大黄泻下法对老年维持性血液透析患者肾性骨病的临床作用

The clinical effects of rhubarb purgation therapy on elderly patients of maintenance hemodialysis with renal osteo dystrophy

目的观察以大黄为主药的泻下法在治疗老年维持性血液透析患者肾性骨病方面的临床作用。方法将60例维持性血液透析治疗1年以上的老年患者分为观察组和对照组,每组30例。两组均予以每周3次透析(2次常规血液透析+1次血液滤过),同时给予骨化三醇、碳酸钙和促红细胞生长素等对症治疗。观察组在此基础上给予以大黄为主药的泻下法为核心的辨证治疗。观察治疗6个月前后两组中医临床症状和中医证候的临床疗效,以及血肌酐(SCr)、尿素氮(BUN)、尿酸(UA)、血β2微球蛋白(β2-MG)、全段甲状旁腺素(iPTH)、钙离子(Ca^(2+))和磷离子(P^(3-))的变化。结果治疗6个月,观察组在腹胀纳呆、五心烦热和大便干结症状改善上和中医证候的总体疗效优于对照组,差异有统计学意义(P<0.05)。两组治疗前后血肌酐(SCr)、尿素氮(BUN)和尿酸(UA)无明显改变(P>0.05),观察组治疗前后β2-MG、iPTH和血磷有明显改善(P<0.05)。结论以大黄为主药的泻下法结合血液滤过治疗,能改善老年维持性血液透析患者的临床症状和证候,也可能通过改善钙磷代谢而提高肾性骨病的临床疗效。

Objective To observe the clinical effect of rhubarb purgation therapy on elderly patients of maintenance hemodialysis with renal osteodystrophy. Methods 60 elderly patients of maintenance hemodialysis more than 1 year were randomly divided into observation group and control group, 30 patients each group. Both groups were given dialysis 3 times a week （2 times regular hemodialysis and 1 time hemofiltration）, and medicines of calcitriol. calcium carbonate and erythropoietine etc. Traditional Chinese medicines of rhubarb was added in the observation group. After 6 months treatment, clinical symptoms, syndromes of traditional Chinese medicine, and the levels of blood SCr, BUN, UA, β2-MG, iPTH, Ca2＋ and p3- were evaluated. Results After treatment for 6 months, the observation group in the symptoms of abdominal distension, dysphoria in chest palms-soles, dry stool and sthenia symptom was improved （P〈0.05）, SCr, BUN and UA between the two groups had no change （P〉0.05）, β2-MG、 iPTH and P3 in the observation group were improved （P〈0.05）. Conclusion The addition of rhubarb purgation therapy can improve the clinical symptoms, syndromes of traditional Chinese medicine, raise the clinical effects of renal osteodystrophy in elderly patients with maintenance hemodialysis.