积雪益肾排毒方加味联合非布司他治疗慢性肾脏病合并无症状高尿酸血症临床研究

Clinical Study on Modified Jixue Yishen Paidu Decoction Combined with Febuxostat for Treating Chronic Kidney Disease with Asymptomatic Hyperuricemia

目的 探讨积雪益肾排毒方加味联合非布司他治疗慢性肾脏病(chronic kidney disease,CKD)合并无症状高尿酸血症(asymptomatic hyperuricemia,AH)的临床疗效。方法 选取106例CKD 2~4期合并AH患者,按照随机数字表法分为观察组和对照组,每组53例。对照组在常规治疗基础上加用非布司他片,观察组在对照组基础上加用积雪益肾排毒方加味治疗。治疗3月后,比较2组临床总有效率、中医证候积分,以及治疗前后血肌酐(serum creatinine,Scr)、尿素氮(blood urine nitrogen,BUN)、尿酸(uric acid,UA)、肾小球滤过率(glomerular filtration rate,GFR)等肾功能指标和24 h尿蛋白、24 h尿微量白蛋白等蛋白尿指标变化。结果 治疗后,2组UA水平均较治疗前下降(P<0.05),且观察组显著低于对照组(P<0.05)。观察组Scr水平较前下降(P<0.05),GFR较前升高(P<0.05),且上述指标显著低于或高于对照组(P<0.05)。2组BUN及蛋白尿指标治疗前后比较,差异均无统计学意义(P>0.05)。2组中医证候积分均较治疗前显著下降(P<0.05),且观察组显著低于对照组(P<0.05)。观察组临床总有效率显著高于对照组(P<0.05)。结论 积雪益肾排毒方联合非布司他治疗CKD合并AH能显著降低尿酸水平,控制CKD潜在的危险因素,保护肾功能。

Objective To explore the clinical efficacy of modified Jixue Yishen Paidu decoction combined with febuxostat in treating chronic kidney disease(CKD)combined with asymptomatic hyperuricemia(AH).Methods One hundred and six patients with CKD stage 2 to 4 combined with AH were selected and divided into observation group and control group according to the random number table method,with 53 cases in each group.The control group was given febuxostat tablets on the basis of conventional treatment,while the observation group was given modified Jixue Yishen Paidu decoction on the basis of the control group.After 3 months of treatment,the clinical total effective rate,TCM syndrome scores and the changes of renal function indexes such as serum creatinine(Scr),blood urea nitrogen(BUN),uric acid(UA)and glomerular filtration rate(GFR)and proteinuria indexes such as 24 h urinary protein and 24 h microalbumin were compared.Results After treatment,the levels of UA in the two groups were decreased(P<0.05),and the observation group was significantly lower than the control group(P<0.05).The level of Scr in the observation group was decreased(P<0.05),while GFR level was increased(P<0.05),and the above indexes were significantly lower or higher than those in the control group(P<0.05).There was no significant difference in terms of BUN levels and proteinuria indexes between the two groups before and after treatment(P>0.05).The TCM syndrome scores in the two groups were significantly lower than before(P<0.05),and the observation group was significantly lower than the control group(P<0.05).The total effective rate in the observation group was significantly higher than that in the control group(P<0.05).Conclusion Jixue Yishen Paidu decoction combined with febuxostat could significantly reduce uric acid levels in the treatment of CKD combined with AH,control the potential risk factors of CKD and protect renal function.