清肾颗粒对慢性肾功能衰竭左心功能的影响

Effect of Qingshen granule on left heart function in patients with chronic renal failure

目的观察清肾颗粒对慢性肾功能衰竭3~5期非透析湿热证病人的临床疗效以及左心功能与结构的影响。方法选取2021年3月至2022年2月安徽中医药大学第一附属医院住院慢性肾功能衰竭3~5期非透析湿热证病人66例,采用随机数字表法分为观察组和对照组各33例,实际完成63例,其中观察组33例,对照组30例。对照组采用一般基础治疗,观察组在对照组基础上加用清肾颗粒,疗程均为12周。观察两组治疗前后临床疗效及中医证候疗效,肾功能、血红蛋白、超敏C反应蛋白、胱抑素C、同型半胱氨酸、N末端脑钠肽前体以及心脏彩超相关指标变化的情况。结果观察组临床疗效及中医证候疗效为84.8%、81.8%,优于对照组73.3%、60.0%,差异有统计学意义(P<0.05),与本组治疗前比较,治疗后血肌酐、超敏C反应蛋白、同型半胱氨酸、胱抑素C、N末端脑钠肽前体明显降低,观察组优于对照组同期(P<0.05)。与本组治疗前相比,左室射血分数(LVEF)明显上升,观察组优于对照组同期(P<0.05),但两组病人治疗前后左房收缩期内径(LADs)、室间隔厚度(IVSTd)、左室后壁舒张期厚度(LVPWTd)、主肺动脉内径(MPAD)、主动脉内径(AODd)、左室舒张末内径(LVDd)、血红蛋白水平差异无统计学意义(P>0.05)。结论清肾颗粒可以有效降低慢性肾功能衰竭3~5期非透析湿热证病人血肌酐、超敏C反应蛋白、胱抑素C、同型半胱氨酸、N末端脑钠肽前体水平,提高左心室射血分数,改善病人临床症状和肾功能,防止心血管并发症的发展。

Objective To observe clinical effects and effects on left heart function and structure exerted by Qingshen(kidney-clearing)granules in patients with damp-heat syndrome of stage 3 to 5 chronic kidney disease without dialysis.Methods A total of 66 patients with damp-heat syndrome of stage 3 to 5 chronic kidney disease without dialysis in the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from March 2021 to February 2022 were selected and randomly divided into treatment group and control group,with 33 cases in each group.Actually 63 cases were completed,including 33 cases in treatment group and 30 cases in control group.Both groups were given the general basic treatment,while the treatment group was given Qingshen granules additionally.Each course of treatment was 12 weeks.The clinical curative effect,TCM syndrome curative effect,renal function,hemoglobin,hypersensitive C-reactive protein,cystatin C,homocysteine,amino-terminal pro-brain natriuretic peptide and cardiac color doppler ultrasonography related indexes in 2 groups were observed before and after treatment.Results The clinical curative effect and TCM syndrome curative effect of the treatment group were 84.8%and 81.8%respectively,which were better than 73.3%and 60.0%of the control group,and the difference was statistically significant(P<0.05).After treatment,both groups had significant reductions in serum creatinine,hypersensitive C-reactive protein,homocysteine,cystatin C and amino-terminal pro-brain natriuretic peptide while the reductions in the treatment group were greater than the control group(P<0.05).After treatment,both groups had significant increase in LVEF,and the treatment group had more substantial increase than the control group(P<0.05).However,there is no statistical significance in the hemoglobin and levels of LADs,IVSTD,LVPWTd,MPAD,AODd,LVDd between 2 groups before and after treatment(P>0.05).Conclusion For patients with damp-heat syndrome of stage 3 to 5 chronic kidney disease without dialysis,Qingshen granules can effectively reduce the levels of serum creatinine,hypersensitive C-reactive protein,cystatin C,homocysteine and amino-terminal probrain natriuretic peptide,improve left ventricular ejection fraction,improve clinical symptoms and renal function,and prevent the development of cardiovascular complications.