加味参苓白术散对持续性非卧床腹膜透析患者脂质代谢的影响研究

Study on the effect of Modified Shenling Baizhu Powder on lipid metabolism in continuous ambulatory peritoneal dialysis patients

目的:观察加味参苓白术散对持续性非卧床腹膜透析(CAPD)中医学辨证为脾虚瘀浊证患者脂质代谢异常的影响。方法:将66例CAPD脾虚瘀浊证患者随机分为对照组和观察组,每组33例,6例退出观察,实际完成60例。2组患者均予CAPD及常规对症治疗。对照组口服阿托伐他汀钙片,观察组在对照组治疗基础上加用加味参苓白术散复方颗粒,疗程8周。检测治疗前后两组患者的血清高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、甘油三酯(TG)、脂联素(APN)、白介素-8(IL-8)、白介素-4(IL-4)水平,检测并计算腹膜透析患者尿素清除指数(Kt/V),评估透析的充分性。结果:治疗后,对照组中医临床有效率56.7%明显低于观察组83.3%,差异有统计学意义(P<0.05)。观察组患者血清IL-8、TC、TG、LDL-C水平与治疗前及对照组同时间段比较均降低,差异有统计学意义(P<0.05);两组患者HDL-C、IL-4、APN水平较治疗前均上升,且对照组升高更明显,差异有统计学意义(P<0.05)。治疗后,对照组Kt/V与治疗前比较,差异无统计学意义(P>0.05);观察组Kt/V较治疗前明显升高,差异有统计学意义(P<0.05)。结论:加味参苓白术散可改善CAPD脾虚瘀浊证患者脂质代谢异常。

Objective:To observe the effect of modified Shenling Baizhu Powder on lipid metabolism in continuous ambulatory peritoneal dialysis(CAPD)patients diagnosed with spleen deficiency and turbid stasis syndrome according to TCM.Methods:66 CAPD patients with spleen deficiency and turbid stasis syndrome were randomly divided into a control group and an observation group,each consisting of 33 patients.6 patients withdrew from the study,leaving 60 patients who completed the study.Both groups received CAPD and routine symptomatic treatment.The control group received oral atorvastatin calcium tablets,and the observation group received modified Shenling Baizhu Powder granules in addition to the treatment provided to the control group.The treatment course was 8 weeks.Serum high-density lipoprotein cholesterol(HDLC),low-density lipoprotein cholesterol(LDL-C),total cholesterol(TC),triglycerides(TG),adiponectin(APN),interleukin-8(IL-8),and interleukin-4(IL-4)levels were measured before and after treatment.The urea clearance index(Kt/V)was also calculated and assessed for dialysis adequacy.Results:After treatment,the clinical effective rate of TCM in the control group(56.7%)was significantly lower than that in the observation group(83.3%),and the difference was statistically significant(P<0.05).In the observation group,the serum levels of IL-8,TC,TG,and LDL-C decreased compared to before treatment and the control group at the same time point,and the differences were statistically significant(P<0.05).The HDL-C,IL-4,and APN levels increased in both groups compared to before treatment,and the increase was more significant in the control group,with statistically significant differences(P<0.05).After treatment,there was no significant difference in Kt/V between the control group and before treatment(P>0.05);however,the Kt/V in the observation group was significantly higher than before treatment(P<0.05).Conclusion:Modified Shenling Baizhu Powder can improve lipid metabolic abnormalities in CAPD patients with spleen deficiency and turbid stasis syndrome.