益肾健脾通腑方对维持性血液透析患者营养状态、微炎症与生活质量的影响

Effects of Yishen Jianpi Tongfu Formula on Nutritional Status,Micro-inflammation,and Quality of Life of Maintenance Hemodialysis Patients

目的探讨益肾健脾通腑方对维持性血液透析(Maintain hemodialysis,MHD)患者营养状态、微炎症及生存质量的影响。方法选取2019年1月—2021年9月期间北京中医医院怀柔医院透析室收治的100例MHD患者,采用随机数字表法分为对照组与治疗组,每组各50例。在常规西医与MHD治疗基础上,对照组给予左卡尼汀,治疗组给予益肾健脾通腑方+左卡尼汀治疗,两组患者均治疗12周。观察比较两组患者治疗前后中医证候积分、血清营养指标[前白蛋白(Prealbumin,PA)、人血白蛋白(Albumin,ALB)、血红蛋白(Hemoglobin,Hb)、转铁蛋白(Transferrin,TRF)]、微炎症指标[超敏-C反应蛋白(Hypersensitive-CRP,hs-CRP)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白细胞介素-6(Interleukin-6,IL-6)]、营养不良-炎症状态评分(Malnutrition inflammation score scale,MIS)、生活质量评分[肾脏及透析相关生存质量量表(Kidney Disease Targeted Areas,KDTA)与健康状况调查简表(Short From Health Survey 36,SF-36)]及不良反应情况。结果治疗后两组患者主症、次症、兼症积分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组主症、次症、兼症积分均较对照组降低,差异有统计学意义(P<0.05)。治疗后两组患者ALB、PA、TRF、Hb水平均较治疗前升高,差异有统计学意义(P<0.05);且治疗组ALB、PA、TRF、Hb水平均较对照组明显升高,差异有统计学意义(P<0.05)。治疗后两组患者hs-CRP、TNF-α、IL-6水平均较治疗前降低,差异有统计学意义(P<0.05);且治疗组hs-CRP、TNF-α、IL-6水平均较对照组降低,差异有统计学意义(P<0.05)。治疗后两组患者MIS评分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组MIS评分较对照组降低,差异有统计学意义(P<0.05)。治疗后两组患者KDTA、SF-36评分均较治疗前升高,差异有统计学意义(P<0.05);且治疗组KDTA、SF-36评分均较对照组明显升高,差异有统计学意义(P<0.05)。治疗期间,治疗组不良反应发生率10.0%与对照组8.16%比较,差异无统计学意义(P>0.05)。结论益肾健脾通腑方能够纠正MHD患者营养不良,减轻微炎症状态,且有利于改善其生存质量,疗效显著,安全性高。

Objective To explore the effects of Yishen Jianpi Tongfu Formula on nutritional status,micro-inflammation,and quality of life of maintenance hemodialysis(MHD)patients.Methods A total of 100 MHD patients admitted to the Dialysis Room of Huairou Hospital,Beijing Hospital of Traditional Chinese Medicine from January 2019 to September 2021 were enrolled and divided into a control group(n=50)and a treatment group(n=50)according to the random number table.On the basis of conventional western medicine and MHD therapy,the patients in the control group were given levocarnitine,while those in the treatment group were given Yishen Jianpi Tongfu Formula+levocarnitine.After 12 weeks of treatment,the traditional Chinese medicine(TCM)syndrome scores,serum nutritional indicators[prealbumin(PA),albumin(ALB),hemoglobin(Hb),and transferrin(TRF)],micro-inflammatory indicators[hypersensitive C-reaction protein(hs-CRP),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)],malnutrition inflammation score(MIS),quality of life[(Kidney Disease Targeted Areas(KDTA)and Short From Health Survey 36(SF-36)],and adverse reactions before and after treatment were compared between the two groups.Results After treatment,the scores of primary symptoms,secondary symptoms,and concurrent symptoms in the two groups were lower than those before treatment(P<0.05),and the treatment group was lower than the control group(P<0.05).After treatment,the levels of ALB,PA,TRF,and Hb in the two groups increased compared with those before treatment(P<0.05),and the treatment group was higher than the control group(P<0.05).After treatment,the levels of hs-CRP,TNF-α,and IL-6 in the two groups were lower than those before treatment(P<0.05),and the treatment group was lower than the control group(P<0.05).After treatment,the MISs of the two groups were lower than those before treatment(P<0.05),and the treatment group was lower than the control group(P<0.05).After treatment,the KDTA and SF-36 scores of the two groups increased compared with those before treatment(P<0.05),and the treatment group was higher than the control group(P<0.05).The incidence of adverse reactions was 10.0%in the treatment group and 8.16%in the control group,indicating no significant difference(P>0.05).Conclusion Yishen Jianpi Tongfu Formula can reduce malnutrition symptoms of MHD patients,reduce micro-inflammation,and improve quality of life,with significant curative efficacy and high safety.