肾衰方防治早期慢性肾衰竭疗效观察

Observation of curative effect of Shenshuai decoction on early chronic renal failure

目的探讨肾衰方防治早期慢性肾衰竭(CKD3期)的临床疗效。方法将早期慢性肾衰竭患者随机分为中医组、西医组、中西医结合组、基础组,每组20例。基础组给予常规治疗,中医组在常规治疗基础上根据有无消化道症状给予肾衰Ⅰ、Ⅱ号方治疗,西医组在常规治疗基础上给予苯那普利口服,中西医结合组在常规治疗基础上给予肾衰Ⅰ、Ⅱ号方联合苯那普利口服。4组均以4周为1个疗程,治疗3个疗程后观察比较4组临床症状积分、实验室指标及临床疗效。结果治疗4周、8周、12周后,中医组和中西医结合组临床症状总积分均低于西医组和基础组(P均<0.05);治疗12周后,中西医结合组血压明显低于其他3组(P均<0.05),中医组和西医组明显低于基础组(P均<0.05),中医组和西医组间比较差异无统计学意义(P均>0.05)。治疗后,中西医结合组Hb明显高于治疗前及西医组和基础组(P均<0.05),其他3组治疗前后比较差异均无统计学意义(P均>0.05);4组治疗前后ALB、i PTH、Ca2+、P3+、K+比较差异无统计学意义(P均>0.05);4组TC、TG水平均明显低于治疗前(P均<0.05),且中医组和中西医结合组均明显低于西医组和基础组(P均<0.05),中医组和中西医结合组间比较差异均无统计学意义(P均>0.05)。中西医结合组血肌酐、尿素氮明显低于治疗前及其他3组(P均<0.05),e GFR明显高于治疗前及其他3组(P均<0.05),其他3组各指标治疗前后比较差异均无统计学意义(P均>0.05);中医组和中西医结合组24 h尿蛋白定量均明显低于治疗前(P均<0.05),中西医结合组明显低于其他3组(P均<0.05)。中西医结合组和中医组总有效率均明显高于西医组和基础组(P均<0.05),而中医组和中西医结合组总有效率比较差异无统计学意义(P均>0.05)。结论肾衰方不仅能缓解早期慢性肾衰竭患者临床症状,亦可不同程度地改善肾功能,其联合苯那普利治疗疗效更好。

Objective It is to explore the clinical curative effect of Shenshuai decotion on early stage of chronic kidney dis- ease at stage 3 （ CKD3 ）. Methods Eighty cases of CKD3 were randomly divided into 4 groups： foundation treatment group （group Ⅰ ） ,western medicine treatment group （group Ⅱ ） ,TCM treatment group （group Ⅲ ） , and TCM ＋ western medicine treatment group （group Ⅳ） , each group had 20 cases. Group Ⅰ was given normal therapy, additionally, group Ⅱ was added with Benazepril, group Ⅲ was added with Shenshuai decoction Ⅰ or Ⅱ according to digestive tract symptoms, group Ⅳ was added with both Shenshuai decoction and Benazepril. 4 weeks as one treatment course, the clinical symptom scores, laboratory diagnostic indices and curative effect were compared after 3 courses in the four groups. Results After 4, 8, 12 weeks of treat- ment, the total scores of symptoms in group Ⅲ and group Ⅳ were lower than that in group Ⅰ and group Ⅱ （ P 〈 0.05） ; after 12 weeks, the blood pressure （BP） in group Ⅳ was lower than the other 3 groups （ P 〈 0.05 ） , BP in group Ⅲ and group Ⅱ was lower than group Ⅰ （P 〈 0.05 ） , no significant difference was found between group Ⅱ and group Ⅲ（ P 〉 0.05 ）. After treatment, Hb in group Ⅳ was higher than that before treatment and in group Ⅰand group Ⅱ （P 〈 0.05） , no significant difference was found in the other 3 groups before and after treatment （P 〉 0.05 ） ; There was no difference in ALB, iPTH, Ca2 ＋ , p3＋ , K ＋ before and after treatment in the 4 groups （ P 〉 0.05 ） ; The levels of TC, TG in 4 groups were lower than that before treatment（P 〈0.05） , and the levels in group Ⅲ and group Ⅳ were lower than that in group Ⅰ and group Ⅱ （P 〈 0.05 ） , no difference was found between group Ⅲ and group Ⅳ （P 〉0.05） ; The levels of SCr, BUN in group Ⅳ were lowerwhile eGFR was higher than that before treatment and in the other groups （ P 〈 0. 05 ） ,there was no significant difference in these indexes before and after treatment in the other 3 groups （P 〉 0. 05 ） ; 24 h urine protein was lower than that before treat- ment in group Ⅲ and group Ⅳ （ P 〈 0.05 ） , and this index in group Ⅳ after treatment was lower than that in other groups （ P 〈 0. 05）. The total effective rate in group Ⅳ and group Ⅲ was higher than that in group Ⅰ and group Ⅱ （P 〈 0. 05） , there was no significant difference in the rate between group Ⅲ and group Ⅳ （P 〉 0. 05）. Conclusion Shenshuai decotion not only can alleviate clinical symptoms in patients with CKD3, but also can improve renal function and other indicators in different degrees, the curative effect would be better when combined with Benazepril.