通腑降浊法对慢性肾衰竭患者消化道症状及血清微炎症指标水平影响

Effect of Tongfu Jiangzhuo Method on Gastrointestinal Symptoms and Levels of Serum Microinflammatory Indexes in Patients with Chronic Renal Failure

目的探讨通腑降浊法对慢性肾衰竭(CRF)患者消化道症状及血清微炎症指标水平的影响。方法随机将120例CRF伴有消化道症状(恶心欲呕、腹胀、便秘等)患者分为对照组和观察组,每组60例。对照组给予甲氧氯普胺片、双耳耳部刮痧及双耳耳穴压豆联合治疗,观察组在对照组基础上加予通腑降浊方中药直肠滴入治疗,比较两组治疗前及治疗2、3周后的消化道症状评分[胃肠道症状分级评分量表(GSRS)中恶心欲呕、腹胀、便秘3种消化道症状评分]及胃肠激素[胃动素(MOT)、生长抑素(SS)、血管活性肠肽(VIP)]、肾功能[尿素氮(BUN)、血清肌酐(Scr)、内生肌酐清除率(Ccr)]、血清微炎症指标[超敏C-反应蛋白(hs-CRP)、白细胞介素6(IL-6)]水平。结果治疗2、3周后,两组GSRS量表中关于恶心呕吐、腹胀及便秘共3项消化道症状评分较治疗前均显著性下降(P<0.05),两组组间效应、时间效应及组间与时间效应对比,差异均有统计学意义(P<0.05),其中组内两两时间点对比,差异均有统计学意义(P<0.05)。治疗2、3周后,两组血清MOT水平较治疗前有显著性下降,两组组间效应、时间效应及组间与时间效应对比,差异均有统计学意义(P<0.05),其中组内两两时间点对比,差异均有统计学意义(P<0.05);两组血清SS及VIP水平组间效应、时间效应及组间与时间效应对比,差异无统计学意义(P>0.05)。治疗2、3周后,对照组血清BUN、Scr、Ccr水平与治疗前比较差异无统计学意义(P>0.05);观察组血清BUN、Scr水平较治疗前有显著性降低(P<0.05),血清Ccr水平较治疗前有显著性提升(P<0.05),其中组内两两时间点对比,差异均有统计学意义(P<0.05)。治疗2、3周后,两组血清hs-CRP、IL-6水平较治疗前有显著性下降(P<0.05),两组组间效应、时间效应及组间与时间效应对比,差异均有统计学意义(P<0.05),其中组内两两时间点对比,差异均有统计学意义(P<0.05)。结论通腑降浊法能有效改善CRF患者的消化道症状,纠正胃肠激素水平紊乱,并有效改善肾功能,消除机体微炎症状态。

Objective To investigate the effect of Tongfu Jiangzhuo method on gastrointestinal symptoms levels of and serum microinflammatory indexes in patients with chronic renal failure(CRF).Methods A total of 120 CRF patients with gastrointestinal symptoms(nausea and vomiting,abdominal distension,constipation,etc.)were randomly divided into control group and observation group,with 60 cases in each group.Control group was given combined treatment of metoclopramide tablets,double ear scraping and double ear auricular pressing beans,and observation group was additionally given Tongfu Jiangzhuo Decoction(通腑降浊方)Chinese medicine for rectal instillation on the basis of control group.The gastrointestinal symptoms scores[three scores of nausea and vomiting,abdominal distension and constipation of gastrointestinal symptom rating scale(GSRS)],gastrointestinal hormones[motilin(MOT),somatostatin(SS),vasoactive intestinal peptide(VIP)],renal function[blood urea nitrogen(BUN),serum creatinine(Scr),endogenous creatinine clearance rate(Ccr)]and serum microinflammatory indexes[high-sensitivity C-reactive protein(hs-CRP),interleukin 6(IL-6)]were compared between the two groups before treatment and after 2 weeks and 3 weeks of treatment.Results After 2 weeks and 3 weeks of treatment,the scores of three gastrointestinal symptoms of nausea and vomiting,abdominal distension and constipation of GSRS scale in the two groups were significantly decreased compared with those before treatment(P<0.05).There were statistically significant differences in between-group effect,time effect and interaction effect of between-group and time between the two groups(P<0.05),and there were statistically significant differences in pairwise time point comparison between the two groups(P<0.05).The level of serum MOT in the two groups after 2 weeks and 3 weeks of treatment was significantly reduced compared to before treatment,and there was a statistically significant difference in between-group effect,time effect and interaction effect of between-group and time between the two groups(P<0.05),and there was a statistically significant difference in pairwise time point comparison between the two groups(P<0.05).There were statistically significant differences in levels of serum SS and VIP from the aspects of between-group effect,time effect and interaction effect of between-group and time between the two groups(P<0.05).After 2 weeks and 3 weeks of treatment,serum BUN,Scr and Ccr levels in control group had no significant changes compared with those before treatment(P>0.05),and the levels of serum BUN and Scr in observation group were significantly decreased compared with those before treatment(P<0.05)while the level of serum Ccr was significantly increased compared to before treatment(P<0.05),and there was a statistically significant difference in pairwise time point comparison between the two groups(P<0.05).The levels of serum hs-CRP and IL-6 after 2 weeks and 3 weeks of treatment in both groups were significantly lower than those before treatment(P<0.05),and there were statistically significant differences in the between-group effect,time effect and interaction effect of between-group and time between the two groups(P<0.05),and there were statistically significant differences in pairwise time point comparison between the two groups(P<0.05).Conclusion Tongfu Jiangzhuo method can effectively improve the gastrointestinal symptoms of patients with CRF,correct the disorder of gastrointestinal hormones,effectively improve the renal function and eliminate the microinflammatory status of the body.