基于归脾丸对MHD CKD贫血患者微炎症状态调节探讨“培土生血”内涵

Discussion on "Enriching Blood by Tonifying Spleen" Connotation from Adjusting of Micro-inflammatory State in Renal Anemia Patients with MHD Technique Interfering by Gui-Pi Pills

目的:从调节微炎症状态角度揭示归脾丸改善运用持续性血液透析(MHD)技术的慢性肾脏病(CKD)5期患者CKD贫血的效应机制,进而探索"培土生血"的科学内涵。方法:60例西医诊断为CKD5期、CKD贫血,中医诊断为脾虚、血虚证的MHD患者随机分成两组,每组30例。对照组采用促红细胞生成素(EPO)干预治疗,治疗组采用归脾丸联合EPO治疗,疗程为60天,两组治疗前后分别检测血细胞比容(Hct)、血红蛋白(Hb)、红细胞数(RBC)、EPO、高敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)。结果:与治疗前比较,治疗后两组患者贫血相关指标Hct、Hb、RBC、EPO皆有明显升高(P<0.05或P<0.01),两组患者干预后上述贫血指标及临床疗效比较,治疗组明显高于对照组(P<0.05)。与治疗前比较,治疗后两组患者炎症相关指标hs-CRP、IL-6、TNF-α皆有明显下降(P<0.05或P<0.01),两组患者上述炎症指标干预后比较,治疗组明显低于对照组(P<0.05或P<0.01)。结论:归脾丸具有抗炎补血作用,此为其培土生血机制之一。

Abstract： This article was aimed to reveal the effect mechanism of improving anemia among stage 5 of chronic kidney disease （CKD） patients with maintenance hemodialysis （MHD） interfering by Gui-Pi （GP） pills from adjusting of micro-inflammatory state, in order to explore the scientific connotation of ＂enriching blood by tonifying spleen＂. A total of 60 MHD patients with the diagnosis of stage 5 of CKD, renal anemia in western medicine, and spleen deficiency, blood deficiency syndrome in traditional Chinese medicine （TCM） diagnosis, were randomly divided into two groups, with 30 patients in each group. Erythropoietin （EPO） therapy was used in the control group; and GP pills combined with EPO treatment was used in the treatment group. The treatment course was 60 days. Indicators, including Hct, Hb, RBC, EPO, hs-CRP, TNF-α and IL-6 were detected before and after treatment in both groups. The results showed that compared with pretreatment, the anemia related indicators such as Hct, Hb, RBC, EPO were obviously increased after interfering with EPO （P 〈 0.05 or P 〈 0.01）. Comparison on anemia indicators and clinical therapeutic effect after interfering between two groups showed that the treatment group was better than the control group with statistical signifieanee（P 〈 0.05）. Compared with pretreatment, the inflammation related indicators such as hs-CRP, IL-6, TNF-α were obviously decreased （P 〈 0.05 or P 〈 0.01）. Comparison on inflammation related indicators after interfering showed that the treatment group was lower than the control group with statistical significance （P 〈 0.05 or P 〈 0.01）. It was concluded that GP pills has the effect of anti-inflammation and enrich blood. It is one of the mechanisms of ＂enriching blood by tonifying spleen＂.