益肾四妙汤加减治疗痛风性肾病合并肾衰竭的疗效及机制

Effect and Mechanism of Yishen Simiaotang on Gouty Nephropathy with Renal Failure

目的:分析益肾四妙汤加减治疗痛风性肾病(GN)合并肾衰竭(RF)的疗效及其作用机制。方法:将2015年3月至2017年12月就诊于铜仁市人民医院的96例GN合并RF患者,按照随机对照原则分为对照组和观察组,各48例。在基础治疗上对照组加用别嘌醇,观察组加用益肾四妙汤加减治疗。治疗2个月后对比两组临床疗效、治疗安全性。比较两组治疗前后尿β2-微球蛋白(β2-microglobulin,β2-MG),α1-微球蛋白(α1-microglobulin,α1-MG),24 h尿蛋白定量(24 h urine protein,24 h Upro)及肾小球滤过率(glomerular filtration rate,e GFR)水平。测定比较治疗前后血白蛋白(albumin,ALB)及尿素氮(urea nitrogen,BUN),肌酐(serum creatinine,SCr),尿酸(uric acid,UA)水平,比较两组治疗前后血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α),白细胞介素-6(interleukin-6,IL-6),超敏C反应蛋白(high sensitive C reactive protein,hs-CRP)指标变化。结果:观察组的总有效率为89.58%,明显高于对照组的72.92%(χ2=4.376,P<0.05)。与本组治疗前比较,治疗后两组的BUN,SCr,UA均明显下降,e GFR水平明显升高(P<0.05),且观察组ALB水平明显升高(P<0.05);治疗后两组β2-MG,α1-MG,24 h Upro均明显下降(P<0.05),且观察组的各指标改善均更加明显(P<0.05)。治疗后两组的TNF-α,hs-CRP,IL-6水平均明显降低,且观察组下降更加明显(P<0.05)。两组的不良反应发生率差异无统计学意义。结论:给予GN合并RF患者益肾四妙汤加减治疗疗效确切,可减轻肾小管损伤,改善肾功能,改善微炎症状态,且安全性高。

Objective:To analyze the therapeutic effect and mechanism of Yishen Simiaotang on gouty nephropathy(GN)complicated with renal failure(RF).Method:Totally 96 cases of GN with RF treated at our hospital from March 2015 to December 2017 were divided into the control group(48 cases)and the observation group(48 cases)according to the random control principle.In addition to the basic therapy,allopurinol was added to the control group,and Yishen Simiaotang was added to observation group.After 2 months of treatment,the clinical efficacy and safety of two groups were compared.The urinary levels ofβ2-microglobulin(β2-MG),α1-microglobulin(α1-MG),24 h urine protein(24 hUpro)and glomerular filtration rate(eGFR)were compared between two groups before and after treatment,and the levels of serum albumin(ALB),urea nitrogen(BUN),serum creatinine(SCr)and uric acid(UA)were detected and compared before and after the treatment.The serum tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),and hypersensitivity C reactive protein(hs-CRP)were compared before and after treatment between two groups.Result:The total effective rate of observation group was89.58%,which was significantly higher than 72.92%of control group(χ2=4.376,P<0.05).After treatment,BUN,SCr and UA in both groups were significantly decreased,whereas eGFR level was significantly increased than before treatment(P<0.05).After treatment,the levels ofβ2-MG,α1-MG,24 hUpro in both groups decreased significantly(P<0.05),while the indexes of observation group improved more significantly(P<0.05).After treatment,the levels of TNF-α,hs-CRP and IL-6 in both groups were significantly lower than those before treatment,and the decrease in observation group was more obvious than that in control group(P<0.05).There was no significant difference in the incidence of adverse reactions between two groups.Conclusion:Yishen Simiaotang is effective in the treatment of GN combined with RF,and can reduce renal tubule injury,improve renal function,regulate the state of micro-inflammation,with a high safety.