益肾养血方联合西药治疗糖尿病肾病(DKD-Ⅴ期)肾性贫血(脾肾气虚)随机平行对照研究
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摘要
[目的]观察益肾养血方联合西药治疗Ⅴ期糖尿病肾病DKD肾性贫血(脾肾气虚)疗效。[方法]使用随机平行对照方法,将60例住院患者按病志号抽签随机分为两组;控制血糖、血压,降低蛋白尿、补充叶酸、纠正酸碱失衡,胰岛素降糖等;血糖控制:空腹<7.0mmol/L,餐后2h<10.0mmol/L;血压控制135/70～148/90mmHg。对照组30例琥珀酸亚铁150mg,1次/d;重组人促红素5000U皮下注射,2次/周,据血红蛋白调整重组人促红素剂量。治疗组30例益肾养血方(黄芪30g,地黄~熟20g,党参10g,当归、丹参各20g,白术~生15g,川芎12g),水煎200mL,1剂/d,早晚温服;琥珀酸亚铁联合重组人促红素治疗同对照组。连续治疗3个月为1疗程。观测临床表现、血红蛋白(hemoglobin,Hb)、血清铁蛋白(serum ferritsn,SF)、转铁蛋白饱和度(transferrin saturation,TAST)、血肌酐(Scr)、血尿素氮(BUN)、β_2微球蛋白、不良反应。连续治疗1个疗程,判定疗效。[结果]治疗组显效21例,有效5例,无效4例,总有效率86.66%;对照组显效19例,有效4例,无效7例,总有效率76.66%;治疗组疗效优于对照组(P<0.05)。Hb、Hct、SF、TAST、BUN、Scr、β_2微球蛋白两组均有改善(P<0.01,P<0.05),治疗组改善优于对照组(P<0.01)。[结论]益肾养血方联合西药治疗Ⅴ期DKD肾性贫血(脾肾气虚),疗效满意,无严重不良反应,值得推广。
[Objective] Observe the kidney nourishing blood party combined western medicine therapy for diabetic nephropathy DKD-Ⅴ period renal anemia(spleen kidney deficiency) curative effect. [Methods]Sixty inpatients were randomly divided into two groups according to the disease record number by lottery using the method of random parallel control. Control blood sugar and blood pressure, reduce proteinuria,supplement folic acid, correct acid-base imbalance, insulin hypoglycemic; Blood glucose control: fasting<7.0 mmol/L, 2 h after meals<10.0 mmol/L; Blood pressure control: 135/70～148/90 mmhg. Control group: 150 mg ferrous succinate for 30 cases, once a day; Subcutaneous injection of recombinant human erythropoietin(5000 U) was performed twice a week, and the recombinant human erythropoietin dose was adjusted according to hemoglobin.30 cases in the treatment group were treated with yishen yangxue fang(30 g of astragalus membranaceus, 20 g of dihuang shu, 10 g of codonopsis pilosa, 20 g of angelica sinensis, 20 g of salvia miltiorrhiza, 15 g of atractylodes macrocephaly, 12 g of chuanxiong). Ferrous succinate combined with recombinant human erythropoietin was treated as control group. Continuous treatment for 3 months for a course of treatment. Observing clinical manifestations, hemoglobin(Hb) hemoglobin, serum ferritin(serum ferritsn, SF), transferrin saturation(transferrin saturation, TAST), serum creatinine(SCr), blood urea nitrogen(BUN), beta 2 microglobulin, adverse reactions. Continuous treatment for 1 course, to determine the efficacy.[Results] The total effective rate was 86.66%. The total effective rate was 76.66%. The efficacy of treatment group was better than that of control group(P<0.05). Hb, Hct, SF, TAST, BUN, Scr, 2 microglobulin were improved in both groups(P<0.01, P<0.05), and the improvement in the treatment group was better than that in the control group(P<0.01). [Conclusions] Kidney nourishing blood square phase combined western medicine therapyⅤ DKD renal anemia(spleen kidney deficiency), curative effect is satisfied, no serious adverse reactions, worthy of promotion.
[Objective] Observe the kidney nourishing blood party combined western medicine therapy for diabetic nephropathy DKD-Ⅴ period renal anemia(spleen kidney deficiency) curative effect. [Methods]Sixty inpatients were randomly divided into two groups according to the disease record number by lottery using the method of random parallel control. Control blood sugar and blood pressure, reduce proteinuria,supplement folic acid, correct acid-base imbalance, insulin hypoglycemic; Blood glucose control: fasting<7.0 mmol/L, 2 h after meals<10.0 mmol/L; Blood pressure control: 135/70～148/90 mmhg. Control group: 150 mg ferrous succinate for 30 cases, once a day; Subcutaneous injection of recombinant human erythropoietin(5000 U) was performed twice a week, and the recombinant human erythropoietin dose was adjusted according to hemoglobin.30 cases in the treatment group were treated with yishen yangxue fang(30 g of astragalus membranaceus, 20 g of dihuang shu, 10 g of codonopsis pilosa, 20 g of angelica sinensis, 20 g of salvia miltiorrhiza, 15 g of atractylodes macrocephaly, 12 g of chuanxiong). Ferrous succinate combined with recombinant human erythropoietin was treated as control group. Continuous treatment for 3 months for a course of treatment. Observing clinical manifestations, hemoglobin(Hb) hemoglobin, serum ferritin(serum ferritsn, SF), transferrin saturation(transferrin saturation, TAST), serum creatinine(SCr), blood urea nitrogen(BUN), beta 2 microglobulin, adverse reactions. Continuous treatment for 1 course, to determine the efficacy.[Results] The total effective rate was 86.66%. The total effective rate was 76.66%. The efficacy of treatment group was better than that of control group(P<0.05). Hb, Hct, SF, TAST, BUN, Scr, 2 microglobulin were improved in both groups(P<0.01, P<0.05), and the improvement in the treatment group was better than that in the control group(P<0.01). [Conclusions] Kidney nourishing blood square phase combined western medicine therapyⅤ DKD renal anemia(spleen kidney deficiency), curative effect is satisfied, no serious adverse reactions, worthy of promotion.
引文
[1]黎磊石,刘志红.中国肾脏病学[M].北京:人民军医出版社,2008626.
[2]Weiss G,Goodnough LT.Anemia of chronic disease[J].N Engl JMed,2005,352(10):1011-1023.
[3]徐首航.当归补血汤联合重组促红细胞生成素治疗肾性贫血40例[J].浙江中医杂志,2013,48(6):414.
[4]易继飞.中西医结合治疗慢性肾衰竭肾性贫血临床研究[J].实用中医药杂志,2016,32(11):1099-1100.
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[7]Am J Kidney Dis.Update on Anemia in ESRD and Earlier Stages of CKD[J].Core Curriculum,2013,71(3):423-435.
[8]Hu SL,Said FR,Epstein D,et al.The impact of anemia on renal recovery and survival in acute kidney injury[J].Clin Nephrol,2013,79(3):221-228
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[10]Lank horsl CE,Wish JB.Anemia in renal disease:diagnosis and management[J].Blood Rev,2010,24(1):39-47.
[11]Chrobak C,Sidler JA,O'Meara A,et al.Iron homeostasis in inflammation:a single centre prospective observational study in medical inpatients[J].Swiss Med Wkly,2017,147(19):14431.
[12]常园园,范秋灵.Erythroferrone-铁调素轴在肾性贫血中的研究进展[J].中国临床研究,2017,30(2):268-271.
[13]李香玲,赵学兰,王炎强,等.益肾补气活血方加中药灌肠联合rHuEPO治11疗肾性贫血的临床观察[J].中成药,2011,33(3):390-392.
[14]钱卫明,安国辉,郭慧娥,等.中药联合小剂量重组人促红细胞生成素治疗肾性贫血疗效观察[J].中国中西医结合肾病杂志,2016,17(1):65-66.
[15]戴芹,曲晓璐,唐咏华.黄芪对慢性肾衰竭大鼠SOD和MDA的影响[J].中国中西医结合肾病杂志,2008,9(12):1083.
[16]高焕,袁捷,程小红.当归补血汤联合促红细胞生成素治疗肾性贫血34例[J].河南中医,2014,34(3):549-550.
[17]谢志芬.慢性肾脏病肾性贫血的中西医结合治疗[J].实用中西医结合临床,2015,15(7):42-43.
[18]周珂,董扬洲,王小玲,等.养血益肾方对肾性贫血患者微炎症状态的影响和疗效观察[J].中国中医急症,2017,26(3):493-495.
[19]赵平,刘伟伟,张亮,等.基于骨髓基质细胞自噬和旁分泌探讨黑地黄丸治疗肾性贫血的作用机制[J].中国实验方剂学杂志,2017,23(2):146-152.
[20]李佳桓,林海红,杜钢军.生血宁对肾性贫血和铁过载慢性肾损伤小鼠的防治作用[J].河南大学学报(自然科学版),2017,47(2):170-176.
[21]孙倩美,王质刚.尿毒症患者红细胞生成抑制因子的实验研究[J].中国血液净化,2006,6(5):320-323.
[22]何敏尔,孔仕波,沈伟钢.加减补中益气汤联合促红细胞生成素治疗肾性贫血疗效观察[J].中国中西医结合肾病杂志,2013,14(3):260-261.
[23]易继飞.中西医结合治疗慢性肾衰竭肾性贫血临床研究[J].实用中医药杂志,2017,11(32):85-88.
[2]Weiss G,Goodnough LT.Anemia of chronic disease[J].N Engl JMed,2005,352(10):1011-1023.
[3]徐首航.当归补血汤联合重组促红细胞生成素治疗肾性贫血40例[J].浙江中医杂志,2013,48(6):414.
[4]易继飞.中西医结合治疗慢性肾衰竭肾性贫血临床研究[J].实用中医药杂志,2016,32(11):1099-1100.
[5]中华人民共和国卫生部.涉及人的生物医学研究伦理审查办法(试行)[S].(2007-03-26)[2017-02-05].http://www.moh.gov.cn/qjjys/s3581/200804/b9f1bfee4ab344ec892e68097296e2a8.shtml.
[6]王海艳.肾脏病临床概览[M].北京:北京大学医学出版社,2010292.
[7]Am J Kidney Dis.Update on Anemia in ESRD and Earlier Stages of CKD[J].Core Curriculum,2013,71(3):423-435.
[8]Hu SL,Said FR,Epstein D,et al.The impact of anemia on renal recovery and survival in acute kidney injury[J].Clin Nephrol,2013,79(3):221-228
[9]郑攸萸.中药(新药)临床研究指导原则[M].北京:中国医药科技出版社,2002:163-168.
[10]Lank horsl CE,Wish JB.Anemia in renal disease:diagnosis and management[J].Blood Rev,2010,24(1):39-47.
[11]Chrobak C,Sidler JA,O'Meara A,et al.Iron homeostasis in inflammation:a single centre prospective observational study in medical inpatients[J].Swiss Med Wkly,2017,147(19):14431.
[12]常园园,范秋灵.Erythroferrone-铁调素轴在肾性贫血中的研究进展[J].中国临床研究,2017,30(2):268-271.
[13]李香玲,赵学兰,王炎强,等.益肾补气活血方加中药灌肠联合rHuEPO治11疗肾性贫血的临床观察[J].中成药,2011,33(3):390-392.
[14]钱卫明,安国辉,郭慧娥,等.中药联合小剂量重组人促红细胞生成素治疗肾性贫血疗效观察[J].中国中西医结合肾病杂志,2016,17(1):65-66.
[15]戴芹,曲晓璐,唐咏华.黄芪对慢性肾衰竭大鼠SOD和MDA的影响[J].中国中西医结合肾病杂志,2008,9(12):1083.
[16]高焕,袁捷,程小红.当归补血汤联合促红细胞生成素治疗肾性贫血34例[J].河南中医,2014,34(3):549-550.
[17]谢志芬.慢性肾脏病肾性贫血的中西医结合治疗[J].实用中西医结合临床,2015,15(7):42-43.
[18]周珂,董扬洲,王小玲,等.养血益肾方对肾性贫血患者微炎症状态的影响和疗效观察[J].中国中医急症,2017,26(3):493-495.
[19]赵平,刘伟伟,张亮,等.基于骨髓基质细胞自噬和旁分泌探讨黑地黄丸治疗肾性贫血的作用机制[J].中国实验方剂学杂志,2017,23(2):146-152.
[20]李佳桓,林海红,杜钢军.生血宁对肾性贫血和铁过载慢性肾损伤小鼠的防治作用[J].河南大学学报(自然科学版),2017,47(2):170-176.
[21]孙倩美,王质刚.尿毒症患者红细胞生成抑制因子的实验研究[J].中国血液净化,2006,6(5):320-323.
[22]何敏尔,孔仕波,沈伟钢.加减补中益气汤联合促红细胞生成素治疗肾性贫血疗效观察[J].中国中西医结合肾病杂志,2013,14(3):260-261.
[23]易继飞.中西医结合治疗慢性肾衰竭肾性贫血临床研究[J].实用中医药杂志,2017,11(32):85-88.