保肾片对透析患者蛋白质能量消耗状态的影响

Effect of Baoshen Tablet on PEW in Dialysis Patients

目的观察保肾片对维持性透析患者蛋白质能量消耗(PEW)的治疗效果,探讨其中医作用机制。方法选取2015年3月-2016年6月在南京中医药大学附属医院肾内科接受治疗的维持性血液透析(HD)及腹膜透析(PD)且符合PEW诊断的患者113例,基础治疗为优质蛋白饮食[1.0~1.2g/(kg·d)]、调节钙磷代谢、纠正贫血、降血压等,糖尿病患者予胰岛素控制血糖,对照组(61例)仅基础和透析治疗,治疗组(52例)在对照组治疗基础上服用保肾片,观察2组治疗前后三角肌皮褶厚度(TSF)、中臂围(MAC)、中臂肌围(MAMC)等体表测量学参数,改良定量主观整体营养评估(MQSGA)评分,血红蛋白(Hb)、血清白蛋白(ALB)、铁蛋白(SF)、超敏-C反应蛋白(hs-CRP)等实验室指标的变化。结果治疗组体质量、体质量指数(BMI)、MAC、MAMC、TSF较治疗前上升(P<0.01),而对照组TSF较治疗前下降(P<0.01),治疗组的体质量、MAC、MAMC、TSF变化优于对照组(P<0.05)。治疗组总有效率显著优于对照组(86.54%vs 42.62%,P<0.01)。2组治疗后MQSGA评分均较治疗前下降(P<0.01),治疗组低于对照组(P<0.01)。治疗后治疗组Hb、ALB、PA水平高于对照组(P<0.01),hs-CRP水平低于对照组(P<0.01)。结论保肾片有改善透析患者PEW的作用,治疗机制与该方培补肾元提高透析耐受性与充分性、增强运动耐力,健脾助运增进食欲,活血解毒缓解微炎症等作用相关。

OBJECTIVE To observe the therapeutic effect of Baoshen tablet on PEW of dialysis patients and explore the mechanism of TCM.METHODS 113 patients who received maintenance hemodialysis(HD)and peritoneal dialysis(PD)and met the PEW from March 2015 to June 2016 in Department of Nephrology of Affiliated Hospital of Nanjing University of Chinese Medicine,and met PEW's diagnosis were selected.The basic treatment was high quality protein diet[1.0-1.2 g/(kg·d)],regulating calcium and phosphorus metabolism,correcting anemia,lowering blood pressure.Diabetes patients were given insulin to control blood sugar.61 cases of control group were treated with basic treatment and dialysis,while 52 cases of treatment group were treated with Baoshen tablet on the basis of the treatment in the control group.The triceps skin fold thickness(TSF),mid arm circumference(MAC),mid arm muscle circumference(MAMC),improved quantitative subjective global nutrition assessment(MQSGA)score,hemoglobin(Hb),serum albumin(ALB),ferritin(SF),high sensitivity C reactive protein(hs CRP)were observed before and after treatment in the two groups.RESULTS The body mass,body mass index(BMI),MAC,MAMC,TSF were higher than before treatment(P<0.01),while the TSF of control group was lower than before treatment(P<0.01).The body weight,MAC,MAMC and TSF of treatment group were better than that of the control group(P<0.05).The total efficiency of treatment group was significantly better than that of the control group(86.54%vs 42.62%,P<0.01).The MQSGA scores in two groups were lower than that before treatment(P<0.01),and the treatment group was lower than the control group(P<0.01).The levels of Hb,ALB and PA in treatment group was higher than that in control group(P<0.01),Hs CRP level was lower than control group(P<0.01).CONCLUSION Baoshen tablet has the effect of improving PEW of dialysis patients,and the therapeutic mechanism is related to the effect of this prescription on improving dialysis tolerance and sufficiency,strengthening exercise endurance,invigorating spleen to stimulate appetite,promoting blood circulation,detoxifying and alleviating micro inflammation.