保肾康方对终末期肾病维持性血液透析患者残余肾功能及微炎症状态的影响

Effect of Baoshenkang formula on residual renal function and microinflammatory state in maintenance hemodialysis patients with end-stage renal diseases

目的探讨保肾康方对终末期肾病维持性血液透析患者残余肾功能的影响。方法选取山东省东营市第二人民医院肾内科2016年12月至2017年12月期间收治的终末期肾病患者80例作为研究对象,随机分为对照组和观察组,每组40例。所有患者均实施维持性血液透析,治疗期间叮嘱患者饮食应低钠、低磷,且应富含蛋白质,透析结束后采用重组促红细胞生成素和左卡尼汀治疗,观察组在上述治疗的基础上给予保肾康方治疗。于治疗前、治疗3个月后,观察患者血常规指标、血生化指标、残余肾功能指标及营养状况变化,并比较两组治疗前后血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6的变化。结果两组的血红蛋白、红细胞水平均较治疗前明显升高(P<0.05),且观察组升高更加明显(P<0.05)。治疗后,两组的24 h尿量、残余肾功能均较治疗前显著下降,对照组下降较观察组更加明显,差异有统计学意义(P<0.05)。治疗后对照组的尿素氮(BUN)、血肌酐(Scr)较治疗前显著升高(P<0.05),观察组BUN、Scr较治疗前无显著变化(P>0.05)。治疗后,观察组的hs-CRP、TNF-α、IL-6水平均较治疗前显著下降(P<0.05),而对照组无显著变化(P>0.05)。治疗后观察组的主观整体营养状况评估量表评分、血白蛋白均较治疗前显著升高,且高于对照组(P<0.05)。治疗后,两组的血糖、血磷、血钾、血钙水平与治疗前比较,差异均无统计学意义(P>0.05)。结论保肾康方能有效保护终末期肾病维持性血液透析患者的残余肾功能,改善患者营养状态,其机制可能与改善透析患者的微炎症状态有关。

Objective To investigate the effect of Baoshenkang formula on residual renal function(RRF)in maintenance hemodialysis patients with end-stage renal diseases.Methods Eighty patients with end-stage renal disease admitted from December 2016 to December 2017 in The Second People’s Hospital of Dongying were selected as the research object,and randomly divided into control group and observation group with 40 cases in each group.All patients underwent maintenance hemodialysis,and were recommended to take low-sodium,low-phosphorus and protein-rich food during treatment.After completion of hemodialysis,erythropoietin and levocarnitine were used for treatment,and the observation group also received Baoshenkang formula treatment on the basis of the above medications.Before treatment and 3 months after treatment,routine blood indexes,biochemical blood indexes,residual renal function indexes and nutritional status were observed.The levels of serum hypersensitivity C reaction protein(hs-CRP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)before and after treatment were compared for the two groups.Results The levels of hemoglobin and red blood cell in both groups were significantly higher than those before treatment(P<0.05),with more significant increase for the observation group(P<0.05).After treatment,24h urine output and RRF in both groups were significantly lower than those before treatment,and the decrease was more significant decrease for the control group than for the observation group,with difference of statistical significance(P<0.05).After treatment,blood urea nitrogen(BUN)and serum creatine(Scr)in the control group were significantly higher than those before treatment(P<0.05),while BUN and Scr in the observation group had no significant changes(P>0.05).After treatment,the levels of hs-CRP,TNF-αand IL-6 in the observation group were significantly lower than those before treatment(P<0.05),but those in the control group had no obvious changes(P>0.05).After treatment,subjective global nutrition assessment scale scores and albumin in the observation group were significantly higher than those before treatment,with more significant increase than the control group(P<0.05).After treatment,there was no significant difference in blood glucose,phosphorus,potassium and calcium in the both groups compared with those before treatment(P>0.05).Conclusions Baoshenkang formula can effectively protect the residual renal function and improve the nutritional status in maintenance hemodialysis patients with end-stage renal diseases.The mechanism may be related to improvement of the micro-inflammatory status of dialysis patients.