“益清方”高位结肠途径治疗尿酸性肾病的临床疗效观察

Clinical efficacy of"Yiqing Fang"high colon approach for uric acid nephropathy

目的 研究“益清方”通过高位结肠途径治疗尿酸性肾病的临床疗效及其对慢性炎症状态的影响。方法 选取2020年1月至2022年2月深圳市第二人民医院的尿酸性肾病患者70例,采用随机数字表法分为对照组、益清方试验组,每组35例。试验组男20例,女15例,年龄范围28~86岁,年龄(57.03±13.05)岁;对照组男27例,女8例,年龄范围29~79岁,年龄(55.31±12.13)岁。对照组在予以低嘌呤食物、碱化尿液(碳酸氢钠片)、降尿酸(别嘌呤醇或非布司他)、降压(除外血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂及利尿药物)、控制基础疾病等基础治疗上联合高位结肠灌洗生理盐水灌肠,试验组在上述基础治疗上联合高位结肠灌洗后予“益清方”高位保留灌肠。比较两组治疗前后血尿酸(uric acid,UA)、尿素氮(blood urea nitrogen,BUN)、血肌酐(serum creatinine,Scr)、胱抑素C(cystatin C,Cys C)、尿蛋白排泄率(urinary protein excretion rate,UAER)、24 h尿蛋白定量(24-hour urinary protein quantitation,24 h-UP)、疼痛视觉模拟量表(visual analog scale,VAS)评分、C反应蛋白(C-reactive protein,CRP)及临床总疗效的变化。结果 试验组:治疗前UA为(514.14±78.01)μmol/L,治疗后UA为(396.36±66.66)μmol/L;治疗前BUN为(6.12±2.43)mmol/L,治疗后BUN为(5.35±1.84)mmol/L。对照组:治疗前UA为(496.70±54.43)μmol/L,治疗后UA为(448.78±71.18)μmol/L;治疗前BUN为(5.54±1.79)mmol/L,治疗后BUN为(5.08±1.61)mmol/L;与治疗前比较,治疗后两组UA、BUN均较前下降(P<0.01,P<0.05),且治疗后试验组UA水平(396.36±66.66)μmol/L低于对照组的(448.78±71.18)μmol/L(P<0.05)。试验组治疗后CRP水平(2.82±1.56)mg/L较治疗前水平(3.90±2.72)mg/L下降(P<0.05);对照组治疗后CRP水平(4.82±5.98)mg/L与治疗前水平(4.37±2.53)mg/L比较,差异无统计学意义。试验组治疗前后UA差值(117.77±75.8)μmol/L显著高于对照组(47.92±48.17)μmol/L(P<0.01)。治疗后试验组UAER为(160.62±62.30)μg/min、对照组UAER为(202.75±75.29)μg/min,较试验组治疗前的(279.34±108.69)μg/min、对照组治疗前的(276.34±130.05)μg/min下降(P<0.05);治疗后24 h-UP试验组为(231.30±89.72)mg、对照组为(292.12±108.42)mg,较试验组治疗前的(402.26±156.52)mg、对照组治疗前的(397.94±187.26)mg下降(P<0.05);治疗后两组疼痛VAS评分,试验组为(1.74±1.36)、对照组为(2.97±1.96),较试验组治疗前(4.14±2.49)、对照组治疗前(4.71±2.47)下降(P<0.05),且治疗后试验组UAER、24h-UP、疼痛VAS评分低于对照组(P<0.05);试验组总有效率(88.6%)高于对照组(65.7%)(P<0.05)。结论 “益清方”高位结肠途径治疗尿酸性肾病疗效确切,能够缓解关节疼痛症状、改善机体慢性炎症状态。

Objective To explore the clinical efficacy of"Yiqing Recipe"for uric acid nephropathy(UAN)through high colonic route and examine its effect on chronic inflammatory state.Methods A total of 70 UAN patients were randomized into two groups of control and Yiqing recipe(n=35 each).In test group,there were 20 males and 15 females with an age of(57.03±13.05)(28-86)year;In control group,there were 27 males and 8 females with an age of(55.31±12.13)(29-79)year.Control group received a low-purine diet,alkalized urine(sodium bicarbonate tablets),reduced uric acid(allopuri-nol or febuxosta),and reduced blood pressure(except angiotensin converting enzyme inhibitor,ACEI),angiotensin II receptor antagonist(ARB)and diuretics,control of underlying diseases and other basic treatment plus high colon irrigation and saline enema.Test group received a high retention enema with"Yiqing Recipe"after basic treatment plus high colon lavage.The parameters of blood uric acid(UA),blood urea nitrogen(BUN),serum creatinine(Scr),cystatin C(Cys C),urinary protein excretion rate(UAER),24-hour urinary protein quantitation(24 h-UP),pain visual analog scale(VAS)score and C-re-active protein(CRP)were recorded.Results In test group,UA at pre-treatment and post-treatment was[(514.14±78.01)μmol/L vs(396.36±66.66)μmol/L]and BUN[(6.12±2.43)mmol/L vs(5.35±1.84)mmol/L].In control group,UA at pre-treatment and post-treatment was[(496.70±54.43)μmol/L vs(448.78±71.18)μmol/L]and BUN[(5.54±1.79)mmol/L vs(5.08±1.61)mmol/L].As compared with pre-treatment,UA and BUN decreased in both groups post-treatment(P<0.01,P<0.05).UA was lower in test group than that in control group[(396.36±66.66)μmol/L vs(448.78±71.18)μmol/L,P<0.05]and CRP[(2.82±1.56)mg/L vs(3.90±2.72)mg/L,P<0.05].In control group,CRP showed no obvi-ous change[(4.82±5.98)mg/L vs(4.37±2.53)mg/L]and UA was significantly higher in test group than that in control group[(117.77±75.8)μmol/L vs(47.92±48.17)μmol/L,P<0.01].As compared with pre-treatment,UAER rose[(160.62±62.30)μg/min vs(202.75±75.29)μg/min;(279.34±108.69)μg/min vs(276.34±130.05)μg/min,P<0.05];24 h-UP declined[(231.30±89.72)mg vs(292.12±108.42)mg;(402.26±156.52)mg vs(397.94±187.26)mg](P<0.05);pain VAS scores dropped[(1.74±1.36)vs(2.97±1.96);(4.14±2.49)vs(4.71±2.47),P<0.05].And the values of UAER,24 h-UP and pain VAS were lower in test group than those in control group post-treatment(P<0.05).Ove-rall effective rate was higher in test group than that in control group(88.6%vs 65.7%,P<0.05).Conclusion"Yiqing Recipe"high colonic approach offers a definite cure for UAN.It may relieve the symptoms of joint pain and improve chronic inflammatory state of body.