尿毒清颗粒结合血液透析对尿毒症肾功能、炎症指标改善作用研究

Improvement of Renal Function and Inflammation Indexes of Uremia Patients by Niaoduqing Granules(尿毒清颗粒)Combined with Hemodialysis

目的评价尿毒清颗粒结合血液透析对尿毒症患者肾功能、炎症指标的改善作用。方法选择2019年1月—2022年1月医院收治的136例尿毒症病人为试验对象,随机将其分成两组。所有患者入院后均给予低盐、低蛋白饮食,控制高血压,纠正贫血和营养不良等。对照组68例患者采用规律血液透析,选择费森4008S型血液透析机,枸橼酸盐透析液,透析血流量在260 mL/min,透析液流量500 mL/min,血液透析通道为颈内静脉,常规肝素抗凝,每周透析3次,每次4 h,连续治疗12周。治疗组68例采用尿毒清颗粒结合血液透析治疗,血液透析方法同对照组,口服尿毒清颗粒,连续治疗12周。比较两组治疗前后中医证候(神疲力乏、肢体沉重、气短懒言、腰膝酸软、脘腹胀满和肌肤甲错)积分变化,肾功能指标[血清尿素氮(Serum urea nitrogen,BUN)、血肌酐(Serum creatinine,SCr)、内生肌酐清除率(Endogenous creatinine clearance,CCr)和24 h尿蛋白定量]变化,炎症指标[转化生长因子-β(Transforming growth factor-β,TGF-β)、白细胞介素-6(interleukin-6,IL-6)和C反应蛋白(C-reactive protein,CRP)水平]变化,营养指标(血浆白蛋白、转铁蛋白和血红蛋白)变化。结果经过12周的治疗,治疗组中达到显效标准的有22例,占比32.35%,达到有效标准的有39例,占比57.35%,总有效人数为61例,占比89.70%。对照组中达到显效标准的有19例,占比27.94%,达到有效标准的有33例,占比48.53%,总有效人数为52例,占比76.47%。组间结果比较显示,治疗组治疗疗效优于对照组(P<0.05);相较于治疗前,治疗后两组病人神疲力乏、肢体沉重、气短懒言、腰膝酸软、脘腹胀满和肌肤甲错等证候积分下降,且治疗组病人的下降幅度较对照组高(P<0.05);相较于治疗前,治疗后两组病人肾功能方面的指标BUN、SCr和24 h尿蛋白定量水平下降,CCr的浓度水平相较于治疗前上升,且治疗组改变的幅度较对照组高(P<0.05);相较于治疗前,治疗后两组病人的CRP、TGF-β和IL-6浓度水平下降,且治疗组改变的幅度较对照组高(P<0.05);治疗组治疗后血浆白蛋白、转铁蛋白和血红蛋白较治疗前升高,且高于同期对照组(P<0.05),对照组治疗前后血浆白蛋白、转铁蛋白和血红蛋白水平比较差异无统计学意义(P>0.05)。结论尿毒清颗粒结合血液透析有助于改善尿毒病人的临床方面症状,降低其中医证候的积分,对残余的肾功能发挥保护功能,降低炎症反应,提高营养指标,其临床应用价值值得进一步研究探讨。

Objective To evaluate the effect of Niaoduqing Granules(尿毒清颗粒)combined with hemodialysis on renal function and inflammation in patients with uremia.Methods A total of 136 patients with uremia in the hospital from January 2019 to January 2022 which were selected as the research objects.All patients were random divided into two groups.Therefore,after admission,the patients were given a low-salt and low-protein diet to control hypertension and correct anemia and malnutrition.The control group(68 cases)was treated with regular hemodialysis,including Faisen 4008S hemodialysis machine,citrate hemodialysis fluid,hemodialysis blood flow of 260 mL/min,hemodialysis fluid flow of 500 mL/min.The hemodialysis was through the internal jugular vein,with routine heparin anticoagulation,3 times a week,4 h for each time.The continuous treatment lasted for 12 weeks.The treatment group(68 cases)used the stilbene capsule combined with Niaoduqing Granules.The hemodialysis method was the same as that of the control group.The treatment was continued for 12 weeks.The integral changes of traditional Chinese medicine syndromes(including fatigue,heavy limbs,shortness of breath and lazy speech,soreness of the waist and knees,fullness of the abdomen and abdomen,and skin nail errors),as well as changes in renal function indicators[serum urea nitrogen(BUN),serum creatinine(SCr),endogenous creatinine clearance(CCr),24-hour urine protein quantification],inflammatory indicators[transforming growth factor-β(TGF-β),changes in levels of interleukin-6(IL-6)and C-reactive protein(CRP)]as well as changes in nutritional indicators(plasma albumin,transferrin,hemoglobin)before and after treatment between the two groups were compared.Results After 12 weeks of treatment,there were 22 cases(32.35%)in the treatment group who met the obvious efficacy standard,and 39 cases(57.35%)who met the effective standard.The total number of effective cases was 61 cases(89.70%).In the control group,19 cases(27.94%)met the effective standard,while 33 cases(48.53%)met the effective standard.The total effective number was 52 cases(76.47%).The comparison of the results between two groups showed that the therapeutic effect of the treatment group was better than that of the control group(P<0.05).Compared to those before treatment,the scores of symptoms such as fatigue,heavy limbs,short breath and lazy speech,soreness in the waist and knees,fullness in the abdomen and abdomen,and skin nail errors in the two groups after treatment were decreased,and the decrease in the treatment group was higher than that in the control group(P<0.05).Compared to those before treatment,the renal function indicators[the levels of BUN,SCr and 24-hour urine protein quantitative]of the two groups were decreased after treatment,while the concentration level of CCr was increased compared to that before treatment.The degree of change in the treatment group was higher than that in the control group(P<0.05).Compared to those before treatment,the levels of CRP,TGF-βand IL-6 of the two groups after treatment were decreased,and the magnitude of changes in the treatment group was higher than that in the control group(P<0.05).After treatment,the levels of plasma albumin,transferrin and hemoglobin in the treatment group were increased compared to those before treatment,and the levels in the observation group were higher than those in the control group during the same period(P<0.05).There was no significant difference in plasma albumin,transferrin or hemoglobin before and after treatment in the control group(P>0.05).Conclusion Combined with hemodialysis,Niaoduqing Granules can help to improve the clinical symptoms of uremia patients,reduce the TCM syndrome score,protect residual renal function,reduce inflammatory response and improve nutritional indicators.Its clinical application value is worthy of further studying and discussing.