加味真武汤治疗慢性肾病(Ⅲ-Ⅳ期)临床研究

Clinical Study on Modified Zhenwu Decoction in Treatment of Chronic Nephropathy (Ⅲ-Ⅳ)

目的:观察加味真武汤治疗慢性肾病(Ⅲ-Ⅳ期)脾肾阳虚证的疗效及对血清中结缔组织生长因子(connective tissue growth factor,CTGF)和肝细胞生长因子(hepatocyte growth factor,HGF)水平的影响。方法:116例慢性肾病Ⅲ-Ⅳ期患者随机分为对照组和观察组均58例。两组均采取常规调压降脂等干预措施。对照组服用辛伐他汀,10 mg·d^(-1)。观察组在对照组基础上采取真武汤加味治疗,1剂·d-1,常规水煮2次温服。两组连续治疗12周。比较两组临床主症评分、24小时尿蛋白定量、尿素氮水平、血肌酐水平及临床疗效。采用酶联免疫吸附法于治疗前后测定两组血清中CTGF和HGF水平。结果:治疗后,观察组治疗后畏寒肢冷等症状评分、24小时尿蛋白定量、尿素氮及血肌酐明显少于对照组(P<0.01);观察组有效率为79.31%,显著高于对照组的60.34%(P<0.05)。治疗后,观察组血清中CTGF和HGF显著高于对照组(P<0.01)。结论:加味真武汤治疗慢性肾病(Ⅲ-Ⅳ期)脾肾阳虚证可明显改善患者的临床症状和体征,提高临床疗效,下调血清中CTGF和HGF水平可能是其机制之一。

Objective： To observe the curative effect of modified Zhenwu Decoction in treatment of chronic kidney disease（ stageⅢ-Ⅳ） with Spleen and Kidney Yang Deficiency Syndrome and the effect on connective tissue growth factor（ CTGF） and hepatocyte growth factor（ hepatocyte growth factor,HGF） levels. Methods： 116 patients with chronic kidney disease were randomly divided into control group and observation group（ n = 58）. Both groups were treated with conventional methods,i. e. methods of pressure-lowering lipid-lowering. The control group received simvastatin,10 mg·d-1. The observation group was treated with modified Zhenwu Decoction in addition to that of the control group. Two groups experienced continuous treatment for 12 weeks. The clinical symptoms,24-hour urine protein quantification,urea nitrogen levels,serum creatinine levels and clinical efficacy of both groups were compared. Serum levels of CTGF and HGF were measured by enzyme-linked immune-sorbent assay（ ELISA） before and after treatment. Results： After treatment,the scores of symptoms such as the limb chills in the observation group were significantly lower than that in the control group（ P〈0. 01）. The effective rate in the observation group was 79. 31%,which was significantly higher than that（ 60. 34%） of the control group（ P〈0. 05）. After treatment,CTGF and HGF in the serum of the observation group were significantly higher than those in the control group（ P〈0. 01）. Conclusion： The treatment of chronic kidney disease（ Ⅲ-Ⅳ）with Spleen and Kidney Yang Deficiency Syndrome can improve the clinical symptoms and signs of patients and improve the clinical curative effect. One of the mechanisms may be the down-regulation of CTGF and HGF in patients＇ serum.