川黄方对2~4期慢性肾脏病合并急性肾损伤患者肾功能及氧化应激的影响

Effects of Chuanhuang Decoction on renal function and oxidative stress in patients of chronic kidney disease at stage 2-4 complicated with acute kidney injury

目的:观察川黄方对2~4期慢性肾脏病(CKD)合并急性肾损伤(AKI)患者的临床疗效,并从氧化应激角度探讨其疗效机制。方法:纳入84例CKD合并AKI患者,随机分为治疗组42例和对照组42例。所有患者均给予基础治疗(纠正水、电解质、酸碱平衡紊乱,控制血压等),对照组患者在此基础上给予前列腺素E1注射液静脉滴注,治疗组在对照组治疗基础上给予川黄方汤剂口服及浓煎剂灌肠,两组疗程均为2周。评价并比较两组患者的临床疗效及中医证候积分,检测并比较两组患者的血肌酐(Scr)、血尿素氮(BUN)、血尿酸(UA)、24 h尿蛋白定量(24 h U-pro)、估算的肾小球滤过率(eGFR)及血清血红素加氧酶-1(HO-1)、丙二醛(MDA)、超氧化物歧化酶(SOD)的水平。结果:①治疗后,治疗组的临床总有效率为71.4%,对照组为45.2%,两组间比较差异有统计学意义(P<0.01),治疗组的疗效优于对照组。②治疗后,两组患者的中医证候积分较治疗前均显著降低(P<0.01),且治疗组患者的积分下降程度较对照组更明显(P<0.05)。③治疗后,两组患者的Scr、BUN、UA水平较治疗前均明显降低(P<0.05,P<0.01),eGFR水平较治疗前显著升高(P<0.05,P<0.01),且治疗组患者的Scr、BUN水平降低程度及eGFR水平升高程度较对照组更明显(P<0.05,P<0.01);两组患者的24 h U-pro较治疗前均降低(P<0.05),且治疗组患者的24 h U-pro降低程度较对照组更明显(P<0.05)。④治疗后,两组患者的血清HO-1、SOD水平较治疗前显著升高(P<0.05),MDA水平较治疗前显著降低(P<0.05,P<0.01),且治疗组患者的HO-1、SOD水平升高程度及MDA水平降低程度较对照组更明显(P<0.05)。结论:川黄方能有效减轻CKD合并AKI患者的肾损伤、保护肾功能,改善患者的中医证候,其机制可能与抑制氧化应激有关。

Objective:To observe the clinical efficacy of Chuanhuang Decoction in treating patients of chronic kidney disease(CKD) at stage 2-4 complicated with acute kidney injury(AKI), and explore its mechanisms from the aspect of oxidative stress. Methods:Eighty-four patients of CKD complicated with AKI were enrolled and randomly divided into the treatment group(42 cases) and the control group(42 cases). All the patients were treated with basic therapy, including correcting the disorder of water, electrolyte and acid-base balance, controlling the blood pressure and so on. Based on above, the patients in the control group were treated with intravenous drip of prostaglandin E1 injection, and the patients in the treatment group were treated with Chuanhuang Decoction by oral administration and concentrated Chuanhuang Decoction by coloclysis based on the treatment for the control group. The treatment course of both groups was 2 weeks. The clinical efficacy and the score of Chinese medical syndrome were evaluated and compared, and the levels of serum creatinine(Scr), blood urea nitrogen(BUN), serum uric acid(UA), 24-hour urinary protein(24 h U-pro), estimated glomerular filtration rate(eGFR), heme oxygenase-1(HO-1), malondialdehyde(MDA) and superoxide dismutase(SOD) were detected and compared. Results: ①After treatment, the total clinical effective rates of the treatment group and the control group were 71.4% and 45.2% respectively, with statistically significant difference between the two groups(P<0.01), and the efficacy of the treatment group was better than that of the control group. ②After treatment, the score of Chinese medical syndrome was significantly decreased in the two groups compared with treatment before(P<0.01), and the decrease of the score in the treatment group was greater than that in the control group(P<0.05). ③After treatment, the levels of Scr, BUN and UA were significantly decreased in the two groups compared with treatment before(P<0.05,P<0.01), the level of eGFR was significantly increased compared with treatment before(P<0.05,P<0.01), and the decrease of Scr and BUN levels and the increase of eGFR level in the treatment group were greater than those in the control group(P<0.05,P<0.01);the level of 24 h U-pro was decreased in the two groups compared with treatment before(P<0.05), and the decrease of 24 h U-pro level in the treatment group were greater than that in the control group(P<0.05). ④After treatment, the levels of HO-1 and SOD were significantly increased in the two groups compared with treatment before(P<0.05), the level of MDA was significantly decreased compared with treatment before(P<0.05,P<0.01), and the increase of HO-1 and SOD levels and the decrease of MDA level in the treatment group were greater than those in the control group(P<0.05). Conclusion: Chuanhuang Decoction can effectively alleviate the kidney injury, protect the renal function and improve the Chinese medical syndrome in patients of CKD complicated with AKI, and its mechanisms may be related to inhibiting oxidative stress.