从湿浊瘀阻论治慢性肾功能不全的临床研究

Clinical Research of Treating Turbid Dampness Blocking on Chronic Renal Insufficiency

目的:探讨从湿浊瘀阻论治慢性肾功能不全早期评估中的价值。方法:选择早中期慢性肾功能不全患者80例,随机分为治疗组(42例)和对照组(38例)。两组患者在接受一般及对症治疗的同时,治疗组加用化湿降浊益肾方治疗,2个月为1个疗程,共观察3个疗程。观察两组治疗2个月、6个月的综合疗效、中医症状积分、肾功能(BUN、SCr)、肌酐清除率(CCr)、血脂(TG、TC、HCL、LCL-C)、血红蛋白(Hb)、白蛋白(ALB)、及其内皮素(ET)、一氧化氮(NO)和脂联素(ADPN)的变化。结果:①治疗2个月及6个月的总有效率分别为52.38%、76.19%,对照组分别为31.58%、39.47%,治疗6个月两组综合疗效比较差异有显著性(P<0.05)。②临床症状的改善随着用药时间的增加其疗效更好,两组比较差异有显著性(P<0.01)。③治疗组治疗2、6个月SCr、BUN有明显下降,与对照组同期比较,差异均有显著性(P<0.05,P<0.01),ADPN、ALB、Hb水平亦明显升高,与治疗前或对照组同期比较,差异均有显著性(P<0.05,P<0.01);多元回归分析表明,ADPN与BUN、SCr、TG、ALB、ET、Hb呈负相关(P<0.05～0.01),与HDL-C、CCr、NO呈正相关(P<0.05～0.01)。结论:慢性肾功能不全早中期即存在营养不良-炎症-动脉粥样硬化综合征(MIA),化湿降浊益肾方治对早中期慢性肾功能不全有较好的疗效,可能与该方对慢性肾功能不全的MIA有较好的拮抗作用有关。

Objective：To investigate the effect of Formula for Dissipating Dampness and Descending Turbidity on chronic renal insufficiency （CRI） in early stage. Method：80 cases with chronic renal insufficiency （CRI） in early stage were chosen and divided into two groups randomly. 42 cases were in treatment group, and 38 cases in control group. The cases in the two groups were all treated by general treatment and symptomatic treatment, while the ones in treatment group were done by Formula for Dissipating Dampness and Descending Turbidity to tonify kidney as well. 1 treatment course included 2 months, and all the cases accepted 3 treatment courses. Then such indexes as synthetic curative effect,TCM symptom accumulated points, renal function （ BUN and SCr）, creatinine clearance rate （ CCr）, blood-fat （ TG, TC, HCL and LCL - C ）, hemoglobin （ Hb）, albumin （ ALB ）, endothelin （ET）, nitrogen monoxidum （NO） and adiponcetin （ADPN） were observed respectively in the second month and the sixth month. Result： ①The total effective rates in the second and sixth month were 52. 38% and 76. 19% respectively in treatment group, and 31.58% and 39.47% in control group. There was significant difference on synthetic curative effect in the sixth month （ P 〈 0. 05 ）. ②The longer it was, the better the symptoms improved. There was significant difference between the two groups on TCM symptom accumulated points （P 〈 0. 01 ）. ③SCr and BUN were decreased markedly in the second and sixth month in treatment group, and there was significant difference contrasting to control group （P 〈 0. 05, P 〈 0. 01 ）. ADPN, ALB and Hb was increased markedly, and there were significant differences between before and after treatment and between the two groups in the same period （ P 〈 0.05, P 〈 0. 01 ）. Multiple regression analysis indicated that inverse correlation showed up between ADPN and BUN, SCr, TG, ALB, ET and Hb （P 〈 0. 05- 0.01 ）, and direct correlation did between ADPN and HI）L-C, CCr and NO （P 〈 0.05 - 0.01 ）. Conclusion： There was the syndrome of malnutritioninflammation-artherosclerosis （MIA） in chronic renal insufficiency （CRI） in early stage. Formula for Dissipating Dampness and Descending Turbidity to tonify kidney has good effect on chronic renal insufficiency （CRI） in early stage. And it may antagonize MIA in chronic renal insufficiency （CRI） in early stage.