健脾补肾通络方对慢性肾脏疾病患者血管钙化及微炎症状态的影响

The Efficacy of Jianpibushentongluo Decoction on Vascular Calcification and Microinflammatory Status in Chronic Kidney Disease

目的:探讨健脾补肾通络方对3期~5期慢性肾脏疾病(CKD)患者血管钙化和微炎症状态的影响。方法:前瞻性选取上海中医药大学附属龙华医院2017年10月~2019年3月CKD非透析患者120例,随机分为中药组、西药组、联合组,每组各40例。在常规治疗的基础上,中药组辅以健脾补肾通络方,西药组辅以骨化三醇,联合组辅以健脾补肾通络方和骨化三醇。连续治疗24 w,比较三组患者的临床疗效,治疗12 w和24 w中医证候总积分、血钙、血磷、血清全段甲状腺激素(iPTH)、Klotho蛋白、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、血清肌酐(SCr)、β2-微球蛋白(β2-MG)、尿素氮(BUN)水平以及颈动脉和心脏超声血管钙化结果。结果:联合组患者显效率(67. 5%)和临床总有效率(97. 5%)均明显高于中药组和西药组;并且与中药组和西药组相比,联合组可有效降低中医证候总积分、血清i PTH、hs-CRP、IL-6、TNF-α、SCr、β2-MG、BUN水平以及血管钙化的总发生率,同时提高血清Klotho水平。另外,治疗12 w和24 w时,中药组和联合组患者血磷和钙磷乘积明显低于西药组;中药组患者血钙水平明显低于西药组和联合组。结论:健脾补肾通络方在改善CKD患者肾功能的基础上,可有效抑制微炎症内环境,调节钙磷代谢,以达到缓解临床症状和降低血管钙化发生率的目的;联合组对中晚期CKD患者预防血管钙化发生的临床获益更明显,值得临床推广。

Objective: To investigate the interventional effect of Jianpibushentongluo decoction on vascular calcification and microinflammatory status in chronic kidney disease( CKD). Methods: A total of 120 non-dialysis CKD patients in our hospital were prospectively selected( fromOctober,2017 to March,2019),then they were divided into TCM group,western medicine group and combination group,40 patients in each group. Based on conventional therapy,patients in TCM group were treated with Jianpibushentongluo Decoction,patients in western medicine group were treated with calcitriol,and patients in combination group were treated with both drugs,for constantly 24 weeks. The clinical efficacy,TCM symptoms scores in 12 and 24 weeks,the levels of serum calcium iron,serum phosphate,intact parathyroid hormone( iPTH),Klotho protein,hypersensitive C-reactive protein( hs-CRP),interleukin-6( IL-6),tumor necrosis factor( TNF-ɑ),serum creatinine( SCr),β2-microglobin( β2-MG),blood urea nitrogen( BUN),and VC occurrence in carotid and heart were detected and compared among the 3 groups. Results: Compared with TCM group and western group,the curative rate and total efficacy rate of patients in combination group were increased,the TCM symptom scores,the levels of i PTH,hs-CRP,IL-6,TNF-α,SCr,β2-MG and BUN,and the total VC occurrence rate were decreased,while the serum Klotho level was increased. Besides,at 12 th and 24 th weeks,the serum phosphate and calcium-phosphorus product in TCM group and combination group were lower than those levels in calcitriol group,while serum calcium iron level in TCM group was lower than that in calcitriol group and combination group. Conclusion: Jianpibushentongluo decoction can improve the renal functions of CKD patients,it can effectively inhibit microinflammatory status,regulate the calcium-phosphorus metabolism,in order to alleviate the clinical syndrome and reduce VC occurrence. The application of Jianpibushentongluo decoction combined with calcitriol may be more effective,which is recommended for the clinical use.