益肾清利、和络泄浊方治疗慢性肾脏病肾性贫血临床研究

Clinical Study on the Treatment of Renal Anemia in Chronic Kidney Disease with Formula for Boosting the Kidney and Clearing the Lung and Soothing the Throat and Harmonizing Collaterals and Discharging Turbidity

目的:观察益肾清利、和络泄浊方治疗慢性肾脏病(chronic kidney disease,CKD)肾性贫血(renal anemia,RA)的临床疗效及对血清促红细胞生成素(erythropoietin,EPO)、肿瘤坏死因子(tumor necrosis factor,TNF)-α、白细胞介素-6(interleukin-6,IL-6)水平的影响,探讨其治疗RA的作用机制。方法:选择南京中医药大学附属淮安中医院肾病科2018年10月至2019年10月门诊和住院治疗的CKD-RA患者60例,随机分为治疗组和对照组,每组30例。对照组给予西医常规治疗,治疗组在对照组治疗的基础上给予益肾清利、和络泄浊方治疗。观察两组治疗前后中医证候积分、血红蛋白(haemoglobin,Hb)、血肌酐(serum creatinine,Scr)、血尿素氮(blood urea nitrogen,BUN)、血清EPO、TNF-α、IL-6、铁蛋白(ferritin,FER)、转铁蛋白(transferrin,TRF)等变化情况。结果:两组治疗后中医证候积分均低于治疗前,两组治疗前后差值比较,治疗组高于对照组,差异有统计学意义(P<0.05);两组治疗后Hb均较治疗前升高,且治疗组治疗前后差值高于对照组,差异有统计学意义(P<0.05),对照组治疗后EPO降低,治疗组治疗后EPO升高,治疗组治疗前后EPO差值高于对照组,差异有统计学意义(P<0.05);两组治疗后TNF-α、IL-6均低于治疗前,但差异无统计学意义(P>0.05),两组治疗前后差值比较,治疗组高于对照组,差异有统计学意义(P<0.05);两组治疗后FER均高于治疗前,但治疗组治疗后FER与治疗前比较,差异有统计学意义(P<0.05),两组治疗前后差值比较,治疗组高于对照组,差异有统计学意义(P<0.05);两组治疗后TRF均高于治疗前,但差异无统计学意义(P>0.05),两组治疗前后差值比较,治疗组低于对照组,差异有统计学意义(P<0.05);两组治疗前后BUN、Scr比较,差异无统计学意义(P>0.05)。结论:益肾清利、和络泄浊方能够改善肾性贫血,作用机制可能与该方可降低CKD-RA患者IL-6、TNF-α水平,减轻炎症状态,提高Hb有关。

Objective:To observe the clinical efficacy of Formula for Boosting the Kidney and Clearing the Lung and Soothing the Throat and Harmonizing Collaterals and Discharging Turbidity on renal anemia(RA)in chronic kidney disease(CKD)and its effects on serum erythropoietin(EPO)and tumor necrosis factor(TNF)-α,and interleukin-6(IL-6)level,and explore the mechanism of its treatment of RA.Methods:A total of 60 patients with CKD-RA were selected from the Department of Nephrology,Huai′an Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from October 2018 to October 2019,and were randomly divided into the treatment group and the control group,with 30 cases in each group.The control group was treated with routine Western medicine,while the treatment group was treated with Formula for Boosting the Kidney and Clearing the Lung and Soothing the Throat and Harmonizing Collaterals and Discharging Turbidity on the basis of the treatment of the control group.The changes of TCM syndrome scores,hemoglobin(Hb),serum creatinine(Scr),blood urea nitrogen(BUN),serum EPO and TNF-α,IL-6,ferritin(FER),transferrin(TRF),etc.before and after treatment were observed between the two groups.Results:The TCM syndrome scores of the two groups after treatment were lower than those before treatment.The difference value between the two groups before and after treatment was higher than that of the control group,and the difference was statistically significant(P<0.05).Hb in both groups increased after treatment,and the difference value before and after treatment in the treatment group was higher than that in the control group,and the difference was statistically significant(P<0.05).EPO in the control group decreased after treatment,while EPO in the treatment group increased after treatment,and the difference value before and after treatment in the treatment group was higher than that in the control group,and the difference was statistically significant(P<0.05).After treatment,TNF-αand IL-6 in both groups were lower than those before treatment,but the differences were not statistically significant(P>0.05).Compared with the difference value before and after treatment,the treatment group′s was higher than the control group′s,and the difference was statistically significant(P<0.05).The FER of the two groups after treatment was higher than that before treatment,but the difference value between the FER of the treatment group after treatment and that before treatment was statistically significant(P<0.05).Compared with the difference value between the two groups before and after treatment,the FER of the treatment group was higher than that of the control group,and the difference was statistically significant(P<0.05).The TRF of the two groups after treatment was higher than that before treatment,but the difference was not statistically significant(P>0.05).Compared with the difference value before and after treatment,the TRF of the treatment group was lower than that of the control group,and the difference was statistically significant(P<0.05).There were no significant differences in BUN and Scr between the two groups before and after treatment(P>0.05).Conclusion:Formula for Boosting the Kidney and Clearing the Lung and Soothing the Throat and Harmonizing Collaterals and Discharging Turbidity can improve renal anemia,and the mechanism may be related to the fact that this formula can reduce IL-6 and TNF-αin patients with CKD-RA level,reduce inflammatory state and improve Hb.