川黄方治疗3~4期CKD患者的临床疗效及对尿IL-18、γ-GT的影响

Clinical efficacy of Chuanhuang Formula in treating patients with chronic kidney disease at stages 3-4 and its influence on urinary IL-18 and γ-GT

目的:观察川黄方治疗3~4期慢性肾脏病(CKD)患者的临床疗效,并探讨其对患者尿液中白介素-18(IL-18)、γ-谷氨酰转移酶(γ-GT)水平的影响。方法:将符合标准的70例3~4期CKD患者按照1∶1比例随机分为治疗组和对照组,每组各35例。对照组患者给予西医常规药物治疗,治疗组患者在对照组治疗基础上联合川黄方口服,疗程为12周。评估两组患者的临床疗效;治疗前后评价并比较两组患者的中医证候总积分;检测所有患者的肾功能指标[包括血清肌酐(Scr)、尿素氮(BUN)、尿酸(UA)、估算肾小球滤过率(eGFR)]、急性肾损伤(AKI)标志物(包括尿IL-18、 γ-GT)水平及24 h尿蛋白定量(24 h U-Pro)。结果:①治疗后,治疗组患者的临床总有效率为68.6%,对照组为42.9%,治疗组的疗效优于对照组(P<0.01)。②治疗后,两组患者的中医证候总积分较治疗前均显著降低(P<0.01),且治疗组患者的积分低于对照组(P<0.05)。③治疗后,两组患者的eGFR水平较治疗前升高(P<0.01),Scr、BUN水平较治疗前降低(P?0.01),且治疗组患者的eGFR水平高于对照组(P<0.05),Scr、BUN水平低于对照组(P<0.05)。④治疗后,治疗组患者的24 h U-Pro水平较治疗前明显降低(P<0.01),且低于对照组(P<0.05);而对照组患者的24 h U-Pro水平治疗前后比较差异无统计学意义(P>0.05)。⑤治疗后,治疗组患者的尿IL-18、γ-GT水平较治疗前均降低(P<0.01),对照组患者的尿IL-18水平较治疗前亦降低(P<0.01),且治疗组患者的尿IL-18、γ-GT水平低于对照组(P<0.05)。结论:与单纯西医常规治疗比较,川黄方结合西医常规治疗能更好地保护3~4期CKD患者的肾功能,促进肾功能恢复,改善患者的中医证候,并能降低患者的尿IL-18、γ-GT水平。

Objective:To observe the clinical efficacy of Chuanhuang Formula in treating patients with chronic kidney disease(CKD)at stages 3-4,and explore its influence on the levels of urinary interleukin-18(IL-18)and-glutamyl transferase(γ-GT).Methods:A total of 70 patients with CKD at stages 3-4 who met the criteria were randomly divided into the treatment group and control group according to 1:1 ratio,35 cases in each group.The patients in the control group were treated with conventional western medicine.The patients in the treatment group were treated with Chuanhuang Formula orally based on the treatment of the control group.The treatment course was 12 wecks.The clinical efficacy of the two groups was evaluated.The total scores of Chinese medical syndrome in the two groups were evaluated and compared before and after treatment.The levels of renal function indexes[including serum creatinine(Scr),blood urea nitrogen(BUN),uric acid(UA)and estimated glomerular filtration rate(eGFR)],acute kidney injury(AKI)markers(including urinary IL-18 and γ-CT)and 24-hour urinary protein quantification(24 h U-Pro)were detected.Results:①After treatment,the total clinical effective rate was 68.5%in the treatment group and 42.8%in the control group,and the effect of the treatment group was better than that of the control group(P<0.01).②After treatment,the total scores of Chinese medical syndrome in the two groups were significantly decreased compared with those before treatment(P<0.01),and the score of the treatment group was lower than that of the control group(P<0.05).③After treatment,thelevel ofeCFR in the twogroups was increased compared with that beforetreatment(P<0.01),thelevels of Scr and BUN were decreased compared with those before treatment(P<0.01),and the level of eGFR in the treatment group was higher than that in the control group(P<0.05),the levels of Scr and BUN were lower than those in the control group(P<0.05).④After treatment,the level of 24h U-Pro in the treatment group was significantly decreased compared with that before treatment(P<0.01),and was lower than that in the control group(P<0.05),while there was no statistically significant difference on the level of 24h U-Pro in the control group between before and after treatment(P>0.05).⑤After treatment,the levels of urinary IL-18 and γ-GT in the treatment group were decreased compared with those before treatment(P<0.01),thelevel of urinary IL-18 in the control group was also decreased compared with that before treatment(P<0.01),and the levels of urinary IL-18 and γ-CT in the treatment group were lower than those in the control group(P<0.05).Conclusion:Compared with conventional western medicine only,Chuanhuang Formula combined with conventional western medicine could better protect therenal function,promote the recoveryof therenal function,improve the Chinese medical syndrome,and reduce the levelsof urinary IL-18and γ-GT in patients with CKDat stages 3-4.