序贯结肠透析治疗慢性肾脏病3～4期患者的临床研究

Effect of sequential colon dialysis on patients with chronic kidney disease in stage 3-4

目的观察序贯结肠透析对慢性肾脏病（chronic kidney disease，CKD）3～4期患者毒素清除及延缓肾功能进展的作用。方法100例CKD3～4期患者随机分为治疗组和对照组，每组各50例，前者采用序贯结肠透析、中草药制剂保留灌肠并口服肾衰宁，后者单用肾衰宁，疗程4周。观察两组治疗前、后及两组间血肌酐（sserum creatinine，SCr）、尿素氮（blood urea nitrogen，BUN）、尿酸（urine acid，UA）、甲状旁腺素（parathyroid hormone，PTH）、Ca^2＋、P、K^＋、Na^＋、C1^-、pH、剩余碱（base excess，BE）及估算肾小球滤过率（estimated glomerular filtration rate．eGFR）变化。结果（1）两组治疗后eGFR、pH、BE较治疗前升高．血SCr、BUN、uA、PTH、P^3-下降。治疗组血K^＋下降。（2）治疗后：对照组血BUN为（1（1．57±3．26）mnlol／l、治疗组为（8．45±2．29）mmool／l；对照组SCr为（213．96±59．67）μmol／L、治疗组为（182．93±52．02）μmol／L；对照组UA为（404．58±36．46）／．mol／L、治疗组为（386．34±31．64）／μmol／L。对照组PTH为（192．98±110．82）ng／L、治疗组为（149．41±76．39）ng／L；对照组P为（1．68±0．68）mmol／1，、治疗组为（1．35±0．52）mmol／L；对照组K^＋为（4．19±0．26）mmol／L、治疗组为（3．82±0．30）mmoL／L；对照组血清pH为（7．36±0．07）、治疗组为（7．42±0．08）；对照组BE为（1．45±0．12）mmol／L、治疗组为（1．87±0．16）mmol／L（P〈0．05）。结论序贯结肠透析能清除CKD3～4期患者毒素，纠正其钙磷代谢紊乱及代谢性酸中毒．延缓肾功能恶化进展。

Objective To evaluate the effect of sequential colon dialysis on patients with chronic kidney disease in stage 3-4（CKD 3-4）. Methods 100 patients with CKD 3-4 were randomly divided in- to the treatment group and control group. The patients in the treatment group were given sequential colon dialysis,Chinese herbs retention enema and oral administration of Shenshuaining,and those in the control group was just given oral administration of Shenshuaining. Each group was treated for 4 weeks. The changes of SCr, BUN, UA, PTH, K＋ , Na- , C1- , Ca-2＋ , P＋ , pH, BE and eGFR before and after treatment were compared. Results （1）The levels of eGFR, pH and BE in two groups were in- creased after treatment （ P〈0.05 ）, while levels of serum SCr, BUN, UA, PTH, and p3 were signifi cantly reduced. In the treatment group, serum K＋ level was decreased significantly as compared with that before treatment （P〈0. 05）. （2） Some biochemistry values in the treatment group were improved more significantly as comparing with the control group （P〈0. 05） ：BUN [（8. 45 ＋ 2. 29） vs （11）. 57 ±3.26） mmol/l.],SCr[（ 182.93 ± 52.02） vs （213.96 ＋ 59. 67） μool/L], UA [（386. 34 ± 31.64） vs （404. 58 ± 36. 46） μmol/L], PTH[（149. 41 ± 76. 39） vs （192. 98 ±110. 82） ng/L],p3- [-（1.35 ± 0. 52） vs（ 1.68 ± 0. 68） mmol/L], K＋ [（3. 82 ± 0. 30） vs （4. 19 ± 0. 26） mmol/L], pHI（7.42 ± 0. 1）8） vs （7.36±0.1）7）],BE[（1.87±0.16） vs（1.45±0.12） mmol/L].Conelusions Sequential eolon dialysis plays a role in the clearance of toxicity, adjustment of calcium and phosphorus metabolism disorder, correction of metabolism acidosis and delaying renal failure progress in patients with CKD 3-4.