肺肠同治指导下中医药灌肠干预持续性血液透析尿毒症皮肤瘙痒研究

Efficacy of Enema of Traditional Chinese Medicine on Uremic Pruritus of Maintenance Hemeodialysis under the Guidance of Lung and Intestine Simultaneou Treatment

目的从"炎症-PTH"循环角度探索"肺肠同治"的科学性及"肠-肺-皮毛"关系内涵。方法240例持续性血液透析(Maintenance Hemodialysis,MHD)尿毒症皮肤瘙痒(Uremic pruritus,UP)的热毒证患者随机分为6组:肺肠同治组(凉膈散)、治肠组(调胃承气汤)、治肺组(凉膈散与调胃承气汤差异药物)、乳果糖组、生理盐水组及氯雷他定组,在慢性肾脏病一体化治疗的基础上,前5组采用封闭式灌肠治疗,氯雷他定组加用氯雷他定口服,持续治疗60天,比较6组治疗前后的临床疗效。并观察其瘙痒可视模拟评分(VAS)、甲状旁腺素(Parathyroid Hormone,PTH)、血钙、磷、及相关炎症指标(hs-CRP、TNF-α、IL-6)的水平。结果各组总有效率由高到低依次为:肺肠同治组(92.11%)>治肠组(84.21%)>治肺组(76.92%)>氯雷他定组(66.23%)、乳果糖组(67.57%)>生理盐水组(58.97%),其中氯雷他定组与乳果糖组无统计学差异。较治疗前,各组治疗后VAS评分、PTH、钙、磷、相关炎症指标(hs-CRP、TNF-α、IL-6)皆有所改善,而治疗后各组间上述指标比较,与有效率指标的比较结果相一致。结论肺肠同治MHD UP具有科学性,"肠-肺-皮毛"存在一定关系。

Objective To explore the scientific nature of“lung-intestinal simultaneous treatment”and the connotation of“intestinal-lung-fur”from the perspective of inflammation-PTH cycle.Methods A total of 240 patients with MHD UP Toxic heat syndrome were randomly divided into 6 groups:lung intestine simultaneous treatment group(Liangge Powder),intestine treatment group(Tiaowei Chengqi Decoction),lung treatment group(different medicine of Liangge Powder and Tiaowei Chengqi Decoction),lactulose group,Saline group and loratadine group.The first 5 groups were treated with closed enema,and the loratadine group was given loratadine orally for 60 days on the basis of integrated treatment of chronic kidney disease.The clinical efficacy of the 6 groups before and after treatment was compared.The visual analogue scale(VAS),parathyroid hormone(PTH),blood calcium,phosphorus and related inflammation indicators(hs-CRP,TNF-alpha and IL-6)were observed.Results The total effective rate of each group was successively from high to low:lung intestine simultaneous treatment group(92.11%)>intestine treatment group(84.21%)>lung treatment group(76.92%)>loratadine group(66.23%)and lactulose group(67.57%)>saline group(58.97%),among which there was no statistical difference between loratadine group and lactose group.VAS score,PTH,calcium,phosphorus and related inflammatory indicators(hs-CRP,TNF-α,IL-6)were all improved in each group after treatment compared with before treatment,and the above indicators were consistent with the comparison results of effective indicators in each group after treatment.Conclusion The treatment of MHD UP with lung and intestine simultaneous treatment is scientific,and there is a certain relationship between“intestine-lung-fur”.