川黄方联合中医外治法治疗2~4期慢性肾脏病的临床研究

Efficacy of Chuanhuang decoction combined with external treatment of traditional Chinese medicine on chronic kidney disease at 2~4 stage

目的观察川黄方联合中医外治法治疗脾肾亏虚、毒瘀互结证慢性肾脏病(CKD)2~4期患者的临床疗效。方法选取2019年5月—2021年12月在上海中医药大学附属市中医医院治疗且辨证为脾肾亏虚、毒瘀互结证的CKD 2~4期患者120例,随机分为对照组、治疗1组和治疗2组,每组40例。对照组给予对症及西医常规药物(α-酮酸和包醛氧淀粉)治疗,治疗1组在对照组治疗基础上给予川黄方口服及中医外治法(穴位注射+中药灌肠)干预,治疗2组在治疗1组基础上加三伏贴治疗,3组疗程均为2周。比较3组治疗前后血尿素氮(BUN)、血肌酐(SCr)、尿酸(UA)、肾小球滤过率(eGFR)、中医症状积分及治疗2周后临床疗效。结果治疗2周后,3组BUN水平及治疗1组、治疗2组SCr、UA水平均明显降低(P均<0.05),治疗1组、治疗2组eGFR均明显升高(P均<0.05);3组治疗2周后BUN、SCr、UA、eGFR比较差异均无统计学意义(P均>0.05),但治疗1组、治疗2组SCr治疗前后差值均明显高于对照组(P均<0.05),治疗1组与治疗2组SCr治疗前后差值比较差异无统计学意义(P均>0.05)。治疗2周后,3组中医症状积分均明显降低(P均<0.05),且治疗1组、治疗2组均明显低于对照组(P均<0.05),治疗2组明显低于治疗1组(P<0.05),治疗1组、治疗2组总有效率明显高于对照组(P均<0.05),治疗1组与治疗2组总有效率比较差异均无统计学意义(P均>0.05)。结论川黄方联合中医外治法能有效改善脾肾亏虚、毒瘀互结证CKD 2~4期患者的肾功能,疗效优于西医常规治疗,且联合三伏贴治疗对改善中医证候更有优势。

Objective It is to observe the clinical efficacy of Chuanhuang decoction combined with external treatment of traditional Chinese medicine in the treatment of patients with chronic kidney disease(CKD)at 2~4 stages with syndrome of spleen-kidney deficiency and toxin-blood stasis blinding.Methods One hundred and twenty patients with CKD at 2~4 stages who were treated at Shanghai Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine from May 2019 to December 2021 and syndrome of spleen-kidney deficiency and toxin-blood stasis blinding were randomly divided into control group,treatment groupⅠand treatment groupⅡ,with 40 cases in each group.The control group was given symptomatic therapy and conventional western medicine(α-Ketone acid and aldehyde-coated oxystarch),the treatment groupⅠwas given Chuanhuang decoction orally and external treatment of traditional Chinese medicine(acupoint injection+traditional Chinese medicine enema)on the basis of the treatment of the control group,and the treatment groupⅡwas treated with three-fu plaster on the basis of the treatment of the treatment groupⅠ,and the course of treatment of the three groups was 2 weeks.The blood urea nitrogen(BUN),serum creatinine(SCr),uric acid(UA),glomerular filtration rate(eGFR),TCM symptom scores before and after treatment and clinical efficacy of the three groups were compared.Results After 2 weeks of treatment,the levels of BUN in the three groups and the levels of SCr and UA in the treatment groupⅠand treatment groupⅡwere significantly decreased(all P<0.05),while the eGFR in the treatment groupⅠand treatment groupⅡwas significantly increased(both P<0.05).There was no statistically significant difference in BUN,SCr,UA and eGFR among the three groups after 2 weeks of treatment(all P>0.05),but the difference in SCr before and after treatment in in the treatment groupⅠand treatment groupⅡwas significantly higher than that in the control group(both P<0.05),there was no significant difference in the the difference in SCr before and after treatment between the treatment groupⅠand treatment groupⅡ(P>0.05).After 2 weeks of treatment,the TCM symptom scores of the three groups were significantly decreased(all P<0.05),and the scores of the treatment groupⅠand treatment groupⅡwere significantly lower than that of the control group(both P<0.05),and the treatment groupⅡwas significantly lower than the treatment group I(P<0.05).The total effective rate of the treatment group I and treatment group II was significantly higher than that of the control group(both P<0.05),there was no significant difference between the treatment groupⅠand treatment groupⅡ(P>0.05).Conclusion Chuanhuang decoction combined with external treatment of traditional Chinese medicine can effectively improve the renal function of patients with CKD at 2~4 stage with syndrome of spleen-kidney deficiency and toxin-blood stasis blinding,its efficacy is better than that of the conventional treatment of western medicine,and the combination of three-fu therapy has more advantages in improving the syndrome of traditional Chinese medicine.