基于补肾活血法的慢病管理模式对肾虚血瘀型慢性肾脏病3期患者的影响

Effects of chronic disease management pattern based on the method of tonifying kidney and promoting blood circulation in chronic kidney disease patients of stage 3 with kidney deficiency and blood stasis type

目的:观察基于补肾活血法的慢病管理模式对肾虚血瘀型慢性肾脏病(CKD)3期患者临床疗效及生活质量的影响。方法:采用前瞻性随机对照研究,将100例肾虚血瘀型CKD 3期患者随机分为对照组和观察组,每组50例。对照组予中西医基础治疗,观察组在对照组的基础上联合慢病管理项目,观察周期为24周。结果:与本组治疗前比较,两组治疗12、24周后的中医证候积分均显著降低(P<0.05);治疗24周时,观察组中医证候积分较同期对照组显著降低(P<0.01)。治疗12、24周后观察组患者血肌酐、尿素氮较治疗前显著降低(P<0.05,P<0.01),eGFR较治疗前显著增加(P<0.05,P<0.01),且显著优于同期对照组(P<0.05);治疗24周后,观察组患者24 h尿蛋白定量较治疗前显著降低(P<0.01),且显著低于同期对照组(P<0.05),白蛋白较治疗前显著增加(P<0.05),且显著高于同期对照组(P<0.05)。在生活质量方面,治疗12、24周后观察组患者各维度的评分均较治疗前显著升高(P<0.05,P<0.01),并在治疗24周后显著高于对照组(P<0.05,P<0.01)。结论:基于补肾活血法的慢病管理模式对肾虚血瘀型CKD3期患者具有良好的临床疗效,可改善患者的生活质量,安全可靠,临床值得推广。

Objective:To observe the effect of chronic disease management pattern based on the method of tonifying kidney and promoting blood circulation on the clinical efficacy and quality of life of CKD stage 3 patients with kidney deiciency and blood stasis type.Methods:A prospective,randomized,controlled study was conducted,100 patients with CKD stage 3 with‘kidney deficiency and blood stasis’were randomly divided into the observation group(50 cases)and the control group(50 cases).The control group was given basic Chinese and Western medicine treatment,and the observation group was combined with chronic disease management programs,with an observation period of 24 weeks.Results:Compared with the pre-treatment period of this group,the TCM evidence points of both groups were significantly lower after 12 and 24 weeks of treatment(P<0.05);at 24 weeks of treatment,the TCM evidence points of the observation group were significantly lower than those of the control group during the same period(P<0.01).The serum creatinine and urea nitrogen of patients in the observation group after 12 and 24 weeks of treatment were significantly lower than before treatment(P<0.05,P<0.01),and eGFR was significantly increased compared with the previous treatment(P<0.05,P<0.01),and significantly better than the control group in the same period(P<0.05);after 24 weeks of treatment,the 24-hour urine protein quantification of patients in the observation group was significantly lower than before treatment(P<0.01),and significantly lower than the control group in the same period(P<0.05).Albumin was significantly increased compared with the previous treatment(P<0.05),and significantly higher than the control group in the same period(P<0.05).In terms of life quality,the scores of all dimensions of patients in the observation group after 12 and 24 weeks of treatment were significantly higher than those before treatment(P<0.05,P<0.01)and were significantly higher than the control group at 24 weeks(P<0.05,P<0.01).Conclusion:The chronic disease management pattern based on‘tonifying kidney and promoting blood circulation’has good clinical efficacy for CKD stage 3 patients with kidney deiciency and blood stasis type,which can improve the quality of life of patients,and is safe and reliable,worthy of clinical promotion.