四君子汤加减联合西医治疗肾虚湿浊证CKD3~5期的疗效及对肾功能、钙磷代谢水平的影响

Effect of Sijunzi Decoction combined with western medicine in the treatment of chronic kidney disease of stage 3-5 with kidney deficiency and dampness turbidity syndrome and its influence on renal function and calcium and phosphorus metabolism levels

目的探讨四君子汤加减联合西医治疗肾虚湿浊证慢性肾脏病(CKD)3~5期的疗效及对患者肾功能、钙磷代谢水平的影响。方法选取武汉市中医医院肾内科2018年1月至2020年12月收治的60例肾虚湿浊证CKD 3~5期患者,按照随机数表法分为观察组和对照组,每组30例。对照组患者给予常规西医治疗,观察组患者在常规西医治疗的基础上给予四君子汤加减治疗,1个疗程一个月,连续治疗3个疗程。比较两组患者治疗3个月后的临床疗效,以及治疗前、治疗3个月后的肾功能血肌酐(Scr)、尿素氮(BUN)水平和钙磷代谢中甲状旁腺激素(PTH)、血清钙(Ca^(2+))、血清磷(P^(3+))水平。结果观察组患者的治疗总有效率为93.33%,明显高于对照组的73.33%,差异有统计学意义(P<0.05);两组患者治疗前的Scr、BUN水平比较差异均无统计学意义(P>0.05),治疗后观察组患者的Scr、BUN水平分别为(191.15±11.14)μmol/L、(17.21±2.62)mmol/L,明显低于对照组的(232.21±15.77)μmol/L、(20.73±3.36)mmol/L,差异均有统计学意义(P<0.05);两组患者治疗前的PTH、P^(3+)、Ca^(2+)水平比较差异均无统计学意义(P>0.05),治疗后观察组患者的PTH、P^(3+)水平分别为(244.13±11.16)ng/dL、(1.73±0.22)mmol/L,明显低于对照组的(302.25±15.71)ng/dL、(2.02±0.32)mmol/L,Ca^(2+)水平为(2.37±0.62)mmol/L,明显高于对照组的(2.03±0.39)mmol/L,差异均有统计学意义(P<0.05);两组患者的不良反应发生情况比较差异无统计学意义(P>0.05)。结论四君子汤加减联合西医治疗肾虚湿浊证CKD 3~5期的临床疗效显著,可改善患者肾脏及钙磷代谢水平,促进机体恢复,且无明显不良反应,值得临床推广应用。

Objective To explore the effect of Sijunzi Decoction combined with western medicine in the treatment of chronic kidney disease(CKD)of stage 3-5 with kidney deficiency and dampness turbidity syndrome and its influence on renal function and calcium and phosphorus metabolism levels.Methods Sixty patients with CKD of stage 3-5 with kidney deficiency and dampness turbidity syndrome treated in the Department of Nephrology,Wuhan Hospital of Traditional Chinese Medicine from January 2018 to December 2020 were randomly divided into an observation group and a control group,with 30 patients in each group.Patients in the control group were treated with conventional western medicine,and the patients in the observation group were treated with Sijunzi Decoction on the basis of conventional western medicine,with one month as a course of treatment,all for 3 courses.The clinical efficacy after 3 months,renal function,serum creatinine(SCR),urea nitrogen(BUN),parathyroid hormone(PTH),serum calcium(Ca^(2+)),and serum phosphorus(P^(3+))were compared between the two groups before and after 3 months of treatment.Results The total effective rate of the observation group was 93.33%,which was significantly higher than 73.33%of the control group(P<0.05).There was no significant difference in the levels of SCR and BUN between the two groups before treatment(P>0.05),while the levels of SCR and BUN in the observation group after treatment were(191.15±11.14)μmol/L,(17.21±2.62)mmol/L,significantly lower than(232.212±15.77)μmol/L,(20.73±3.36)mmol/L in the control group(P<0.05).There were no significant difference in PTH,P^(3+),Ca^(2+) levels between the two groups before treatment(P>0.05);after treatment,PTH and P^(3+) levels in the observation group were(244.13±11.16)ng/dL,(1.73±0.22)mmol/L,significantly low-er than(302.25±15.71)ng/dl,(2.02±0.32)mmol/L,and the Ca^(2+) level of the observation group was(2.37±0.62)mmol/L,significantly higher than(2.03±0.39)mmol/L in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Sijunzi Decoction combined with western medicine has significant clinical effect in the treatment of CKD of stage 3-5 with kidney deficiency and dampness turbidity syndrome.It can improve the level of kidney and calcium and phosphorus metabolism and promote recovery,which is worthy of clinical application.