益气健脾消瘀方对慢性肾脏病患者PEW状态的改善作用

The improvement effect of Yi-Qi-Jian-Pi-Xiao-Yu formula on protein-energy wasting status in patients with chronic kideny disease

目的益气健脾消瘀方对气虚夹瘀型慢性肾脏病(CKD)3~5期患者血清胰岛素样生长因子1(IGF-1)水平及蛋白质-能量消耗状态(PEW)的影响,探讨IGF-1的改变对CKD患者PEW的影响及意义.方法选取2017年12月至2018年12月浙江省中医院收治的CKD患者60例,随机分成对照组和观察组各30例.对照组予西医基础治疗,观察组在西医基础治疗上加用益气健脾消瘀方,治疗12周.所有患者在治疗前、治疗第12周检测血肌酐(Scr)、尿素氮(BUN)、血清白蛋白(Alb)、血清前白蛋白(PAB)、血红蛋白(Hb)、IGF-1水平及体重指数(BMI)、上臂肌围(MAMC).分析对比治疗后两组上述指标的变化.采用线性回归分析IGF-1改变量与血Alb及PAB改变量的相关性.结果治疗后两组的中医证候积分比较,观察组低于对照组(P<0.05),Scr、BUN、BMI、MAMC、Alb、PAB、IGF-1的变化量,观察组较对照组的变化明显,且有统计学意义(P<0.01);治疗后的PAB改变量与IGF-1改变量呈正相关(P<0.01,B=1.184).结论益气健脾消瘀方能够改善CKD3~5期患者的PEW状态,这一作用可能通过增加IGF-1水平实现.

Objective To observe the impact of Yi-Qi-Jian-Pi-Xiao-Yu formula on serum insulin-like growth factor 1(IGF-1)and proteinenergy wasting(PEW)and to explore the effect of IGF-1 change on PEW in stage 3-5 chronic kidney disease(CKD)patients of qi deficiency and blood stasis.MethodsA total of 60 CKD patients admitted to Zhejiang Provincial Hospital of Traditional Chinese Medicine from December 2017 to December 2018 were divided randomly into the control(30 cases)and test group(30 cases).The control group was treated mainly with western medicine,while the test group with Yi-Qi-Jian-Pi-Xiao-Yu formula on basis of normal western medicine.Both groups were kept on treating for 12 weeks.Serum creatinine(Scr),blood urea nitrogen(BUN),albumin(Alb),prealbumin(PAB),hemoglobin(Hb),IGF-1,body mass index(BMI)and mid arm muscle circumference(MAMC)of all patients were measured before the Yi-Qi-Jian-Pi-Xiao-Yu formula therapy and 12 weeks after the therapy.The changes of the above indexes in the two groups after treatment were analyzed and compared.Correlations among indexes were analyzed by linear regression.Results After the treatment,the TCM symptom scores of the test group lower than that of the control group(P<0.05),the changes of Scr,BUN,BMI,MAMC,Alb PAB and IGF-1 in the experimental group were significantly higher than those in the control group,with statistical significance(P<0.01).After the treatment,the change of PAB was positively correlated with the change of IGF-1,with statistical significance(P<0.01,B=1.184).Conclusion Yi-Qi-Jian-Pi-Xiao-Yu formula can improve the PEW condition of CKD3-5 patients probably by increasing the level of IGF-1.