泻浊化瘀扶正法对慢性肾功能衰竭急性加重患者C-反应蛋白和血清补体的影响及其干预作用

The influence of Xiezhuo Huayu Fuzheng method(泻浊化瘀扶正法) on C-reactive protein and serum complements in cases with chronic renal failure accompanied by acute exacerbation and the interventional effect of the method

目的:观察泻浊化瘀扶正法治疗慢性肾功能衰竭(CRF)伴急性加重的临床疗效。方法:选择未行透析的CRF伴近期急性加重患者40例,按随机数字表法分为两组:治疗组22例,采用中药内服(由大黄、黄芪、白术、茯苓、当归、丹参、红花、川芎、木香、泽泻、生地、山楂组成)及中药灌肠(由大黄、黄连、黄芩组成)联合治疗;对照组18例,采用口服爱西特治疗;两组均治疗30 d。观察两组临床疗效、肾功能及C-反应蛋白和血清补体的变化。结果:治疗组显效率(31.82%)、总有效率(77.27%)均明显高于对照组(16.66%和44.44%),两组总有效率比较差异有显著性(P<0.05)。治疗组治疗后倦怠乏力、腰膝酸痛、纳少腹胀、恶心呕吐、头晕头痛等症状积分较治疗前均显著下降,且前3个症状较对照组治疗后也显著下降(P<0.05或P<0.01)。治疗后24 h尿蛋白定量、血尿素氮、血肌酐、内生肌酐清除率以及血清补体C 3、C 4、CH 50和C-反应蛋白也均较治疗前明显改善,且较对照组改善程度为好,差异均有显著性(P<0.05或P<0.01);未见明显不良反应发生。结论:泻浊化瘀扶正法能明显减轻CRF急性加重患者恶化的肾功能及炎症反应,从而延缓肾功能衰竭的进展。

Objective： To investigate the clinical therapeutic effect of Xiezhuo Huayu Fuzheng method （泻浊化瘀扶正, discharging turbidity, dissolving stasis and improving vital energy., a Chinese medical therapy） on chronic renal failure （CRF） accompanied with acute exacerbation. Methods： Forty patients with CRF accompanied with the acute exacerbation of renal function recently who did not take hemodialysis or peritoneal dialysis were randomly divided into a treatment group and a control group. Those 22 patients in the treatment group received the therapy of taking traditional Chinese medicine （composed of radix et rhizoma rhei （大黄）, radix astragali （黄芪）, rhizoma atractylodis macrocephalae （ 白术 ）, poria （茯苓）, radix angelicae sinensis （当归）, radix et rhizoma salviae miltiorrhizae （丹参）, flos carthami （红花）, rhizoma chuanxiong （川芎）, radix aucklandiae （木香）, rhizoma alismatis （泽泻）, rehmannia dride rhizome （生地）, fructus crataegi （山楂）] internally combined with the treatment of enema （including radix et rhizoma rhei （大黄）, rhizoma coptidis （黄连）, radix scutellariae （黄芩）] for 30 days. Another 18 patients in the control group took medicinal charcoal orally for 30 days. Then the clinical therapeutic effect,renal function,the C- reactive protein （CRP） and the serum complements of two groups were compared. Results： The marked therapeutic effective rate （31.82% vs. 16.66%） and the total therapeutic effective rate （77.27% vs. 44.44%, P%0.05） of the treatment group were both obviously higher than those of the control group. The symptoms scores of lassitude ,debilitation, aching pain of the waist and knees ,poor appetite and distension in the abdomen, nausea and vomiting, dizziness and capitis dolor, etc. were significantly decreased after treatment in treatment group, compared with those before treatment, and the former three symptoms scores were also lower than those after treatment in control group （P〈0.05 or P〈0.01）. After the treatment, the 24 hours urine protein quantum, serum urea nitrogen, serum creatinine, endogeneous creatinine clearance, serum complements C3, C4, CH50 and CRP of these two groups were obviously improved compared with those before treatment, the improvement being better in the treatment group than in the control group （P〈0.05 or P〈0.01）. In the treatment group, no adverse reaction was seen. Conclusion： Xiezhuo Huayu Fuzheng method can delay the progress of CRF and ameliorate the disease situation in patients with CRF accompanied by acute exacerbation.