中药调理脾胃对改善尿毒症维持性血液透析患者微炎症及营养状况的临床观察

Clinical Observation on Chinese Medicine Regulation of Spleen and Stomach with for Improving Microinflammation and Nutritional Status in Patients with Uremia and Maintenance Hemodialysis

目的观察自拟中药方“理中清浊汤”加减对慢性肾功能衰竭并尿毒症,维持性血液透析患者微炎症及营养不良的治疗效果。方法选取2014年1月至2019年1月甘肃庆阳市人民医院收治的63例慢性肾功能衰竭合并尿毒症维持性血液透析有营养不良及微炎症的患者,按照随机数字表法分为对照组(31例)及治疗组(32例)。两组患者均行常规血液透析(HD)或血液透析滤过(HDF)治疗2~3次/周,治疗组按中药辩证施治给予自拟中药方“理中清浊汤”加减口服,4周1个疗程,3个疗程后比较治疗组和对照组测定干体重、超敏C反应蛋白、血清白蛋白、血清前白蛋白、血红蛋白、淋巴细胞计数,同时测定肱三头肌皮褶厚度、上臂围等指标。结果治疗后,两组各指标改善明显,与治疗前比较差异有统计学意义(P<0.05)。治疗组总有效率90.63%(29/32),高于对照组的51.61%(16/31),差异有统计学意义(P<0.05)。结论慢性肾功能衰竭尿毒症维持性血液透析患者,在充分透析的情况下配合理中清浊汤加减治疗,能增加患者食欲,提升干体重、血浆白蛋白、前白蛋白、血红蛋白、淋巴细胞计数,降低患者的血浆hs-CRP,并有效改善患者的皮下脂肪以及骨骼肌的量、营养状况以及微炎症状态,从而提高透析患者生活质量。

Objective To observe the therapeutic effect of Chinese herbal medicine Lizhong Qingzhuo Decoction on the treatment of chronic renal failure and uremia patients with micro-inflammation and malnutrition in maintenance hemodialysis.Methods From January 2014 to January 2019,63 patients with chronic renal failure and uremic maintenance hemodialysis from Qingyang People's Hospital of Gansu Province were selected and randomly divided into control groups(31 Cases)and treatment group(32 cases).Patients in the two groups were treated with routine hemodialysis(HD)or hemodiafiltration(HDF)2 to 3 times a week.The treatment group was given modified Lizhong Qingzhuo Decoction according to syndrome differentiation,4 weeks as a course of treatment.After 3 courses,the treatment group and the control group were compared to measure dry body weight,high-sensitivity C-reactive protein,serum albumin,serum prealbumin,hemoglobin,and lymphocyte counts.At the same time,triceps brachii skinfold thickness was measured,Upper arm circumference and other indicators,and conduct comparative analysis.Results After treatment,the indicators of the two groups improved significantly,and the difference was statistically significant compared with that before treatment(P<0.05).The total effective rate in the treatment group was 90.63%(29/32),which was higher than 51.61%(16/31)in the control group,and the difference was statistically significant(P<0.05).Conclusion For patients with chronic renal failure uremic maintenance hemodialysis under the condition of adequate dialysis,additional CM treatment of modified Lizhong Qingzhuo Decoction can increase the patient’s appetite,increase dry weight,plasma albumin,prealbumin,hemoglobin,and lymphocyte count,reduce the patient's plasma hs-CRP,also effectively improve the patient's subcutaneous fat and skeletal muscle,improve the patient's nutritional status,and at the same time improve the micro-inflammatory state,thereby improve the quality of life of dialysis patients.