川黄方对3~4期CKD患者临床疗效及对尿L-FABP、CHI3L1影响

Clinical Efficacy of Chuan Huang Recipe on Patients with Stage 3~4 CKD and its Effect on Urinary L-FABP and CHI3L1

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,及对急性肾损伤(AKI)标志物尿L-FABP、CHI3L1的影响。方法:将3~4期CKD患者92例,按照1∶1的比例随机分到治疗组或对照组,即每组46例。对照组给予内科基础治疗;治疗组在对照组基础上加服川黄方。疗程为12周。进行临床疗效评价,并观察中医证候积分变化。检测治疗前后肾功能(Scr、BUN、UA、eGFR),24 h U-pro,尿L-FABP、尿CHI3L1变化。结果:(1)治疗组总有效率为73.9%,对照组43.5%,治疗组高于对照组(P<0.05)。(2)用药后,两组患者肾Scr、BUN、UA均有一定程度的降低,eGFR均有一定程度的升高,肾功能得到了改善。治疗组更明显(P<0.01)。两组患者UA差异无统计学意义(P>0.05)。(3)治疗后两组患者24 h U-pro均有降低,治疗组更显著(P<0.01)。(4)两组患者尿L-FABP、CHI3L1治疗前后比较,差异均有统计学意义(P<0.01)。治疗组降低更明显。(5)治疗后,两组患者中医证候积分均显著降低(P<0.01),说明两种治疗方法均有利于改善患者临床症状。结论:川黄方联合内科基础治疗的临床疗效优于单纯内科基础治疗,能更好地促进3~4期CKD患者肾功能恢复、延缓CKD进展,并能显著降低患者尿L-FABP和尿CHI3L1。

Objective:To observe the clinical efficacy of Chuanhuang recipe in treating chronic kidney disease(stages 3~4)patients,and the effects on biomarkers of acute kidney injury(urinary liver fatty acid binding protein(L-FABP)and chitinase 3-like protein 1(CHI3L1)).Methods:92 patients with CKD(stages 3~4)were randomly divided into treatment group and control group,with 46 patients in each group.The control group was treated with basic medical treatment.Besides,the treatment group was additionally given Chuanhuang recipe based on control group.The duration of treatment lasted 12 weeks.We evaluated the clinical efficacy and observed the change of TCM syndrome score.Changes of serum creatinine(Scr),urea nitrogen(BUN),uric acid(UA),estimated glomerular filtration rate(eGFR),24-hour urinary protein quantification(24 h U-pro),urine L-FABP and urine CHI3L1 were detected before and after treatment.Results:(1)The total effective rate of the treatment group was 73.9%,which was better than 43.5%in the control group(P<0.05).(2)After medication,Scr,BUN,and UA in both groups were decreased,and renal function was improved,especially in the treatment group(P&lt;0.01)There was no significant difference in UA between the two groups(P>0.05).(3)24 h U-Pro in the treatment group was significantly lower than that before treatment(P<0.01),while no significant decrease in control group(P>0.05);Comparing two groups,24 h U-Pro decreased more significantly in the treatment group(P<0.01).(4)After treatment,urinary L-FABP and CHI3L1 decreased in both groups(P<0.01);After treatment,the decrease was more significant in the treatment group(P<0.01).(5)After treatment,TCM syndrome scores of patients in both groups were significantly decreased(P<0.01).Conclusion:Compared with basic medical treatment alone,the clinical efficacy of Chuanhuang recipe combining basic medical treatment is better.It could better promote the recovery of renal function in patients with CKD(stages 3~4),delay the progress of CKD,and significantly reduce urinary L-FABP and urinary CHI3L1.