益气清热降浊方合个案管理对脾肾阳虚型慢性肾脏病Ⅲ~Ⅳ期患者肾功能及氧化应激的影响

Effect of Case Management Combined with Tonifying Qi and Clearing Heat for Reducing Turbidity Therapy on Renal Function and Oxidative Stress in Patients with Chronic Kidney Disease of Yang Deficiency of Spleen and Kidney Type in StageⅢ~Ⅳ

目的研究益气清热降浊方合个案管理对脾肾阳虚型慢性肾脏病Ⅲ~Ⅳ期患者肾功能及氧化应激的影响。方法选取2018年6月—2019年6月治疗的慢性肾脏病患者100例,按照随机数字表法分为对照组和观察组(各50例)。对照组采用常规西医治疗,观察组在对照组基础上联用益气清热降浊方治疗,2组在治疗期间均给予个案管理干预,周期为2个月。比较2组患者治疗前后中医证候积分、肾功能指标、血清MDA、SOD、GSH-Px水平。结果与治疗前相比,2组患者治疗后腰膝酸软、困倦乏力、水肿不消、胃呆腹胀中医证候积分、尿24 h UTP、血清Scr、BUN、MDA均降低,且观察组低于对照组,血清SOD、GSH-Px均上升,且观察组高于对照组(均P<0.05)。结论益气清热降浊方联合个案管理对脾肾阳虚型慢性肾脏病Ⅲ~Ⅳ期患者具有缓解临床症状,延缓病情进展、改善肾功能及氧化应激状态的作用。

Objective To study the effect of case management of tonifying qi,clearing heat and reducing turbidity therapy on renal function and oxidative stress in patients with chronic kidney disease of spleen kidney yang deficiency type in stageⅢ~Ⅳ.Methods A total of 100 patients with chronic kidney disease admitted to our hospital from June 2018 to June 2019 were collected and divided into control group and the observation group(50 cases each)according to the random number table method.Patients in the control group were treated with conventional Western medicine,and patients in the observation group were treated with tonifying qi and clearing heat for reducing turbidity therapy on the basis of the control group.Both groups were given case management intervention during the treatment period,with a cycle of2 months.The TCM syndrome score,renal function index,serum MDA,SOD and GSH-Px levels were compared between the two groups before and after treatment.Results Compared with those before treatment,TCM syndrome scores of sore waist and knees,drowsiness and fatigue,edema,stomach stuffing and abdominal distension,24-hour urine UTP,serum Scr,BUN and MDA were all decreased in both groups after treatment,and the observation group were lower than the control group.The levels of serum SOD and GSH-Px increased in both groups,and the levels in the observation group were higher than those in the control group(all P<0.05).Conclusion Tonifying qi and clearing heat for reducing turbidity therapy combined with case management can alleviate the clinical symptoms in patients with chronic kidney disease of spleen and kidney yang deficiency typeⅢ~Ⅳ,slow disease progression,and improve renal function and oxidative stress state.