肾衰泄浊汤治疗Ⅳ型心肾综合征伴贫血患者的临床疗效研究

Clinical efficacy of Shenshuaixiezhuo Decoction in the treatment of Type 4 cardiorenal syndrome with anemia

目的探讨中药复方肾衰泄浊汤对Ⅳ型心肾综合征伴贫血患者的临床疗效。方法选择符合Ⅳ型心肾综合征同时伴有贫血的患者60例,采用随机数字表法将患者随机分为治疗组和对照组各30例,对照组采用西医常规治疗,并予以促红细胞生成素及铁剂治疗,治疗组在对照组的治疗基础上加服中药复方肾衰泄浊汤,比较两组患者治疗后的临床疗效,以及比较两组患者治疗前后的中医证候总积分、肾功能(Scr、BUN、e-GFR)、心脏损害指标(LVDd、LVDs、IVST、LVPWT、LVMI)、贫血相关指标(RBC、Hb、SF、TSAT)及微炎症相关指标(CRP、hs-CRP、IL-6)的变化。结果(1)治疗组临床总有效率为83.4%,对照组临床总有效率为56.7%,治疗组临床疗效优于对照组(P<0.05);治疗后两组患者中医证候总积分均下降,且治疗组优于对照组(P<0.01)。(2)在改善肾功能方面,治疗组改善Scr、BUN、e-GFR优于对照组(P<0.01)。(3)在改善心脏损害方面,治疗后治疗组LVDd、LVDs、IVST、LVPWT、LVMI均降低,且比对照组降低显著(P<0.01)。(4)在改善贫血状态方面,治疗后治疗组上调RBC、Hb、SF、TSAT优于对照组(P<0.01)。(5)在改善微炎症状态方面,治疗后治疗组降低CRP、hs-CRP、IL-6优于对照组(P<0.01)。结论中药复方肾衰泄浊汤联合西医常规治疗,可改善患者肾功能及心脏损害,并能改善患者贫血及微炎症状态,进而改善Ⅳ型心肾综合征伴贫血患者的临床症状。

Objective To investigate the clinical effect of Shenshuaixiezhuo Decoction on patients with type IV cardiorenal syndrome with anemia.Methods 60 patients with typeⅣcardiorenal syndrome and anemia were selected and randomly divided into treatment group and control group with 30 cases in each group.The control group was treated with conventional western medicine and erythropoietin and iron,while the treatment group was treated with Shenshuaixiezhuo Decoction on the basis of the control group.The clinical efficacy of the two groups after treatment was compared,The total score of TCM syndromes,renal function(Scr,BUN,e-GFR),cardiac damage indicators(LVDD,LVDS,ivst,LVPWT,LVMI),anemia related indicators(RBC,Hb,SF,TSAT)and micro inflammation related indicators(CRP,hs-CRP,IL-6)were compared between the two groups before and after treatment.Results①The total clinical effective rate of the treatment group was 83.4%,and that of the control group was 56.7%.The clinical efficacy of the treatment group was better than that of the control group(P<0.05);After treatment,the total score of TCM syndromes in the two groups decreased,and the treatment group was better than the control group(P<0.01).②In terms of improving renal function,the treatment group improved SCR,bun,e-gfr better than the control group(P<0.01).③In terms of improving cardiac damage,LVDD,LVDS,ivst,LVPWT and LVMI in the treatment group were decreased after treatment,which were significantly lower than those in the control group(P<0.01).④In terms of improving anemia,the treatment group upregulated RBC,Hb,SF,TSAT better than the control group after treatment(P<0.01).⑤in terms of improving the micro inflammatory state,the treatment group was better than the control group in reducing CRP,hs CRP and IL-6 after treatment(P<0.01).Conclusion Shenshuaixiezhuo decoction combined with conventional western medicine treatment can improve the renal function and heart damage of patients,and can improve the anemia and micro inflammatory state of patients,thus improving the clinical symptoms of patients with type IV cardiorenal syndrome and anemia.