益气祛风汤联合针灸治疗慢性肾脏病2-3期脾肾气虚型蛋白尿患者的临床观察

Clinical Efficacy of Yiqi Qufeng Decoction Combined with Acupuncture and Moxibustion on Proteinuria with Spleen-Kidney Qi Deficiency Syndrome in Stages 2-3 Chronic Kidney Disease

目的 观察针刺联合中药治疗脾肾气虚型慢性肾脏病(Chronic kidneydisease,CKD)2-3期蛋白尿的临床疗效。方法 选取2021年10月—2023年2月期间上海中医药大学附属上海市中西医结合医院肾病科收治的脾肾气虚型CKD2-3期蛋白尿患者90例,按随机数字表法分为治疗组和对照组,每组各45例。两组患者均给予基础治疗,对照组在基础治疗上给予氯沙坦钾片100 mg/d治疗,治疗组在对照组基础上给予益气祛风汤联合针灸治疗。治疗3个月后,观察比较两组患者临床疗效、中医证候疗效及安全性,治疗前后中医证候积分、尿蛋白[24 h尿蛋白定量(24 hours urine total protein,24 h UTP)、尿微量白蛋白(Microalbunminuria,MAU)、尿α1微球蛋白(Urine α 1-Microglobulin,Uα1-MG)、尿β2微球蛋白(Urinary β2-microglobulin,Uβ2-MG)]、肾功能[血肌酐(Serum creatinine,Scr)、尿素氮(Blood urea nitrogen,BUN)、肾小球滤过率(Estimated glomerular filtration rate,eGFR)、胱抑素-C(Cystatin-C,Cys-C)]、甲状旁腺激素(Parathyroid hormone,PTH)、微炎症因子[超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)]水平。结果 治疗后治疗组中医临床证候疗效总有效率78.05%(32/41)明显高于对照组70.00%(28/40),差异有统计学意义(P<0.05)。治疗后治疗组临床总有效率80.49%(33/41)明显高于对照组72.00%(29/40),差异有统计学意义(P<0.05)。治疗后两组患者中医证候积分均明显低于治疗前,差异有统计学意义(P<0.05);且治疗组中医证候积分明显低于对照组,差异有统计学意义(P<0.05)。治疗后治疗组24 h UTP、MAU、Uα1-MG和Uβ2-MG水平均较治疗前明显降低,差异有统计学意义(P<0.05);且治疗组24 h UTP、MAU、Uα1-MG和Uβ2-MG水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗后对照组Cys-C水平明显高于治疗前,差异有统计学意义(P<0.05)。治疗后治疗组PTH水平较治疗前降低,差异有统计学意义(P<0.05);且治疗组PTH水平明显低于对照组,差异有统计学意义(P<0.05)。治疗期间,两组患者均无明显不良反应发生,安全性良好。结论 针药结合治疗CKD2-3期脾肾气虚型蛋白尿可有效改善患者中医证候,延缓肾功能损伤,同时能够调节甲状旁腺功能、预防钙磷代谢紊乱,对机体微炎症反应具有抑制作用,且安全有效。

Objective To observe the clinical efficacy of acupuncture combined with Chinese medicine in treating proteinuria in patients with stages 2-3 chronic kidney disease(CKD)with spleen-kidney qi deficiency syndrome.Methods From October 2021 to February 2023,90 proteinuria patients with stages 2-3 CKD with spleen-kidney qi deficiency syndrome were enrolled from the Department of Nephrology of Shanghai Traditional Chinese Medicine(TCM)Integrated Hospital,Shanghai University of TCM.They were randomly divided into two groups:the treatment group and the control group,with 45 patients in each group.Both groups received basic treatment;the control group was additionally treated with Losartan Potassium tablets(100 mg/d),while the treatment group received Yiqi Qufeng Decoction combined with acupuncture based on the treatment of the control group.After three months of treatment,the clinical efficacy,TCM syndrome efficacy,and safety were compared between the two groups.TCM syndrome scores,urine protein levels[24-hour urine total protein(24h UTP),microalbuminuria(MAU),urine α1-microglobulin(Uα1-MG),and urine β2-microglobulin(Uβ2-MG)],renal function indicators[serum creatinine(Scr),blood urea nitrogen(BUN),estimated glomerular filtration rate(eGFR),and cystatin-C(Cys-C)],parathyroid hormone(PTH),and microinflammatory factors[high-sensitivity C-reactive protein(hs-CRP)] were evaluated before and after treatment.Results After treatment,the overall efficacy rate of TCM clinical syndrome in the treatment group was 78.05%(32/41),significantly higher than 70.00%(28/40)in the control group(P<0.05).The total clinical efficacy rate in the treatment group was 80.49%(33/41),significantly higher than 72.00%(29/40)in the control group(P<0.05).Both groups showed significantly lower TCM syndrome scores after treatment compared to those before treatment(P<0.05),with the treatment group showing significantly lower scores than the control group(P<0.05).The treatment group showed significant reductions in 24h UTP,MAU,Uα1-MG,and Uβ2-MG levels after treatment compared to those before treatment(P<0.05),and these levels were significantly lower in the treatment group than in the control group(P<0.05).After treatment,the Cys-C level in the control group was significantly higher than that before treatment(P<0.05).The treatment group showed a significant reduction in PTH levels after treatment compared to that before treatment(P<0.05),and these levels were significantly lower than in the control group(P<0.05).No significant adverse reactions were observed in either group during the treatment period,indicating good safety.Conclusion The combination of acupuncture and Chinese medicine in treating proteinuria in stages 2-3 CKD with spleen-kidney qi deficiency syndrome effectively improved TCM syndrome,delayed renal function deterioration,regulated parathyroid function,prevented calcium-phosphorus metabolism disorders,and inhibited microinflammatory responses,with safety and effectiveness.