中医药治疗慢性肾脏病5期(非透析)临床研究

Clinical Study on Traditional Chinese Medicine in Treatment of Chronic Kidney Disease Stage 5(Non-dialysis)

目的:通过观察中医药治疗慢性肾脏病(CKD)5期(非透析)患者的临床疗效、安全性,探讨中医药治疗CKD的优势之所在。方法:回顾性分析2011年1月至2015年12月住院的CKD 5期(非透析)患者97例,予以中医药治疗,设立主要观察指标或结局指标以及次要观察指标;计算患者的肾脏累积生存率,分析不同因素对肾脏累积生存率的影响;分析治疗前后患者相关肾脏指标、营养指标有无改善。结果:97例入组患者平均随访时间为(10.47±7.43)个月,41例患者在随访期间进入透析期。纳入患者在脾肾气(阳)虚主症中最易出现的中医症状(频数>30)有神疲乏力、纳呆、腰膝酸软,兼症则以失眠、夜尿增多较多见。入组患者肾脏累积生存率6个月时为81%,1年时为67%,2年时为48%,3年时为43%,3年以上为29%;既往有高血压病病史、糖尿病病史者,其肾脏累积生存率低于无高血压病病史、糖尿病病史者(P<0.05);入组时不同肌酐分层对肾脏累积生存率的影响无统计学意义(P>0.05);少量蛋白尿患者、中等量蛋白尿患者、大量蛋白尿患者其肾脏累积生存率逐渐递减(P<0.05)。结论:CKD 5期(非透析)患者最常出现神疲乏力、纳呆、腰膝酸软、失眠、夜尿增多等症状,符合脾肾气虚证临床表现;采用中医药治疗其6个月以上生存率可达81%,高血压病史、糖尿病病史、大量蛋白尿是影响肾脏生存率的独立危险因素。

Objective:To explore the advantages of traditional Chinese medicine in the treatment of chronic kidney disease by observing the clinical efficacy and safety of traditional Chinese mecicine in the treatment of chronic kidney disease(CKD)5 stage(non-dialysis).Methods:A retrospective analysis of 97 patients with CKD 5 stage(non-dialysis)hospitalized from January 2011 to December 2015 was made.Patients were treated with traditional Chinese medicine,and the main observation indexes or outcome indexes and secondary observation indexes were established.The cumulative renal survival rate was calculated and its different influencing factors were analyzed.The renal and nutritional indexes were analyzed before and after treatment.Results:This study included 97 patients,the mean follow-up time was 10.47±7.43 months,among them 41 cases entered dialysis during the follow-up period.The most frequent main symptoms of patients with spleen and kidney qi(yang)deficiency syndrome included lassitude,anorexia,soreness and weakness of waist and knees,and the secondary symptoms of spleen and kidney qi(yang)deficiency syndrome included insomnia and night urine.The cumulative renal survival rate of all 97 cases was 81%in 6 months,67%in one year,48%in two years,43%in 3 years and 29%over 3 years.The cumulative renal survival rate of patients with hypertension or diabetes was lower than that of patients not having hypertension and diabetes(P<0.05).Different creatinine stratification had no significant effect on the cumulative survival rate(P>0.05).The cumulative renal survival rate gradually decreased among patients of low proteinuria,moderate proteinuria and massive proteinuria(P<0.05).Conclusion:The patients with CKD 5 stage(non-dialysis)most frequently show symptoms of lassitude,anorexia,soreness and weakness of waist and knees,insomnia,and increasing nocturia,which is in conformity with the spleen and kidney qi deficiency syndrome.The cumulative renal survival rate of patients treated for over 6 months is 81%.Hypertension,diabetes,massive proteinuria are relative factors affecting the cumulative renal survival rate of CKD 5 stage.