健脾益肾排毒方对 CKD4脾肾气虚患者 eGFR及中医证候的影响

Effects of Jianpiqishen decoction on eGFR and TCM syndromes in patients with stage 4 chronic kidney disease

目的:观察健脾益肾排毒方对CKD4期患者eGFR及中医证候的影响.方法:将80例脾肾气虚患者分为对照组与治疗组各40例.对照组给予饮食营养、控制血压、纠正贫血、改善钙磷代谢紊乱、调节酸碱代谢平衡等常规治疗.治疗组在上述基础上予健脾益肾排毒方水煎剂,每日1剂,分2次服.分别检测患者治疗后2周、4周、3个月、6个月血肌酐、血尿素氮,并计算其相应GFR及中医证候积分.最终对照组患者有33例、治疗组有34例完成试验.结果:治疗组和对照组肾功能在治疗后表现为Scr和BUN出现短暂小幅度上升,随后缓慢下降,eGFR呈相反趋势,至治疗后3个月,无统计学差异.在治疗后6个月,治疗组血肌酐及血尿素氮均有所降低,而治疗组eGFR有所升高,与对照组比较,均有统计学差异(P<0.05).治疗过程中,2组患者中医证候积分呈进行性下降,治疗后6个月,治疗组与对照组比较,有统计学差异(P<0.05).结论:健脾益肾排毒方能改善CKD4期脾肾气虚患者肾功能及临床症状,在治疗6个月后可使eGFR升高,中医证候积分下降.

Aim：To observe the effects of Jianpiqishen decoction on eGFR and TCM syndroms in patients with stage 4 chronic kidney disease.Methods：The 80 CKD4 patients with spleen-kidney Qi deficiency were divided into two groups,one was the control group（n =40）,and the treatment group（n =40）.The two groups were given conventional therapy such as nutritional diet,blood pressure control,anaemia correction,calcium and phosphorus metabolism disorders correction,and the acid-base balance control.The treatment group was treated with the Jianpiyishen decoction.The serum creatinine,blood urea nitrogen,and TCMsyndromes were determined and reviewed at 2 weeks,4 weeks,3 months and 6 months after the treatment.At the end of the study,there were 33 patients of the control group and 34 patients of the treatment group completed the research.Results：After 3 months＇treatment,there was no statistically significant differences in renal function between the two groups.The serum creatinine and blood urea nitrogen increased slightly in a short period of time but subsequently lowered at the end. Meanwhile,the eGFR was oppositely changed.After 6 months＇treatment,the serum creatinine and blood urea nitrogen of the two groups were both lower than before,while eGFR increased significantly in the treatment group with statistical difference（P 〈0.05）when compared to the control group.The scores of TCMsyndrome of both groups decreased progressively after the treatment with statistical difference（P 〈0.05）.Compared to the control group,the treatment group decreased even more obviously（P 〈0.05）. Conclusion：Jianpiyishen decoction can improve the renal function of CKD4 patients and ameliorate clinical symptom of spleen-kidney Qi deficiency,after 6 months of treatment,it can increased eGFR,and decreased the scores of TCMsyndromes.