桃红四物汤合五苓散加减联合氢氯噻嗪治疗慢性肾衰竭血瘀水湿证的临床研究

Clinical Study of modified Taohong Siwu Decoction and Wuling Powder combined with hydrochlorothiazide in treating chronic renal failure with blood stasis and water damp syndrome

目的 探讨桃红四物汤合五苓散加减联合氢氯噻嗪治疗慢性肾衰竭(CRF)血瘀水湿证的临床疗效。方法 选择首都医科大学附属北京中医医院及北京市平谷区中医医院肾病科门诊2018年4月—2020年5月收治的CRF血瘀水湿证患者60例,按照随机数字表法分为观察组和对照组各30例。对照组给予常规治疗+口服氢氯噻嗪片,观察组在对照组基础上联合桃红四物汤合五苓散加减治疗,疗程2个月。所有受试者治疗前后进行中医证候积分、36项健康调查简表(SF-36)及急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)评分,并检测肾功能指标血清肌酐(Cr)、尿素氮(BUN)水平及24 h尿蛋白定量(24 h-UTP),以及血清炎症指标,包括白介素-6 (IL-6)、肿瘤坏死因子-α (TNF-α)、C反应蛋白(CRP)浓度,统计不良反应发生情况。结果 观察组总有效率为90.0%,对照组为60.0%,2组比较差异有统计学意义(P<0.01)。与治疗前比较,治疗后2组中医证候积分均降低(P<0.01),观察组低于对照组(P<0.01)。与治疗前比较,治疗后2组血清Cr、BUN、IL-6、TNF-α、CRP及24 h-UTP均降低(P<0.01),观察组指标低于对照组(P<0.01)。与治疗前比较,治疗后2组SF-36评分均升高(P<0.05),APACHEⅡ评分均降低(P<0.01);与对照组比较,治疗后观察组SF-36评分升高,APACHEⅡ评分降低(P<0.01)。2组不良反应均较少且轻微。结论 桃红四物汤合五苓散加减联合氢氯噻嗪治疗CRF血瘀水湿证能显著下调患者血清相关炎症因子的表达水平,改善肾功能,安全且有效。

Objective To explore the clinical effect of modified Taohong Siwu Decoction and Wuling Powder combined with hydrochlorothiazide on chronic renal failure(CRF) with blood stasis and water damp syndrome. Methods 60 CRF patients with blood stasis and water dampness syndrome received by Department of Nephrology of Beijing Hospital of Traditional Chinese Medicine Affiliated to the Capital Medical University and Beijing Pinggu District Hospital of Traditional Chinese Medicine from April 2018 to May 2020 were selected and divided into observation group(n=30) and control group(n=30). All patients were given the same routine treatment plus orally taking hydrochlorothiazide,and on the basis of treatment in observation group, the control group also combined modified Taohong Siwu Tang plus Wuling Powder treatment, with the treatment course of 2 months. Before and after treatment,TCM syndrome score, 36 Health Survey Synopsis(SF-36), acute physiological and chronic health condition score II(Apache II), renal function index including serum creatinine(CR), urea nitrogen(Bun) level and 24h-UTP,inflammatory index including serum interleukin-6(IL-6),tumor necrosis factor factor(TNF-α), c-reactive protein(CRP)concentration were measured. Results The total effective rate of the observation group was 90.00%(27/30), which was significantly higher than that of the control group(60.00%, 18/30)(P<0.01). Compared with that before treatment, TCM syndrome scores of both two groups were decreased after treatment(P<0.01), and the observation group was lower than the control group(P<0.01). The levels of CR, Bun, IL-6, TNF-α, CRP and 24h-UTP in the two groups after treatment were significantly lower than those before treatment(P<0.05), but the levels of above index in the observation group were significantly lower than those in the control Group(P<0.01). Compared with that of the control group,SF-36 scores were significantly increased(P<0.01) and Apache II scores were significantly decreased(P<0.01) in both groups after treatment, and SF-36 scores were significantly higher(P<0.01) and Apache II scores were significantly lower(P<0.01) in the observation group than in the control group. The side effects were few and mild in both groups. Conclusion Modified Taohong Siwu Decoction and Wuling Powder combined with hydrochlorothiazide can effectively and safely decrease the expression of serum inflammatory factors in CRF patients with blood stasis and dampness syndrome,and improve their renal function.