温肾化痰方对高血压肾损害CKD2-4期患者肾功能影响的临床观察

Clinical Observation on Effects of Wenshen Huatan Recipe(温肾化痰方)on Renal Function in Patients with CKD2-4 stage of Hypertensive Nephropathy

目的在高血压肾损害的常规治疗基础上加用温肾化痰方,为其减轻高血压患者肾损害提供客观依据。方法选取2017年1月—2018年6月上海岳阳医院肾内科、心内科门诊及住院高血压肾损害患者60例,中医辨证符合肾虚固摄无权,瘀血湿浊阻滞,随机分成两组,每组各30例,均给予低蛋白饮食、控制血压等常规治疗。治疗组在常规治疗基础上加用温肾化痰方,每日两次,疗程3个月;对照组予常规治疗,疗程3个月。观察两组患者治疗前后肾功能[(Scr)、内生肌酐清除率(CCr)、肾小球滤过率(eGFR)]、尿微量白蛋白(UMA),尿β-N-乙酰氨基葡萄糖苷酶(UNAG)、尿β2微球蛋白(β-MG)、血脂、总有效率、中医证候积分变化、终点事件(血透、腹透、肾移植、死亡)及不良反应。结果治疗组治疗3个月的总有效率为80%(24/30),优于对照组73%(22/30 P<0.01)。治疗组中医证候积分下降明显,两组比较差异有统计学意义(P<0.05)。治疗组在升高eGFR、CCr、降低Scr、UMA、TG、TC方面均优于对照组(P<0.05)。结论温肾化痰方能改善高血压肾损害患者肾脏功能,并改善脂质代谢。

Objective To study the clinical effect of Wenshen Huatan Recipe(温肾化痰方,WHR)in randomized treatment of hypertensive nephropathy.To provide objective basis of WHR reducing renal damage of patients with hypertension.Methods Sixty outpatients and inpatients with hypertensive nephropathy of kidney Yang deficiency and phlegm-damp stagnation syndrome,ad⁃mitted to the department of Nephrology and Cardiology of Yueyang Hospital from January in 2017 to June in 2018,were recruited and randomly assigned to the treatment group(30 cases)and the control group(30 cases).All patients received conventional and symptomatic treatment,including low protein diet,blood pressure control and so on.In addition,patients in the treatment group re⁃ceived WHR twice a day,while those in the control group received conventional treatment.The observation was lasted for three months.The renal functions[including serumcreatinine(Scr),creatinine clearance(CCr),estimated glomerular filtration rate(eG⁃FR)],urinary albumin(UMA),urinary N-acetyl-β-glucosaminidase(UNAG),urineβ2-microglobulin(β2-MG),blood lipids,the total efficacy,the traditional Chinese medicine syndrome integral and endpoint events(including hemodialysis,perito⁃neal dialysis,kidney transplantation,death)as well as adverse reactions were observed before and after treatment.Result After three months of treatment,the total effective rate in the treatment group was 80%(24/30),which was higher than that in the con⁃trol group[73%(22/30),P<0.01].The traditional Chinese medicine symptoms in the treatment group were obviously im⁃proved,showing statistical difference between the two groups(P<0.05).Better effects in increasing eGFR,CCr and lowering Scr,UMA,triglyceride(TG)and total cholesterol(TC)were obtained in the treatment group(P<0.05).Conlusions WHR could im⁃prove the renal function and the lipid metabolism of patients with hypertensive nephropathy.