益肾补脾法改善慢性肾脏病4～5期非透析患者蛋白质能量消耗的经验

Experience of Tonifying the Kidney and Invigorating the Spleen Method on Improving Protein Energy Consumption of Stage 4-5 Chronic Kideny Disease Non-dialysis Patients

目的探讨益肾补脾法对慢性肾脏病(chronic kidney disease,CKD)4～5期非透析患者蛋白质能量消耗(protein-energy wasting,PEW)状态的影响。方法选择住院及门诊CKD4～5期非透析患者120例,根据PEW诊断标准最后入组26例PEW患者,将PEW患者随机分为治疗组14例与对照组12例,2组均给予低磷、低盐、优质低蛋白饮食,改善贫血,控制血糖、血脂、血压等,治疗组在基础治疗的基础上采用益肾补脾方加减治疗,评估2组体质量指数(BMI)、中臂围(MAC)、肱三头肌皮褶厚度(TSF)和中臂肌围(MAMC)变化,检测2组治疗前后红细胞(RBC)、血红蛋白(Hb)、血尿素氮(BUN)、血肌酐(Scr)、白蛋白(Alb)、血清前白蛋白(p Alb)、超敏C反应蛋白(hs-CRP)等指标变化,并对以上结果进行统计学分析。结果 PEW患病率为21.67%。治疗组BMI和MAC均明显升高,Alb、p Alb、Hb水平均明显上升(P<0.05),治疗组hs-CRP水平较治疗前及对照组治疗后均明显下降(P<0.05)。结论益肾补脾法能有效改善CKD4～5期非透析患者微炎症状态,改善PEW状态。

Objective To investigate the effect of tonifying the kidney and invigorating the spleen method on improving protein energy consumption of stage 4-5 chronic kideny disease non-dialysis patients.Methods 120 patients with CKD4-5 non-dialysis patients in Suzhou hospital of TCM were selected.According to the PEW diagnostic criteria,26 patients with PEW were enrolled.PEW patients were randomly divided into treatment group(n=14)and control group(n=12).Both groups were given low phosphorus and low salt,high-quality low-protein diet,and we improve anemia,control blood sugar,blood lipids,blood pressure,etc.In the treatment group,apart from the treatment used in control group,the patients were treated with Yishen Bupi Decoction.The changes of BMI,MAC,TSF and MAMC were evaluated.The levels of RBC,Hb,BUN,Scr,Alb,pAlb,hs-CRP were measured before and after treatment,and then we statistically analyze the above results.Results The prevalence of PEW was 21.67%.The index of BMI and MAC of the treatment group were significantly increased,the level of Alb,pAlb and Hb were significantly increased(P<0.05),while the level of hs-CRP were decreased in the treatment group(P<0.05).Conclusion The tonifying the kidney and invigorating the spleen method can effectively improve the microinflammatory status of CKD4-5 non-dialysis patients and PEW status.