补益脾肾、秘精通络泄浊法治疗慢性肾脏病3-4期的临床观察

Clinical observation on the treatment of CKD3-4 patients with the method of tonifying spleen and kidney,invigorating collaterals and purging turbid

目的:观察补益脾肾、秘精通络泄浊法治疗慢性肾脏病(CKD)3-4期的临床疗效,保护残余肾脏功能,延缓CKD进展,提高生活质量。方法:将60例患者随机分为治疗组、对照组,各30例。两组给予基础治疗的前提下,治疗组加用以补益脾肾、秘精通络泄浊为治则中药水煎服,每日1剂,分2次,口服。对照组加用尿毒清颗粒,每次1袋,每日4次。两组均连续治疗24周。观察两组中医证候积分、临床理化检查指标,监测不良反应。结果:综合疗效比较:治疗组总有效率(86.7%,26/30)优于对照组(66.7%,20/30),差异有统计学意义(P<0.05)。中医证候疗效比较:治疗组总有效率(90.0%,27/30)优于对照组(63.3%,19/30),差异有统计学意义(P<0.05)。两组组内治疗后血清尿素氮(BUN)、血肌酐(Scr)、β2微球蛋白(β2-MG)、肾小球滤过率(eGFR)、血红蛋白(HB)、24h尿蛋白(24huqp)、尿N-乙酰-β-氨基葡萄糖苷酶(NAG)与治疗前比较差异有统计学意义(P<0.05);两组组间比较BUN、Scr、β2-MG、eGFR、24huqp、HB、尿NAG差异有统计学意义(P<0.05)。结论:补益脾肾、秘精通络泄浊法治疗CKD3-4脾肾气虚兼湿浊瘀血阻络证有较明显临床疗效。

Objective:To observe the clinical efficacy of tonifying spleen and kidney,invigorating collaterals and purging turbidity in the treatment of patients with chronic kidney disease(CKD)stage 3-4,protect residual renal function,delay the progress of CKD and improve the quality of life.Methods:60 patients were randomly divided into treatment group(n=30)and control group(n=30).Under the premise of basic treatment in the two groups,the treatment group was added with traditional Chinese medicine for tonifying spleen and kidney,secret essence dredging collaterals and purging turbid,once a day,twice a day,orally.The control group was treated with Niaoduqing granule,1 bag each time,4 times a day.Both groups were treated continuously for 24 weeks.The TCM syndrome scores,clinical physical and chemical examination indexes and adverse reactions were observed in the two groups.Results:Comparison of comprehensive curative effect:the total effective rate of the treatment group(86.7%,26/30)was better than that of the control group(66.7%,20/30).The difference was statistically significant(P<0.05).Comparison of the curative effect of TCM syndrome:the total effective rate of the treatment group(90.0%,27/30)was better than that of the control group(63.3%,19/30),and the difference was statistically significant(P<0.05).There were significant differences in serum urea nitrogen(BUN),serum creatinine(Scr),β2-MG,glomerular filtration rate(eGFR),hemoglobin(HB),24-hour urinary protein(24huqp)and urinary N-acetyl-β-glucosaminidase(NAG)between the two groups after treatment.There were significant differences in BUN,Scr,2-MG,eGFR,24huqp,HB and urine NAG between the two groups(P<0.05).Conclusion:The method of tonifying spleen and kidney,invigorating collaterals and purging turbidity has obvious clinical effect on CKD3-4 patients with spleen and kidney qi deficiency and dampness and blood stasis blocking collaterals.