温肾补脾生血方联合左卡尼汀对MHD伴促红细胞生成素低反应性患者血清维生素D、叶酸、维生素B12和炎症因子的影响

Effects of Wenshen Bupi Shengxue decoction combined with L-Carnitine on serum vitamin D,folic acid,vitamin B12 and inflammatory factors in patients with MHD accompanied by erythropoietin hyporesponsiveness

目的观察温肾补脾生血方联合左卡尼汀治疗维持性血液透析(MHD)伴促红细胞生成素(EPO)低反应性的疗效及对患者血清维生素D、叶酸、维生素B12和炎症因子的影响。方法将2016年1月—2019年1月内蒙古医科大学附属医院收治的60例MHD伴EPO低反应性患者随机分为2组:对照组30例给予MHD联合左卡尼汀治疗,观察组30例在对照组治疗基础上给予温肾补脾生血方治疗,疗程均为2个月。比较2组治疗前后血清总蛋白(TP)、白蛋白(ALB)、血红蛋白(Hb)、维生素D、叶酸、维生素B12、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)水平,评价临床疗效及不良反应发生情况。结果观察组和对照组总有效率分别为73.3%(22/30)和55.0%(16/30),观察组明显高于对照组(P<0.05)。治疗后2组TP、ALB、Hb、维生素D、叶酸、维生素B12水平均明显增高(P均<0.05),IL-6、TNF-α、CRP水平均明显降低(P均<0.05),治疗后观察组以上指标均明显优于对照组(P均<0.05)。观察组和对照组不良反应总发生率分别为16.7%(5/30)和36.7%(11/30),观察组明显低于对照组(P<0.05)。结论温肾补脾生血方联合左卡尼汀治疗可显著改善MHD伴EPO低反应性患者的营养状况,提高血清维生素D、叶酸、维生素B12水平,减轻炎症反应,减少不良反应发生。

Objective It is to observe the effect of Wenshen Bupi Shengxue decoction combined with L-Carnitine on serum vitamin D,folic acid,vitamin B12 and inflammatory factors in maintenance hemodialysis(MHD)patients with erythropoietin(EPO)hyporesponsiveness.Methods Sixty MHD patients with EPO responsiveness treated in the Affiliated Hospital of Inner Mongolia Medical University from January 2016 to January 2019 were randomly divided into 2 groups:30 patients in the control group were treated with MHD combined with L-carnitine,30 patients in the observation group were treated Wenshen Bupi Shengxue decoction based on the control group.Both groups were treated for 2 months.The levels of serum total protein(TP),albumin(ALB),hemoglobin(Hb),vitamin D,folic acid,vitamin B12,serum interleukin-6(IL-6),tumor necrosis factor alpha(TNF-α),C-reactive protein(CRP)before and after treatment were compared between the two groups,The clinical curative effect and adverse reactions were evaluated.Results The total effective rates of the observation group and the control group were 73.3%(22/30)and 55.0%(16/30)respectively,and the observation group was significantly higher than the control group(P<0.05).After treatment,the levels of TP,ALB,Hb,vitamin D,folic acid and vitamin B12 were increased significantly(P<0.05),and the levels of IL-6,TNF-αand CRP were decreased significantly(P<0.05).After treatment,the above indicators in the observation group were significantly better than the control group(P<0.05).The total incidence of adverse reactions in the observation group and the control group were 16.7%(5/30)and 36.7%(11/30),respectively,and the observation group was significantly lower than the control group(P<0.05).Conclusion Wenshen Bupi Shengxue combined with L-carnitine can improve the efficacy of MHD patients with low erythropoietin response,improve nutritional status,increase the levels of serum vitamin D,folic acid and vitamin B12,reduce inflammatory factors and reduce adverse effects.