基于“脾主腹”理论观察加味参苓白术散对腹膜透析患者腹膜功能及纤维化指标的影响

Effect of Jiawei Shenling Baizhu Powder on Peritoneal Function and Fibrosis Indices in Patients Undergoing Peritoneal Dialysis: An Analysis Based on the Theory of "Spleen Governs Abdomen"

目的基于“脾主腹”理论观察和分析加味参苓白术散对持续性不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)脾虚瘀浊证患者腹膜透析功能及腹膜纤维化指标的影响。方法将64例CAPD脾虚瘀浊证患者随机分为治疗组和对照组,每组32例,每组2例患者退出观察,实际每组完成30例。两组患者均予CAPD和常规对症治疗,治疗组在对照组治疗基础上加服加味参苓白术散,疗程16周。观察两组患者治疗前后中医证候积分的变化,检测并计算腹膜透析血尿素清除指数(Kt/V),评估腹膜透析充分性;测定并计算4 h透析液与血液中肌酐的浓度比值(dialysate-to-plasma ratio of creatinine,D/Pcr),评估腹膜转运功能;测定24 h腹膜透析超滤量(ultrafiltration,24hUF),评估腹膜超滤功能;测定患者治疗前后血清转化生长因子β1(transforming growth factor-β1,TGF-β1)和纤维连接蛋白(fibronectin,Fn)水平。结果治疗组中医证候疗效优于对照组(P<0.05)。治疗后治疗组Kt/V、D/Pcr和24 h UF水平均较治疗前和同期对照组显著升高(P<0.05);治疗后治疗组血清TGF-β1、Fn水平均较治疗前显著降低(P<0.05),且下降程度显著大于对照组(P<0.05);治疗前后两组腹膜转运类型变化的差异无统计学意义(P>0.05),但治疗组低平均转运和高平均转运患者例数较治疗前增加。结论加味参苓白术散可改善CAPD脾虚瘀浊证患者腹膜透析功能,提高腹膜透析充分性,其机制可能与该方降低血清TGF-β1、Fn水平,防治腹膜纤维化有关。

Objective To investigate the effect of Jiawei Shenling Baizhu Powder on peritoneal dialysis function and peritoneal fibrosis indices in patients with syndrome of spleen deficiency and stasis undergoing continuous ambulatory peritoneal dialysis(CAPD)based on the theory of"spleen governs abdomen".Methods A total of 64 CAPD patients with syndrome of spleen deficiency and stasis were randomly divided into treatment group and control group,with 32 patients in each group;2 patients in each group withdrew from the treatment,and 30 patients in each group actually completed the treatment.The patients in both groups were given CAPD and conventional symptomatic treatment,and those in the treatment group were given oral administration of Jiawei Shenling Baizhu Powder in addition to the treatment in the control group,with a course of treatment of 16 weeks.The changes in traditional Chinese medicine(TCM)syndrome scores after treatment were observed for both groups,and urea clearance index(Kt/V)of peritoneal dialysis was measured and calculated to evaluate peritoneal dialysis adequacy;dialysate-to-plasma ratio of creatinine(D/Pcr)at 4 hours was measured and calculated to evaluate peritoneal transport function;the 24-hour ultrafiltration volume of peritoneal dialysis was measured to evaluate peritoneal ultrafiltration function;the levels of transforming growth factor-β1(TGF-β1)and fibronectin(Fn)were measured before and after treatment.Results After treatment,the treatment group had a significantly better outcome of TCM syndrome than the control group(P<0.05).The treatment group had significant increases in Kt/V,D/Pcr,and 24-hour ultrafiltration volume after treatment,with significant increases compared with the control group(P<0.05).After treatment,the treatment group had significant reductions in the serum levels of TGF-β1 and Fn(P<0.05),with significantly greater reductions than the control group(P<0.05).There was no significant change in peritoneal transport type after treatment in either group(P>0.05),but the treatment group had increases in the numbers of patients with low mean transport or high mean transport after treatment.Conclusion In patients with syndrome of spleen deficiency and stasis undergoing CAPD,Jiawei Shenling Baizhu Powder can improve peritoneal dialysis function and peritoneal dialysis adequacy,possibly by reducing the serum levels of TGF-β1 and Fn and preventing peritoneal fibrosis.