓解长期维持性血液透析的CKD-MBD患者骨痛的临床疗效评价
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摘要
目的观察并评价补肾活血颗粒缓解长期维持性血液透析的骨矿物质和骨代谢异常(CKD-MBD)患者骨痛症状及骨代谢指标异常的临床疗效。方法采用多中心、平行随机对照的前瞻性临床试验的设计方案,将177例行长期维持性血液透析的CKD-MBD患者随机分为对照组88例和中药组89例。对照组采用对症治疗方案,中药组在对照组基础上加用补肾活血颗粒,均治疗3个月。分别于治疗前后测定疼痛视觉模拟评分(VAS),评价临床疗效;比较2组患者治疗前后血钙、磷、全段甲状旁腺激素(i-PTH)、血清骨特异性碱性磷酸酶(BAP)等钙磷代谢及骨转化指标的变化。结果治疗后,中药组和对照组疼痛VAS评分均下降,中药组评分下降程度显著大于对照组(P<0.01),临床疗效显著优于对照组(P<0.01)。第3个月,中药组血钙上升(P<0.01),血磷下降(P<0.05)。第3、6个月时,中药组血i-PTH有下降趋势,血BAP显著下降,与对照组比较差异有统计学意义(P<0.01)。结论补肾活血中药能够有效缓解长期维持性血液透析CKD-MBD患者的骨痛症状,并能改善其骨矿物质代谢,改善亢进的骨转换。
引文
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[4] 张宁.肾性骨病患者生存质量主要影响因素的研究[J].中华中医药杂志,2005,20(5):287-289.
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[8] 张宁,刘世巍,任可,等.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[J].现代中医临床,2005,12(4):1-3.
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[11] Nigwekar SU,Tamez H,Thadhani RI.Vitamin D and chronic kidney disease-mineral bone disease(CKD-MBD)[J].Bonekey Reports,2014,3:498.
[12] Beto JA,Bansal VK,Ramirez WE.Dyslipidemias,in Nutrition in Kidney Disease[J].Springe,2014,137-146.
[13] Martin KJ,González EA.Prevention and control of phosphate retention/hyperphosphatemia in CKD-MBD:what is normal,when to start,and how to treat[J].Clin J Am Soc Nephrol,2011,6(2):440-446.
[2] Martin KJ,González EA.Long-term Management of CKD-Mineral and Bone Disorder[J].American Journal of Kidney Diseases,2012,60(2):308-315.
[3] London GM.Arterial calcifications and bone histomor-phometry in end-stage renal disease[J].Journal of the American Society of Nephrology,2004,15(7):1943-1951.
[4] 张宁.肾性骨病患者生存质量主要影响因素的研究[J].中华中医药杂志,2005,20(5):287-289.
[5] 张宁,刘世巍,李同侠,等.补肾活血法改善165例例长期维持性血液透析肾性骨病患者生存质量的临床疗效评价[J].北京中医药,2012,31(3):169-171.
[6] 刘世巍.165 例长期维持性血液透析肾性骨病患者中医证候分析[J].世界中医药,2012,7(3):198-200.
[7] 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.
[8] 张宁,刘世巍,任可,等.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[J].现代中医临床,2005,12(4):1-3.
[9] Moe SM.Definition and classification of renal osteody-strophy and chronic kidney disease-mineral bone disorder(CKD-MBD)[J].The spectrum of mineral and bone disorders in chronic kidney disease.New York:Oxford University,2010:1-14.
[10] Brandenburg VM,Floege J.Adynamic bone disease—bone and beyond[J].NDT plus,2008,1(3):135-147.
[11] Nigwekar SU,Tamez H,Thadhani RI.Vitamin D and chronic kidney disease-mineral bone disease(CKD-MBD)[J].Bonekey Reports,2014,3:498.
[12] Beto JA,Bansal VK,Ramirez WE.Dyslipidemias,in Nutrition in Kidney Disease[J].Springe,2014,137-146.
[13] Martin KJ,González EA.Prevention and control of phosphate retention/hyperphosphatemia in CKD-MBD:what is normal,when to start,and how to treat[J].Clin J Am Soc Nephrol,2011,6(2):440-446.