真武汤辨证加减对维持性血液透析患者残余肾功能和营养状况的影响

Influence of Addition and Subtraction Therapy of Zhenwutang to Residual Renal Function and Nutritional Status of Patients with Maintenance Hemodialysis

目的:观察真武汤辨证加减对维持性血液透析(MHD)患者残余肾功能(RRF),营养状况、透析充分性和生活质量的影响效果。方法:将136例MHD患者按随机数字表法分为对照组和观察组各68例。两组患者进行MHD治疗,3次/周,4 h/次;左卡尼汀注射液,1 g溶于5~10 mL注射用水中,2~3 min静脉推注,每次透析后使用1次;重组人红细胞生成素注射液,3000 U,皮下注射,3次/周,共注射4周;缬沙坦胶囊,80 mg/次,1次/d,连续服用3个月。对照组口服慢肾宁合剂,35 mL/次,3次/d。观察组给予真武汤辨证加减内服,1剂/d,连续服用3个月。测量治疗前后尿素氮(BUN),肌酐(Cr),24 h尿量,计算RRF,计算每月RRF下降速度和尿量下降速率;检测治疗前后血红蛋白(Hb),白蛋白(Alb),前白蛋白(PA)和转铁蛋白(TRF)水平;评价治疗前后标准化蛋白代谢率(nPCR),尿素清除指数(Kt/V),肾小球滤过率(eGFR);进行治疗前后改良主观全面营养评价表(SGA),透析相关生存质量(KDTA)和健康调查简表(SF-36)评分;治疗结束后随访6个月,记录一级终点事件(24 h尿量≤400 mL)和无残存肾功能(24 h尿量≤100 mL)的发生情况。结果:观察组RRF,Kt/V,nPCR和eGFR均高于对照组(P<0.01);观察组Hb,Alb,PA和TRF水平均高于对照组(P<0.01);观察组SGA评分低于对照组,KDTA总分和SF-36总分均高于对照组(P<0.01);观察组每月RRF下降速度和尿量下降速率均少于对照组(P<0.01);观察组一级终点事件的发生率为27.94%(19/68),低于对照组的47.06%(32/68)(χ2=5.302,P<0.05);观察组无残存肾功能的发生率为17.65%(11/68),低于对照组的36.76%(25/68)(χ2=6.274,P<0.05);观察组BUN,Cr水平均低于对照组,24 h尿量多于对照组(P<0.01)。结论:采用真武汤辨证加减内服治疗MHD患者可维护RRF,改善营养状况,提高了透析充分性和患者生活质量。

Objective:To discuss influence of addition and subtraction therapy of Zhenwutang to residual renal function(RRF),nutritional status,dialysis adequacy and quality of life of patients with maintenance hemodialysis(MHD).Method:One hundred and thirty-six patients were randomly divided into control group(68 cases)and observation group(68 cases)by random number table.Patients in two group got MHD,3 times/week,4 h/time,levocarnitine injection(1 g dissolved in 5-10 mL water for injection)after the dialysis,2-3 min/time,recombinant human erythropoietin injection with subcutaneous injection for 4 weeks,3000 U,3 times/day,valsartan capsules for 3 months,80 mg/time,1 time/day.The control group took Manshenning mixture,35 mL/time,3 times/day.Patients in observation group added addition and subtraction therapy of Zhenwutang for 3 months,1 dose/day.Before and after treatment,urea nitrogen(BUN),creatinine(CR)and 24 hours’urine volume were recorded.And RRF,rate of decrease of RRF and rate of decrease in urine volume were also calculated.Levels of hemoglobin(HB),albumin(ALB),prealbumin(PA)and transferrin(TRF)were detected.After treatment,standardized protein metabolism rate(nPCR),urea clearance index(Kt/V)and glomerular filtration rate(EGFR)were discussed.And improved subjective comprehensive nutrition assessment(SGA),dialysis related quality of life(kdta)and health survey summary(SF-36)were graded.Six months’follow-up,primary end point event(24 h urine volume≤400 mL)and no residual renal function(24 h urine volume≤400 mL)were recorded.Result:Levels of RRF,Kt/V,nPCR,eGFR,Hb,Alb,PA,TRF and total scores of KDTA and SF-36 in observation group were higher than those in control group(P<0.01).And score of SGA,rate of decrease of RRF and rate of decrease in urine volume were less than those in control group(P<0.01).Incidence rate of primary end point event was 27.94%(19/68)lower than 47.06%(32/68)in control group(χ2=5.302,P<0.05),incidence rate of no residual renal functionwas 17.65%(11/68)lower than 36.76%(25/68)in control group(χ2=6.274,P<0.05).And BUN and Cr were lower than those in control group(P<0.01),24 h urine volume was more than that in control group(P<0.01).Conclusion:Addition and subtraction therapy of Zhenwutang can maintenance of RRF,improvement of nutritional status,improvement of dialysis adequacy and quality of life of patients.