真武汤加减对维持性血液透析尿毒症患者残余肾功能及血管钙化的影响

Effects of the Zhenwu decoction with modifications on residual renal function and vascular calcification in maintenance hemodialysis patients with uremia

目的:探讨真武汤加减对维持性血液透析尿毒症患者残余肾功能及血管钙化的影响。方法:本次研究共纳入研究对象52例,均自如皋市第三人民医院中选取,均为维持性血液透析尿毒症患者,于2021年1月-2022年9月完成选例,以随机数字表法将患者分为对照组和观察组,每组26例,对照组接受血液透析常规治疗,观察组在对照组基础上联合真武汤加减治疗。治疗时间为3个月。比较两组营养状况、中医证候积分、血管钙化指标、残余肾功能指标、炎症反应指标及不良反应发生情况。结果:与治疗前相比,治疗1个月、治疗3个月两组Detskey评分均呈依次降低趋势,组间比较,观察组更低;治疗3个月两组中医证候积分、血清骨成型蛋白2(Bone Morphogenetic Protein 2,BMP-2)、护骨素(Osteoprotegerin,OPG)、血清肌酐(Serum Creatinine,Scr)、尿素氮(Blood Urea Nitrogen,BUN)、转化生长因子β1(Transforming Growth Facter-β1,TGF-β1)、血小板反应蛋白-1(Thrombospondin-1,TSP-1)、肿瘤坏死因子-α(Tumor Necrosis Factor-α,TNF-α)水平、钙磷乘积均有所降低,组间比较观察组水平更低;与治疗前相比,治疗3个月两组残余肾功能(Residual Renal Function,RRF)水平均有所降低,组间比较观察组更高,差异有统计学意义(P<0.05)。结论:真武汤加减能够有效缓解维持性血液透析尿毒症患者临床症状,改善营养状况,防止血管钙化,延缓残余肾功能下降,减轻炎症反应,且安全性较好。

Objective:To investigate the effects of the Zhenwu decoction(真武汤)on residual renal function and vascular calcification in patients with uremia in maintenance hemodialysis.Methods:A total of 52 subjects were included in this study,all of which were selected from the Third People’s Hospital of Rugao.The subjects were patients with uremia during maintenance hemodialysis,and they were selected from January 2021 to September 2022.The patients were divided into two groups based on the random number table method,26 patients in each group.The control group received routine hemodialysis treatment.The observation group received the Zhenwu decoction more,for 3 months.The nutritional status,TCM syndrome score,vascular calcification index,residual renal function index,inflammatory reaction index and adverse reactions were compared between the two groups.Results:Compared with before treatment,the Detskey score in the two groups were decreased in turn after treatment for 1 month and 3 months,and that in the observation group was lower than the control group.After 3 months of treatment,the TCM syndrome score and serum bone morphogenetic protein,osteoprotegerin,serum creatinine,blood urea nitrogen,transforming growth facter-β1,thrombospondin-1,tumor necrosis factor-α,calcium and phosphorus product in the two groups were all decreased,and those in the observation group were lower than the control group.Compared with before treatment,the level of residual renal function in the two groups were decreased after 3 months of treatment,and that in the observation group was higher than the control group(P<0.05).Conclusion:The Zhenwu decoction can effectively relieve the clinical symptoms of uremia patients with maintenance hemodialysis,improve nutritional status,prevent vascular calcification and delay the decline of residual renal function,reduce the inflammatory reaction and has good safety.