穴位温灸联合健脾益肾方治疗脾肾阳虚证维持性腹膜透析患者临床研究

Clinical Study on Warming Moxibustion at Points Combined with Jianpi Yishen Prescription for Patients with Spleen-Kidney Yang Deficiency Syndrome Undergoing Continuous Ambulatory Peritoneal Dialysis

目的:观察穴位温灸联合健脾益肾方对脾肾阳虚证维持性腹膜透析(CAPD)患者肾小球滤过率(eGFR)、残余肾功能(RRF)及微炎症状态的影响。方法:选取106例接受CAPD治疗的慢性肾脏病患者为研究对象,采用随机数字表法均分为2组各53例。2组均在CAPD基础上进行对症支持治疗,同时给予健脾益肾方口服,观察组另取中脘、神阙和关元3个穴位分别以艾条温灸30 min,疗程均为6个月。比较2组临床疗效,比较2组治疗前后中医证候积分、GFR、RRF及微炎症状态。结果:观察组治疗总有效率89.13%,高于对照组72.34%(P<0.05)。治疗前,2组畏寒肢冷、腰膝酸软、倦怠乏力、气短懒言、食少纳呆等中医证候积分比较,差异无统计学意义(P>0.05);治疗后,2组上述中医证候积分均降低(P<0.05),且观察组低于对照组(P<0.05)。治疗前,2组尿素清除率(Kt/V)、总肌酐清除率(TCCr)比较,差异无统计学意义(P>0.05);治疗后,对照组Kt/V、TCCr明显降低(P<0.05),观察组Kt/V、TCCr无明显变化(P>0.05),且观察组Kt/V、TCCr高于对照组(P<0.05)。治疗前,2组24 h尿量、eGFR、RRF比较,差异无统计学意义(P>0.05);治疗后,观察组24 h尿量、eGFR、RRF及对照组24 h尿量无明显变化(P>0.05),对照组eGFR、RRF降低(P<0.05),且观察组eGFR、RRF高于对照组(P<0.05)。治疗前,2组血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平比较,差异无统计学意义(P>0.05);治疗后,2组血清CRP、IL-6、TNF-α水平均降低(P<0.05),且观察组低于对照组(P<0.05)。结论:穴位温灸联合健脾益气方治疗脾肾阳虚证CAPD患者,可促进症状缓解并增强疗效,同时还有利于提升透析充分性,减轻肾功能损害并改善机体微炎症状态。

Objective:To observe the effect of warming moxibustion at points combined with Jianpi Yishen Prescription on glomerular filtration rate(eGFR),residual renal function(RRF)and microinflammation status in patients with spleen-kidney yang deficiency syndrome undergoing continuous ambulatory peritoneal dialysis(CAPD).Methods:A total of 106 cases of patients with chronic kidney disease undergoing CAPD were selected and divided into two groups according to the random number table method,with 53 cases in each group.Both groups were given symptomatic support treatment and oral administration of Jianpi Yishen Prescription based on CAPD,and the observation group was additionally treated with warming moxibustion for 30 minutes at three points,namely Zhongwan(RN 12),Shenque(RN 8),and Guanyuan(RN 4).Both groups were treated for six months.The clinical effects were compared between the two groups;traditional Chinese medicine(TCM)syndrome scores,GFR,RRF,and microinflammation status before and after treatment were compared between the two groups.Results:The total effective rate was 89.13%in the observation group,higher than that of 72.34%in the control group(P<0.05).Before treatment,there was no significant difference being found in the comparison of the scores of TCM syndromes including fear of cold and cold limbs,soreness and weakness in waist and knees,fatigue and lack of strength,shortage of qi and unwilling to talk,and torpid intake between the two groups(P>0.05).After treatment,the above TCM syndrome scores in the two groups were decreased(P<0.05),and the scores in the observation group were lower than those in the control group(P<0.05).Before treatment,there was no significant difference being found in the comparison of urea excretion ratio(Kt/V)and total creatinine clearance rate(TCCr)between the two groups(P>0.05).After treatment,Kt/V and TCCr in the control group were significantly decreased(P<0.05),and there was no significant change in Kt/V and TCCr in the observation group(P>0.05);Kt/V and TCCr in the observation group were higher than those in the control group(P<0.05).Before treatment,there was no significant difference being found in the comparison of 24-hour urine volume,eGFR and RRF between the two groups(P>0.05).After treatment,there was no significant change in 24-hour urine volume,eGFR,and RRF in the observation group and 24-hour urine volume in the control group(P>0.05),eGFR and RRF in the control group were decreased(P<0.05);after treatment,eGFR and RRF in the observation group were higher than those in the control group(P<0.05).Before treatment,there was no significant difference being found in the comparison of the levels of C-reactive protein(CRP),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)in serum between the two groups(P>0.05).After treatment,the levels of CRP,IL-6,and TNF-αin serum in the two groups were decreased(P<0.05),and the above levels in the observation group were lower than those in the control group(P<0.05).Conclusion:Jianpi Yishen Prescription combined with for CAPD patients with spleen-kidney yang deficiency syndrome can promote symptom relief,enhance curative effect,help to enhance dialysis adequacy,reduce kidney function damage,and improve microinflammation status of the body.