加味参芪化浊饮联合高通量血液透析治疗慢性肾功能衰竭患者的临床疗效及对其氧化应激炎症反应的影响

Effect of Jiawei Shenqi Huazhuo Decoction Combined with High-Flux Hemodialysis on Oxidative Stress and Inflammatory Response in Patients with Chronic Renal Failure

目的 探究加味参芪化浊饮联合高通量血液透析(High-flux hemodialysis,HFHD)对慢性肾功能衰竭患者氧化应激、炎症反应的影响。方法 选取2022年4月—2023年4月期间广州中医药大学附属宝安中医院收治的慢性肾功能衰竭患者94例,按照随机数字表法分为HFHD组和联合组,每组各47例。HFHD组患者使用HFHD治疗,联合组使用加味参芪化浊饮联合HFHD治疗,连用4周。观察比较两组患者临床疗效,治疗前后中医证候评分、肾功能[尿素氮(Blood Urea Nitrogen BUN)、血肌酐(Serum creatinine Scr)]、肾血流动力学、免疫功能[CD4^(+)、CD3^(+)]、氧化应激[TAOC、AOPP]、炎症反应[超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)]水平。结果 治疗后两组患者中医证候评分均较治疗前降低,差异有统计学意义(P<0.05);且联合组中医证候评分明显低于HFHD组,差异有统计学意义(P<0.05)。治疗后两组患者肾功能指标BUN、SCr水平均较治疗前降低,差异有统计学意义(P<0.05);且联合组肾功能指标BUN、SCr水平均明显低于HFHD组,差异有统计学意义(P<0.05)。治疗后两组患者肾动脉内径、肾血流量均较治疗前升高,差异有统计学意义(P<0.05);且联合组肾动脉内径、肾血流量均明显高于HFHD组,差异有统计学意义(P<0.05)。治疗后两组患者CD4^(+)、CD3^(+)水平均较治疗前升高,差异有统计学意义(P<0.05);且联合组CD4^(+)、CD3^(+)水平均明显高于HFHD组,差异有统计学意义(P<0.05)。治疗后两组患者TAOC、AOPP、hs-CRP、TNF-α水平均较治疗前降低,差异有统计学意义(P<0.05);且联合组TAOC、AOPP、hs-CRP、TNF-α水平均明显低于HFHD组,差异有统计学意义(P<0.05)。治疗后联合组临床总有效率93.62%(44/47)明显高于HFHD组78.72%(37/47),差异有统计学意义(P<0.05)。结论 使用加味参芪化浊饮联合HFHD对慢性肾功能衰竭患者进行治疗,能够减轻患者中医证候严重程度,改善患者肾功能、肾血流动力学、免疫功能,减轻患者氧化应激损伤、炎症反应严重程度,治疗效果显著。

Objective To explore the effect of Jiawei Shenqi Huazhuo Decoction combined with high-flux hemodialysis(HFHD)on oxidative stress and inflammatory response in patients with chronic kidney failure.Methods A total of 94 patients with chronic renal failure admitted to our hospital from April 2022 to April 2023 were selected and randomly divided into two groups:the HFHD group and the combination group,with 47 patients in each group.The HFHD group was treated with HFHD,while the combination group was treated with Jiawei Shenqi Huazhuo Decoction combined with HFHD.Both groups were treated for 4 consecutive weeks.Clinical efficacy was observed and compared between the two groups,including pre-and post-treatment traditional Chinese medicine(TCM)syndrome scores,renal function[blood urea nitrogen(BUN),and serum creatinine(Scr)],renal hemodynamics,immune function [CD4^(+),CD3^(+)],oxidative stress [total antioxidant capacity(TAOC),and advanced oxidation protein products(AOPP)],and inflammatory response [hypersensitive C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α)] levels.Results After treatment,the TCM syndrome scores of both groups decreased compared to before treatment,with statistical significance(P<0.05),and the combination group had significantly lower TCM syndrome scores than the HFHD group(P<0.05).The renal function indicators BUN and SCr levels of both groups remarkably decreased after treatment compared to before treatment(P<0.05),and the BUN and SCr levels of the combination group were significantly lower than those of the HFHD group(P<0.05).The renal artery diameter and renal blood flow of both groups increased after treatment compared to before treatment,with statistical significance(P<0.05);the renal artery diameter and renal blood flow of the combination group were significantly higher than those of the HFHD group(P<0.05).The CD4^(+) and CD3^(+) levels of both groups significantly increased after treatment compared to before treatment(P<0.05);the CD4^(+) and CD3^(+) levels of the combination group were significantly higher than those of the HFHD group(P<0.05).The TAOC,AOPP,hs-CRP,and TNF-α levels of both groups significantly decreased after treatment compared to before treatment(P<0.05);moreover,the levels of these indicators of the combination group were significantly lower than those of the HFHD group(P<0.05).The overall clinical effective rate of the combination group after treatment was 93.62%(44/47),substantially higher than that of the HFHD group at 78.72%(37/47),with statistical significance(P<0.05).Conclusion Using a combination of Jiawei Shenqi Huazhuo Decoction and HFHD for the treatment of chronic renal failure patients can reduce the severity of TCM syndromes,improve renal function,renal hemodynamics,and immune function,alleviate oxidative stress damage and inflammation,and achieve significant therapeutic effect.