热敏灸联合益气化瘀解毒方对CKD 3~4期伴动脉粥样硬化患者影响的临床研究

Clinical Study on the Influence of Heat-Sensitive Moxibustion Combined Yiqihuayujiedu Prescription on CKD Stage 3~4 Patients with Atherosclerosis

目的:观察热敏灸联合益气化瘀解毒方对慢性肾脏病(CKD)3~4期伴动脉粥样硬化患者影响的临床疗效。方法:选取2021年10月至2022年10月江西省中西医结合医院肾内科收治的CKD 3~4期合并动脉粥样硬化患者(辨证属脾肾气虚、湿浊瘀阻型)70例为研究对象,按照拆信封方式分为对照组与治疗组,各35例。两组均给予基础治疗,对照组在此基础上给予尿毒清口服,治疗组在基础治疗上加用热敏灸联合益气化瘀解毒方治疗。观察并比较两组临床疗效、中医证候积分、肾功能指标、血脂指标、动脉僵硬度指标。结果:治疗组治疗总有效率为81.25%,高于对照组的54.84%(P<0.05);治疗后,治疗组中医证候积分均低于对照组(P<0.05);治疗后,治疗组肾功能指标均优于对照组,差异有统计学意义(P<0.05);治疗后,治疗组总胆固醇(TC)、甘油三酯(TG)、血浆致动脉硬化指数(AIP)水平低于对照组,高密度脂蛋白胆固醇(HDL-C)水平高于对照组,差异有统计学意义(P<0.05);治疗后,治疗组颈动脉内膜中层厚度(IMT)、颈-股动脉脉搏波传导速度(cf-PWV)均低于对照组,差异有统计学意义(P<0.05)。结论:热敏灸联合益气化瘀解毒方干预CKD 3~4期合并动脉粥样硬化可延缓CKD进程,改善中医证候,并且能够调节脂质代谢,改善血管硬化程度,减轻动脉粥样硬化,降低心血管事件发生风险。

Objective:To obser ve the clinical effect of heat-sensitive moxibustion combined Yiqihuayujiedu prescription on chronic kidney disease(CKD)stage 3~4 patients with atherosclerosis.Methods:Seventy patients with CKD stage 3~4 complicated with atherosclerosis(syndrome differentiation of spleen-kidney qi deficiency,dampness-turbidity and stasis)admitted to the renal department of Jiangxi provincial hospital of integrated traditional chinese and western medicine from October 2021 to October 2022 were selected as the study objects.They were divided into control group and treatment group according to the way of envelope opening,35 cases in each group.Both groups were given basic treatment,and the control group was given oral uridoxin on this basis.In the treatment group,heat-sensitive moxibustion combined with Yiqihuayujiedu prescription was added to the basic treatment.The clinical efficacy,TCM syndrome score,renal function index,lipid index and arterial stiffness index of the two groups were observed and compared.Results:The total effective rate of treatment group was 81.25%,which was higher than that of control group 54.84%(P<0.05).After treatment,TCM syndrome scores in the treatment group were lower than those in the control group(P<0.05).After treatment,renal function indexes[serum creatinine(SCr),glomerular filtration rate(eGFR),urea nitrogen(BUN)]in the treatment group were better than those in the control group,the difference was statistically significant(P<0.05).After treatment,the levels of total cholesterol(TC),triglyceride(TG)and plasma arteriosclerosis index(AIP)in the treatment group were lower than those in the control group,the level of high density lipoprotein cholesterol(HDL-C)was higher than that of control group,and the difference was statistically significant(P<0.05).After treatment,the carotid intima-media thickness(IMT)and cervical-femoral pulse wave velocity(cf-PWV)detected by color ultrasound in the treatment group were lower than those in the control group,and the difference was statistically significant(P<0.05).Conclusion:Heat sensitive moxibustion combined with Yiqihuayujiedu prescription can delay the progression of CKD stage 3~4 complicated with atherosclerosis.It can improve TCM syndromes,regulate lipid metabolism,improve the degree of vascular sclerosis,reduce atherosclerosis,and reduce the risk of cardiovascular events.