温阳活血法联合常规治疗对阳虚血瘀型3～4期慢性肾脏病患者的临床疗效
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摘要
目的探讨温阳活血法联合常规治疗对阳虚血瘀型3～4期慢性肾脏病患者的临床疗效。方法 80例患者随机分为治疗组和对照组,每组40例,对照组给予常规治疗,治疗组在对照组基础上加用温阳活血法(真武汤联合桃核承气汤),3个月为1个疗程。然后,Pearson分析考察不对称二甲基精氨酸(ADMA)与肾功能指标的相关性,观察2组临床疗效、肾功能指标、不良反应。结果治疗组总有效率显著高于对照组(P<0. 05)。治疗后,2组血肌酐(Scr)、尿素氮(BUN)、ADMA显著降低(P<0. 05),估算肾小球滤过率(e GFR)显著升高(P<0. 05),以治疗组更显著(P<0. 05)。Scr、BUN与ADMA呈正相关性(P<0. 05),而e GFR与后者呈负相关性(P<0. 05)。2组均未发现明显不良反应。结论 ADMA可作为阳虚血瘀型3～4期慢性肾脏病患者肾功能损伤程度的预测因子。温阳活血法能明显改善患者肾功能及ADMA水平,安全性良好。
AIM To explore the clinical effects of Warming Yang and Promoting Blood Circulation Method combined with conventional treatment on patients with stage 3-4 chronic kidney disease due to Yang Deficiency and Blood Stasis. METHODS Eighty patients were randomly divided into control group for 3-month conventional treatment and treatment group for 3-month treatment of Warming Yang and Promoting Blood Circulation Method( Zhenwu Decoction combined with Taohe Chengqi Decoction) on the basis of the conventional treatment,40 cases in each group. Subsequently,the investigation of correlations between asymmetric dimethylarginine( ADMA) and renal function indices by using Pearson analysis and observation of the clinical efficacy,renal function indices,adverse reactions in both groups were practiced. RESULTS The treatment group demonstrated significantly higher total effective rate than the control group( P<0. 05). Both groups shared significantly decreased post-treatment serum creatinine( Scr),blood urea nitrogen( BUN) and ADMA( P<0. 05),and markedly increased estimated glomerular filtration rate( eGFR)( P<0. 05),which was particularly obvious in the treatment group( P<0. 05). Positive correlations between Scr and ADMA,BUN and ADMA( P<0. 05),and a negative correlation between eGFR and ADMA( P < 0. 05) were all observed. No obvious adverse reactions were found in the two groups.CONCLUSION ADMA,the predictor of renal function damage degree in patients with stage 3-4 chronic kidney disease due to Yang Deficiency and Blood Stasis demonstrates obvious improvement of patients' renal function managed by Warming Yang and Promoting Blood Circulation Method,and the good safety of the method.
AIM To explore the clinical effects of Warming Yang and Promoting Blood Circulation Method combined with conventional treatment on patients with stage 3-4 chronic kidney disease due to Yang Deficiency and Blood Stasis. METHODS Eighty patients were randomly divided into control group for 3-month conventional treatment and treatment group for 3-month treatment of Warming Yang and Promoting Blood Circulation Method( Zhenwu Decoction combined with Taohe Chengqi Decoction) on the basis of the conventional treatment,40 cases in each group. Subsequently,the investigation of correlations between asymmetric dimethylarginine( ADMA) and renal function indices by using Pearson analysis and observation of the clinical efficacy,renal function indices,adverse reactions in both groups were practiced. RESULTS The treatment group demonstrated significantly higher total effective rate than the control group( P<0. 05). Both groups shared significantly decreased post-treatment serum creatinine( Scr),blood urea nitrogen( BUN) and ADMA( P<0. 05),and markedly increased estimated glomerular filtration rate( eGFR)( P<0. 05),which was particularly obvious in the treatment group( P<0. 05). Positive correlations between Scr and ADMA,BUN and ADMA( P<0. 05),and a negative correlation between eGFR and ADMA( P < 0. 05) were all observed. No obvious adverse reactions were found in the two groups.CONCLUSION ADMA,the predictor of renal function damage degree in patients with stage 3-4 chronic kidney disease due to Yang Deficiency and Blood Stasis demonstrates obvious improvement of patients' renal function managed by Warming Yang and Promoting Blood Circulation Method,and the good safety of the method.
引文
[1]张蜜蜜,赵艳,朱英莉.个体化低蛋白饮食干预对慢性肾脏病患者肾功能的影响[J].中国医学科学院学报,2015,37(4):384-391.
[2] Yang C W. Leptospirosis renal disease:emerging culprit of chronic kidney disease unknown etiology[J]. Nephron,2018,138(2):129-136.
[3]中国非公立医疗机构协会肾脏病透析专业委员会.中国常染色体显性多囊肾病临床实践指南[J].临床肾脏病杂志,2016,16(10):580-588.
[4]王会玲,胡伟锋.中医药在慢性肾脏病不同分期的合理应用[J].中华肾病研究电子杂志,2017,6(2):49-53.
[5]付丽娜,陈孟华.非糖尿病慢性肾脏病1~4期患者血尿酸与非对称二甲基精氨酸的关系[J].宁夏医科大学学报,2016,38(1):59-62.
[6]侯金花,蒋琦,刘志红. 2017KDIGO临床实践指南更新:慢性肾脏病矿物质与骨异常诊断、评估、预防和治疗[J].肾脏病与透析肾移植杂志,2017,26(5):462-466.
[7]周贝,刘亚琳,唐健元,等.我国中药新药临床研究技术指导原则体系发布概况[J].中国临床药理学杂志,2017,33(18):1850-1852.
[8]严陈燕,邬步云,徐琳,等.慢性肾脏病患者不同e GFR公式的结果差异研究[J].中华肾脏病杂志,2017,33(4):249-257.
[9]肖菲,戴欢子,张建国,等. Ig A肾病伴高血压患者血压节律异常与肾脏结构和功能损伤的关系[J].临床内科杂志,2017,34(9):608-611.
[10] Testa A,Mallamaci F,Leonardis D,et al. Synergism between asymmetric dimethylarginine(ADMA)and a genetic marker of uric acid in CKD progression[J]. Nutr Metab Cardiovasc Dis,2015,25(2):167-172.
[11] Park M J, Oh K S, Nho J H, et al. Asymmetric dimethylarginine(ADMA)treatment induces apoptosis in cultured rat mesangial cells via endoplasmic reticulum stress activation.[J]. Cell Biol Int,2016,40(6):662-670.
[12] Rao P V L N S,Bitla A R. Simultaneous determination of arginine,citrulline,and asymmetric dimethylarginine in plasma by reverse-phase high-performance liquid chromatography[J].J Lab Physicians,2017,9(4):243-248.
[13]In E,Deveci F,Kaman D. Assessment of heat shock proteins and endothelial dysfunction in acute pulmonary embolism[J].Blood Coagul Fibrinolysis,2016,27(4):378-383.
[14] Alan C,Kurt H A,Topaloglu N,et al. Nitric oxide and asymmetric dimethyl arginine(ADMA)levels in an experimental hydronephrotic kidney caused by unilateral partial ureteral obstruction[J]. Int Braz J Urol,2016,42(3):614-620.
[15]朱辟疆,刁金囡.慢性肾脏病中医药治疗应重视清利湿热、活血化瘀药物的应用[J].中国中西医结合肾病杂志,2016,17(10):908-909.
[16]崔明晓,王济生.王济生治疗慢性肾脏病临床经验总结[J].世界中西医结合杂志,2017,12(11):1513-1516.
[17]王汝建.参苓白术散合熟附子(30g)治疗老年脾肾阳虚泄泻随机平行对照研究[J].实用中医内科杂志,2017,31(7):17-19.
[18]王少杰,李晓洁,徐志猛,等.大黄素对小鼠急性脂肪肝的改善作用[J].中国药科大学学报,2017,48(1):89-95.
[19]李慧,黄帅,单连海,等.茯苓皮中三萜酸类成分的研究[J].华西药学杂志,2016,31(1):6-10.
[20]胡晓慧,代向东,李来来,等.生甘草与炙甘草的抗氧化能力比较研究[J].天津中医药大学学报,2016,35(2):114-117.
[2] Yang C W. Leptospirosis renal disease:emerging culprit of chronic kidney disease unknown etiology[J]. Nephron,2018,138(2):129-136.
[3]中国非公立医疗机构协会肾脏病透析专业委员会.中国常染色体显性多囊肾病临床实践指南[J].临床肾脏病杂志,2016,16(10):580-588.
[4]王会玲,胡伟锋.中医药在慢性肾脏病不同分期的合理应用[J].中华肾病研究电子杂志,2017,6(2):49-53.
[5]付丽娜,陈孟华.非糖尿病慢性肾脏病1~4期患者血尿酸与非对称二甲基精氨酸的关系[J].宁夏医科大学学报,2016,38(1):59-62.
[6]侯金花,蒋琦,刘志红. 2017KDIGO临床实践指南更新:慢性肾脏病矿物质与骨异常诊断、评估、预防和治疗[J].肾脏病与透析肾移植杂志,2017,26(5):462-466.
[7]周贝,刘亚琳,唐健元,等.我国中药新药临床研究技术指导原则体系发布概况[J].中国临床药理学杂志,2017,33(18):1850-1852.
[8]严陈燕,邬步云,徐琳,等.慢性肾脏病患者不同e GFR公式的结果差异研究[J].中华肾脏病杂志,2017,33(4):249-257.
[9]肖菲,戴欢子,张建国,等. Ig A肾病伴高血压患者血压节律异常与肾脏结构和功能损伤的关系[J].临床内科杂志,2017,34(9):608-611.
[10] Testa A,Mallamaci F,Leonardis D,et al. Synergism between asymmetric dimethylarginine(ADMA)and a genetic marker of uric acid in CKD progression[J]. Nutr Metab Cardiovasc Dis,2015,25(2):167-172.
[11] Park M J, Oh K S, Nho J H, et al. Asymmetric dimethylarginine(ADMA)treatment induces apoptosis in cultured rat mesangial cells via endoplasmic reticulum stress activation.[J]. Cell Biol Int,2016,40(6):662-670.
[12] Rao P V L N S,Bitla A R. Simultaneous determination of arginine,citrulline,and asymmetric dimethylarginine in plasma by reverse-phase high-performance liquid chromatography[J].J Lab Physicians,2017,9(4):243-248.
[13]In E,Deveci F,Kaman D. Assessment of heat shock proteins and endothelial dysfunction in acute pulmonary embolism[J].Blood Coagul Fibrinolysis,2016,27(4):378-383.
[14] Alan C,Kurt H A,Topaloglu N,et al. Nitric oxide and asymmetric dimethyl arginine(ADMA)levels in an experimental hydronephrotic kidney caused by unilateral partial ureteral obstruction[J]. Int Braz J Urol,2016,42(3):614-620.
[15]朱辟疆,刁金囡.慢性肾脏病中医药治疗应重视清利湿热、活血化瘀药物的应用[J].中国中西医结合肾病杂志,2016,17(10):908-909.
[16]崔明晓,王济生.王济生治疗慢性肾脏病临床经验总结[J].世界中西医结合杂志,2017,12(11):1513-1516.
[17]王汝建.参苓白术散合熟附子(30g)治疗老年脾肾阳虚泄泻随机平行对照研究[J].实用中医内科杂志,2017,31(7):17-19.
[18]王少杰,李晓洁,徐志猛,等.大黄素对小鼠急性脂肪肝的改善作用[J].中国药科大学学报,2017,48(1):89-95.
[19]李慧,黄帅,单连海,等.茯苓皮中三萜酸类成分的研究[J].华西药学杂志,2016,31(1):6-10.
[20]胡晓慧,代向东,李来来,等.生甘草与炙甘草的抗氧化能力比较研究[J].天津中医药大学学报,2016,35(2):114-117.