Comparative efficacy of traditional Chinese herbal injection for chronic renal failure:A systematic review and network meta-analysis of randomized controlled trials

Objective: To conduct a systematic review and network meta-analysis(NMA) for the comparison of the efficacy and safety of Chinese herbal injection(CHI) combined with Western medicine(WM) and WM monotherapy for chronic renal failure(CRF).Methods: Eight databases were searched from inception to August 30, 2022. Randomized controlled trials(RCTs) regarding the comparison of CHI-WM combination therapy and WM monotherapy were included. Literature search, risk-of-bias assessment, and data extraction were conducted by 2 reviewers independently. NMA was performed by Stata 14.0, R 4.0.4 software, and the latest risk of bias assessment tool 2(RoB 2).Results: A total of 53 RCTs were finally included, involving 4445 participants and 16 CHIs. RoB 2 showed that 2 of these studies had a high risk of bias. Tianqi injection(TQ) + WM was the most effective in reducing serum creatinine(Scr) level. Xingding injection(XD) + WM was the most effective in reducing blood urea nitrogen(BUN) and cystatin C(Cys C) levels. Guhong injection(GH) + WM had the highest endogenous creatinine clearance rate(Ccr). Shuxuetong injection(SXT) + WM was the most effective in improving the clinical effective rate. Danhong injection(DH) + WM resulted in the lowest 24-h urinary protein quantity(24 h-UPQ), while Danshen injection(DS) + WM led to the lowest blood uric acid(UA)level. Shenfu injection(SF) + WM was the most effective in increasing hemoglobin(Hb) level.Conclusion: CHIs-WM combination therapy is more effective than WM monotherapy in treating CRF.Considering all of the indicators, SK + WM may be the optimal treatment option for improving renal function in patients with CRF.

Effect of adjuvant salvia miltiorrhiza and ligustrazine therapy on renal function, renal blood perfusion as well as CTGF and TGF-β1 content in patients with chronic renal failure

Objective:To analyze the effect of adjuvant salvia miltiorrhiza and ligustrazine therapy on renal function, renal blood perfusion as well as connective tissue growth factor (CTGF) and transforming growth factor (TGF)-β1 content in patients with chronic renal failure.Methods:80 patients with chronic renal insufficiency treated in our hospital between March 2013 and March 2016 were selected for study and randomly divided into observation group (n=40) and control group (n=40). Control group received conventional therapy and observation group received conventional + adjuvant salvia miltiorrhiza and ligustrazine therapy. After 3 months of treatment, differences in renal function indexes, illness-related indexes, renal blood perfusion, CTGF and TGF-β1 content, and so on of two groups of patients were determined. Results: After 3 months of treatment, serum urea nitrogen (BUN), serum creatinine (Scr),β2 microglobulin (β2-MG), intermedin (IMD), fibroblast growth factor 23 (FGF23), cystatin C (CysC), CTGF and TGF-β1 content as well as 24 h urine albumin excretion rate (UAER) level in urine of observation group were significantly lower than those of control group (P<0.05) while glomerular filtration rate (GFR) level and serum adiponectin (APN) content were significantly higher than those of control group (P<0.05);renal perfusion parameters renal cortex Tmax (ATc) and medulla Tmax (ATm) levels of observation group were significantly lower than those of control group while cortex peak intensity change (ΔAc), medulla peak intensity change (ΔAm) and peak intensity (PI) levels were significantly higher than those of control group.Conclusions:Adjuvant salvia miltiorrhiza and ligustrazine therapy can effectively control the overall condition of patients with chronic renal failure, and plays a positive role in improving renal function and increasing renal blood perfusion.

Clinical Study of Trilogy Detoxicating Therapy Combined with Routine Western Medicine on Patients with Chronic Renal Failure

Objective： To investigate the mechanism of Trilogy Detoxicating Therapy in treating patients with chronic renal failure （CRF）. Methods： A total of 142 patients were assigned to the Trilogy Detoxicating Therapy group （the treatment group, 82 patients） and the Western medicine treatment group （the control group, 60 patients）. All of the patients were treated with NovoNorm 1 mg and metformin hydrochloride tablets 0.15 g thrice per day for lowering the blood glucose, as well as Perindopril 4 mg twice daily for lowering blood pressure, recombinant human erythropoietin 2 000 U and a hypodermic injection thrice a week for rectifying anemia, 30 days as one course of treatment, and all patients were treated for two courses. Patients in the treatment group were treated with the Trilogy Detoxicating Therapy [dispersing the five-zang （脏） organs, expelling toxins through colonic dialysis and skin dialysis fumigation] in addition to the aforementioned drugs. Parameters observed and recorded in the study included renal function [serum creatinine （SCr）, blood urea nitrogen （BUN）], blood lipids [triglyceride （TG）, total cholesterol （TC）, low-density lipoprotein C （LDL-C）, high-density lipoprotein C （HDL-C）], plasma total protein （TP）, hemoglobin （Hb）, serum interleukin-6 （IL-6）, and tumor necrosis factor-α （TNF-α） before and after the treatment. Results： After two courses of treatment, the levels of SCr, BUN, TG, TC, LDL-C, serum IL-6 and TNF-α decreased significantly, meanwhile HDL-C increased in the treatment group （P〈0.05 or P〈0.01）. In contrast, no obvious changes of the above mentioned items occurred in the control group. In both groups, the levels of TP and Hb were significantly elevated （P〈0.05 or P〈0.01）, but the changes were more obvious in the treatment group （P〈0.01）. Conclusion： Trilogy Detoxicating Therapy played a therapeutic role on patients with CRF possibly through lowering the levels of blood lipids, serum IL-6 and TNF- α.

Clinical Observastion on 30 Cases of Chronic Renal Failure Trested with Shentekang Capsule(肾特康胶囊)and Peritoneal Dialysis

Objective: To evaluate the effect of Shentekang Capsule (STKC) combined with peritonealdialysis (PD) in treating chronic renal failure (CRF). Methods: With single-blind, parallel control and random method, 60 cases of CRF patients were equally divided into 2 groups: (1 ) STKC group treated with combined therapy of STKC and PD; (2 ) control group treated with PD alone. The course of treatment were 1~ 2 months for both groups. Clinical manifestations, blood urea nitrogen, serum creatinine, total protein and hemoglobin were observed before and after the treatment. Results: Blood urea nitrogen decreased in both groups after treat ment as compared with that before treatment significantly (P< 0. 05), but no obvious difference was found be tween blood urea nitrogen levels of the two groups (P > 0. 05 ). However, levels of serum total protein and hemoglobin of the STKC group after treatment were higher than those of the control group (P < 0. 01 ). Clinical manifestation in STKC group also showed more improvement after treatment than that in the control group.Conclusion: STKC could improve nutritional state and quality of CRF patient's life treated with PD.

高通量血液透析联合血液透析滤过序贯治疗慢性肾衰竭的临床效果及对钙磷代谢、预后的影响

目的分析高通量血液透析(HFHD)联合血液透析滤过(HDF)序贯治疗慢性肾衰竭(CRF)的临床效果。方法选取2020年1月至12月我院接收的90例CRF患者为研究对象,随机将其分为常规组(45例,常规HFHD治疗)和联合组(45例,HFHD联合HDF序贯治疗)。比较两组的治疗效果。结果联合组的治疗总有效率高于常规组(P<0.05)。治疗后,联合组的血尿素氮(BUN)、血肌酐(Scr)、甲状旁腺素(PTH)及β2-微球蛋白(β2-MG)水平低于常规组,内生肌酐清除率(Ccr)显著高于常规组(P<0.05)。治疗后,联合组的钙(Ca)水平高于常规组,磷(P)、成纤维细胞生长因子-23(FGF-23)、镁(Mg)、降钙素(CT)及碱性磷酸酶(ALP)水平低于常规组,差异具有统计学意义(P<0.05)。治疗后,联合组的肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)及白细胞介素-8(IL-8)水平低于常规组,白细胞介素-10(IL-10)水平高于常规组,差异具有统计学意义(P<0.05)。联合组的不良反应总发生率低于常规组,差异具有统计学意义(P<0.05)。结论HFHD联合HDF序贯治疗CRF可取得理想的效果。

影响慢性肾衰竭CRRT患者细菌感染发生的独立危险因素分析

目的 探讨影响慢性肾衰竭连续肾脏替代疗法(CRRT)患者发生细菌感染的独立危险因素。方法 回顾性分析2019年12月~2022年12月在运城市中心医院进行CRRT治疗的1 000例慢性肾衰竭患者。记录发生细菌感染的患者例数,分析细菌感染病原菌分布状况。将细菌感染患者267例设为观察组,余下未感染患者733例设为对照组,比较两组基线资料,并将有差异的指标纳入二元logistic回归分析,得到影响慢性肾衰竭CRRT患者出现细菌感染的独立危险因素。结果 1 000例慢性肾衰竭CRRT治疗患者,共发生细菌感染267例(观察组),发生率为26.70%;未发生细菌感染733例(对照组)。两组患者年龄、治疗时间、体质量指数(BMI)、合并糖尿病、糖尿病肾病、合并心力衰竭、留置静脉导管、血红蛋白(Hb)及血清白蛋白差异比较具有统计学意义(χ^(2)=8.123、5.463、8.631、5.043、8.898、8.052、4.861、8.658、4.803,P<0.05)。多因素logistic回归分析结果显示,≥65岁、≥1年治疗时间、BMI <20 kg/m2、合并糖尿病、合并心力衰竭、留置静脉导管、糖尿病肾病、Hb <70 g/L及血清白蛋白<30 g/L为影响慢性肾衰竭患者CRRT治疗过程中出现细菌感染的独立危险因素(P<0.05)。结论 慢性肾衰竭CRRT患者年龄、治疗时间、BMI、合并糖尿病与心力衰竭、留置静脉导管、糖尿病肾病、Hb及血清白蛋白均可影响细菌感染的发生,临床应针对上述危险因素构建干预方案,预防细菌感染。

双罐串联连续血液净化对慢性肾衰竭尿毒症患者血清可溶性转铁蛋白受体和人巨噬细胞趋化蛋白-1水平及生存质量的影响

目的:探讨双罐串联连续血液净化(CRRT)对慢性肾衰竭尿毒症患者血清可溶性转铁蛋白受体(sTfR)和人巨噬细胞趋化蛋白-1(MCP-1)水平及生存质量的影响。方法:选择2022年4月至2023年4月新疆医科大学第一附属医院行血液透析治疗的96例慢性肾衰竭尿毒症患者,随机分为单罐组(CRRT连续血液净化单个灌流器)和双罐串联组(CRRT连续血液净化2个灌流器串联),每组48例。分别于治疗前,治疗后2个月、半年及1年时检测两组患者血清sTfR和MCP-1水平,判断其治疗后皮肤瘙痒缓解程度;分别于治疗前及治疗后72h记录两组白细胞水平、急性生理与慢性健康量表(APACHEⅡ)评分情况。采用中文版欧洲五维量表(CEQ-5D-3L)、视觉模拟量表(VAS)评分,评估两组患者治疗前后生命质量。结果:两组治疗前血清sTfR水平比较差异无统计学意义(P>0.05)。治疗后2个月、半年及1年各时间点,双罐串联组血清sTfR水平均低于单罐组,差异有统计学意义(t=5.089、18.410、41.306,P<0.05);两组治疗前血清MCP-1水平比较,差异无统计学意义(P>0.05)。治疗后2个月、半年及1年各时间点,双罐串联组血清MCP-1水平均低于单罐组,差异有统计学意义(t=8.554、8.019、10.744,P<0.05);两组治疗后原有皮肤瘙痒程度均有所改善,但单罐组缓解程度明显低于双罐串联组,差异有统计学意义(x^(2)=8.540,P<0.05);两组治疗前白细胞、APACHEⅡ评分比较,差异无统计学意义(P>0.05),治疗后72h白细胞、APACHEⅡ评分均降低,且双罐串联组改善程度均优于单罐组,差异有统计学意义(t=5.549、14.781,P<0.05);两组治疗前血清CEQ-5D-3L评分比较,差异无统计学意义(P>0.05)。治疗后2个月、半年及1年各时间点,双罐串联组健康描述系统标准总分均低于单罐组,VAS评分高于单罐组,差异有统计学意义(t健康描述系统标准总分=4.744、5.103、9.418,tVAS评分=3.375、2.866、3.126,P<0.05)。结论:双罐串联连续血液净化可有效降低慢性肾衰竭尿毒症患者血清sTfR,MCP-1水平,缓解皮肤瘙痒程度,提高生存质量,同时还能有效降低白细胞水平,改善APACHEⅡ评分和血常规。

Chronic kidney disease prediction is an inexact science: The concept of “progressors” and “nonprogressors”

In 2002,the National Kidney Foundation Kidney Disease Outcomes Quality Initiative(NKF KDOQI)instituted new guidelines that established a novel chronic kidney disease(CKD)staging paradigm.This set of guidelines,since updated,is now very widely accepted around the world.Nevertheless,the authoritative United States Preventative Task Force had in August 2012acknowledged that we know surprisingly little about whether screening adults with no signs or symptoms of CKD improve health outcomes and that we deserve better information on CKD.More recently,the American Society of Nephrology and the American College of Physicians,two very well respected United States professional physician organizations were strongly at odds coming out with exactly opposite recommendations regarding the need or otherwise for"CKD screening"among the asymptomatic population.In this review,we revisit the various angles and perspectives of these conflicting arguments,raise unanswered questionsregarding the validity and veracity of the NKF KDOQI CKD staging model,and raise even more questions about the soundness of its evidence-base.We show clinical evidence,from a Mayo Clinic Health System Renal Unit in Northwestern Wisconsin,United States,of the pitfalls of the current CKD staging model,show the inexactitude and unpredictable vagaries of current CKD prediction models and call for a more cautious and guarded application of CKD staging paradigms in clinical practice.The impacts of acute kidney injury on CKD initiation and CKD propagation and progression,the effects of such phenomenon as the syndrome of late onset renal failure from angiotensin blockade and the syndrome of rapid onset end stage renal disease on CKD initiation,CKD propagation and CKD progression to end stage renal disease all demand further study and analysis.Yet more research on CKD staging,CKD prognostication and CKD predictions are warranted.Finally and most importantly,cognizant of the very serious limitations and drawbacks of the NKF K/DOQI CKD staging model,the need to individualize CKD care,both in terms of patient care and prognostication,cannot be overemphasized.

双重血浆分子吸附系统序贯血浆置换联合连续性肾脏替代疗法治疗慢加急性肝衰竭合并急性肾损伤的效果分析

目的观察双重血浆分子吸附系统(DPMAS)序贯血浆置换(PE)联合连续性肾脏替代疗法(CRRT)治疗慢加急性肝衰竭(ACLF)合并急性肾损伤(AKI)患者的临床效果。方法回顾性纳入2019年1月—2022年12月于贵州医科大学附属医院住院治疗的ACLF合并AKI的90例患者临床资料,依据不同的血液净化方式,分为DPMAS序贯PE联合CRRT组(观察组,n=31),DPMAS序贯PE组(对照组,n=59)。收集所有患者入院一般资料、血液净化治疗前后实验室指标,包括肝肾功能、凝血功能、炎症指标等,计算eGFR、MELD-Na评分。正态分布的计量资料两组间比较采用成组t检验;非正态分布的计量资料组内前后比较采用Wilcoxon符号秩和检验,两组间比较采用Mann-Whitney U检验。计数资料两组比较采用χ^(2)检验或Fisher精确检验。结果观察组治疗有效率为48.4%(15/31),高于对照组治疗的有效率27.1%(16/59)(χ^(2)=4.071,P=0.044)。两组血液净化方式均可有效改善TBil、ALT、AST、PTA、Scr、PCT、CRP、e GFR及MELD-Na评分(P值均<0.05);两组治疗后PLT及Hb均显著降低(P值均<0.05);而BUN、Alb、INR治疗前后差异均无统计学意义(P值均>0.05)。对照组与观察组的AST、Scr、PCT、e GFR、MELD-Na评分、Hb、PLT治疗前后差值比较,差异均有统计学意义(P值均<0.05)。结论DPMAS序贯PE联合CRRT模式可有效清除炎症介质,改善肾功能,稳定机体内环境,获得较好的临床疗效。

多学科团队干预对维持性血液透析患者生活质量的影响

目的研究维持性血液透析(maintenance hemodialysis,MHD)患者在多学科团队干预下生活质量改善的有效性。方法纳入2020年1月-2022年12月在上海市浦东医院血液透析室行MHD治疗患者100例。按随机数字表1∶1分为干预组(n=50)和对照组(n=50)。干预组由肾科医生、营养师和护士组成的医护团队干预,对照组由护理团队采用日常标准护理。干预12个月,干预组和对照组各退出1例,最终干预组和对照组各49例。比较两组自我管理能力、生活质量和营养状况等。结果干预前两组一般资料、生活质量、自我管理能力和营养状况差异均无统计学意义(P>0.05)。干预后,干预组自我管理评分和生活质量评分均高于对照组(P<0.05);体质指数、血清白蛋白、血清铁蛋白、总胆固醇均优于对照组(P<0.05)。结论对MHD患者进行多学科团队干预,可以改善患者的营养状况,提高患者的自我管理能力和生活质量。

甲磺酸萘莫司他与枸橼酸抗凝在慢性肾衰竭伴高危出血患者连续性肾替代治疗中的疗效评估

目的评价在慢性肾衰竭伴高危出血患者中行连续性肾替代治疗(CRRT)应用甲磺酸萘莫司他(NM)与局部枸橼酸(CA)抗凝的安全性和有效性。方法回顾性研究2021年1月至2023年9月在本中心接受NM或CA抗凝的慢性肾衰竭伴高危出血患者,评估滤器寿命或出血及其他并发症,采用多因素Cox回归分析确定滤器衰竭相关危险因素。结果共纳入125例患者,其中59例接受CA抗凝,66例接受NM抗凝。与CA组相比,NM组高血压、冠心病比例较高,两组在其他基线特征上无显著性差异。CA组滤器寿命长于NM组[12(8~24)h vs.8(8~13.13)h,P=0.003],NM组滤器衰竭的风险显著增高(HR=22.886,95%CI:3.935~133.12,P<0.001),但在8 h以内,两种抗凝滤器凝血率相当。CA组新发出血6例(10.17%),与NM组9例(13.64%)相当(P=0.552)。两组输血浆、红细胞、血小板均无差异。CA组代谢性碱中毒(5.08%)发生率略高于NM组(4.55%)(P=0.042)。结论在慢性肾衰竭伴高危出血患者CRRT中,使用NM与局部CA相比出血风险相当,抗凝效果稍差,但可满足8 h内的治疗需要。

补中益气汤合五皮饮联合艾灸治疗慢性肾功能衰竭疗效观察

目的:观察补中益气汤合五皮饮联合艾灸治疗慢性肾功能衰竭的临床疗效。方法:将符合纳入标准的63例慢性肾功能衰竭患者随机分为对照组(32例)和治疗组(31例)。对照组予西医常规治疗,治疗组在对照组基础上口服补中益气汤合五皮饮联合艾灸治疗,疗程均为30天。比较两组患者临床疗效,24 h尿蛋白定量、尿沉渣分析、肾功能情况。结果:治疗组显效率(51.61%)明显高于对照组(25.00%),治疗组总有效率(96.77%)明显高于对照组(87.50%),两组比较差异均有统计学意义(P﹤0.05);治疗后,治疗组肾功能指标水平较对照组明显改善(P﹤0.01),红细胞计数、24 h尿蛋白量、症状评分较对照组明显降低(P﹤0.01)。结论:补中益气汤合五皮饮联合艾灸能明显减少慢性肾功能衰竭患者尿蛋白、尿红细胞,改善肾功能水平及临床症状。

连续性肾脏替代治疗与普通血液透析治疗慢性肾病合并心力衰竭患者的临床效果比较

目的比较两种不同的方法治疗慢性肾病(Chronic Kidney Disease,CKD)合并心力衰竭(Heart Failure,HF)患者的临床效果。方法方便选取2020年1月—2023年1月武威市凉州医院重症医学科收治的91例CKD合并HF患者为研究对象,以随机数表法分为对照组(n=45,普通血液透析治疗)和观察组[n=46,连续性肾脏替代治疗(Continuous Renal Replacement Therapy,CRRT)]治疗,对比两组临床疗效、生命体征、心功能指标及肾功能指标。结果观察组临床总有效率为97.83%,高于对照组的80.00%,差异有统计学意义(χ^(2)=5.680,P<0.05)。治疗后,两组患者心率、呼吸频率、平均动脉压及血清尿素氮、肌酐、半胱氨酸蛋白酶抑制剂均下降,观察组优于对照组,差异有统计学意义(P均<0.05)。治疗后,两组左心室射血分数、6 min步行距离较治疗前上升,左心室舒张末期内径及左心室收缩末期内径下降,且观察组各项指标优于对照组,差异有统计学意义(P均<0.05)。结论CRRT治疗CKD合并HF临床疗效更优,可维持患者生命体征稳定状态,有效改善患者心功能及肾功能状态,利于疾病转归。

中医药治疗肾性贫血的理论与实践

肾性贫血(RA)是慢性肾衰竭患者最常见的临床表现之一,是由促红细胞生成素(EPO)绝对或相对缺乏,以及红细胞寿命及生成受尿毒症毒素影响而发生的贫血。RA的发病率随慢性肾脏病的进展而增加,影响患者的日常生活质量,增加心血管事件及死亡的风险。中医药在促进内源性EPO产生、改善铁代谢、抑制炎症反应及氧化应激、改善营养状态等方面具有较好疗效,且不良作用少。现作者对近年RA的中医药治疗做一综述,以期为临床治疗提供参考。

芪参活肾汤治疗早中期慢性肾衰竭临床观察

目的:观察芪参活肾汤治疗早中期慢性肾功能衰竭患者的临床疗效。方法:选取符合纳入标准的92例脾肾亏虚、浊毒瘀阻型慢性肾衰竭患者,随机分为两组各46例。对照组予西医常规疗法,治疗组在对照组基础上加服芪参活肾汤中药汤剂,两组均治疗8周。比较两组患者治疗前后血肌酐(Scr)、尿素氮(BUN)、血清胱抑素C(Cys-C)、24小时尿蛋白定量(24hU-TP)水平及中医证候积分、临床疗效情况。结果:治疗组总有效率为84.78%,对照组为60.87%,两组比较,差异有统计学意义(P﹤0.05)。治疗后,治疗组BUN、Scr、24hU-TP、Cys-C水平均低于对照组(P﹤0.05);治疗组患者气短懒言、倦怠乏力、食少纳呆等中医证候评分较治疗前明显降低,且低于对照组(P﹤0.05)。结论:芪参活肾汤治疗脾肾亏虚、浊毒瘀阻型早中期慢性肾衰竭患者临床疗效较好,能有效缓解患者临床症状,改善肾功能。

傅晓骏教授“健脾补肾,化瘀祛浊”思想治疗慢性肾功能衰竭经验介绍

目的:总结傅晓骏教授治疗慢性肾功能衰竭的具体用药规律以及具体的临证思路,以推广傅晓骏名中医诊治慢性肾功能衰竭的学术思想及用药经验。方法:通过每周三天跟随傅晓骏名中医的专家门诊抄方及每周一次的中医名家病房查房,以整理傅晓骏教授治疗慢性肾功能衰竭的具体病案资料,并通过广泛阅读临床相关的学术文献,挖掘分析阐述傅晓骏教授论治慢性肾功能衰竭思路,探讨傅晓骏教授治疗慢性肾功能衰竭的具体用药特点及用药规律,以总结其治疗慢性肾功能衰竭的学术思想及临证经验。结果:傅晓骏教授治疗慢性肾功能衰竭,临证时特别强调标本同治,提倡治病求本,首当扶正,治疗方法中尤其重视从瘀论治,调理中焦脾胃,强调“中央健,四旁如”诊治思想,治则上以益气温阳方法为主,辅以活血化瘀、泄浊解毒、健脾利湿、清热解毒等治疗方法,并随症加减,始终强调身心同治,强调中医药一体化综合治疗的学术思想。傅晓俊教授临床诊治慢性肾功能衰竭时擅长运用药对,大大提高了临床治疗效果。通过将黄芪与水蛭、仙茅与淫羊藿配伍应用,可以有效治疗脾肾阳虚患者,同时还能够补充肝肾,增强精气,促进气血流通,从而缓解慢性肾功能衰竭患者的腰腿痛、疲劳,减少蛋白尿,提高肾功能。结论:傅晓俊教授以其独具匠心的中西医融会贯通,将传统中医和现代技术有机地融为一体,以期能够迅速、有效地控制肾脏疾病进展,临床效果显著,可改善慢性肾功能衰竭患者肾功能,延缓肾损害进展,具有一定的临床推广应用价值。

探讨左卡尼汀联合血液透析疗法治疗慢性肾功能衰竭的临床疗效

目的 分析左卡尼汀+血液透析疗法治疗慢性肾功能衰竭的效果。方法 选取2020年4月—2023年4月本院慢性肾功能衰竭患者80例为研究对象,随机分成对照组和观察组,每组40例。对照组采取血液透析治疗,观察组在对照组的基础上加用左卡尼汀治疗,比较两组的治疗效果。结果 观察组的血清肌酐、尿素氮低于对照组,内生肌酐清除率高于对照组(P<0.05);观察组的CRP、IL-6、TNF-α均低于对照组(P<0.05);观察组的生活质量评分高于对照组(P<0.05)。结论 对于慢性肾功能衰竭患者,左卡尼汀与血液透析疗法联合治疗,对患者肾功能与炎症血清炎症指标的改善效果显著,还可提高患者生活质量,利于疾病的控制。

参芪地黄汤加减联合肾脏替代疗法治疗对慢性肾衰竭患者的影响

目的探讨参芪地黄汤加减联合肾脏替代疗法治疗对慢性肾衰竭(CRF)患者的影响。方法选取2022年12月—2023年12月开阳县中西医结合医院收治的80例CRF患者为研究对象,按照随机数字表法将其分为对照组和观察组,每组40例。对照组采用肾脏替代疗法治疗,观察组在对照组基础上加以参芪地黄汤加减治疗,两组持续治疗8周。对比两组患者的临床疗效、中医证候评分、炎症指标及不良反应发生情况。结果观察组治疗总有效率为95.00%,高于对照组的77.50%,差异有统计学意义(P<0.05)。治疗后,两组各项中医证候评分均低于治疗前,且观察组均低于对照组,差异有统计学意义(P<0.05);两组白细胞介素-6、C反应蛋白、肿瘤坏死因子-α均低于治疗前,且观察组均低于对照组,差异有统计学意义(P<0.05)。两组均未出现不良反应。结论参芪地黄汤加减联合肾脏替代疗法可提高CRF患者的临床疗效,控制炎症,值得临床借鉴。

HELENICC评分预测脓毒症相关急性肾损伤行持续肾脏替代治疗患者早期病死率的价值

目的分析肝衰竭、乳酸、去甲肾上腺素、医疗条件和肌酐评分(HELENICC评分)对脓毒症相关急性肾损伤(S-AKI)行持续肾脏替代治疗(CRRT)患者早期病死率的预测价值。方法选取2019年1月—2022年12月入住本院重症监护室(ICU)的S-AKI行CRRT的99例患者为研究对象,根据7 d死亡率分为存活组55例和死亡组44例。CRRT开始时,评估2组急性生理与慢性健康评分Ⅱ(APACHEⅡ评分)、序贯性器官功能衰竭评分(SOFA评分)、简化急性生理学评分3(SAPS3评分)以及HELENICC评分,并计算APACHEⅡ评分、SOFA评分、SAPS3评分、HELENICC评分的受试者工作特征(ROC)曲线的曲线下面积(AUC)。结果死亡组ICU机械通气时间、ICU住院时间长于存活组,差异有统计学意义(P<0.01);死亡组去甲肾上腺素剂量、乳酸、肌酐值、肝衰竭发生比率、医疗条件、APACHEⅡ评分、SOFA评分、SAPS3评分、HELENICC评分均高于存活组,差异有统计学意义(P<0.05或P<0.01)。随着HELENICC评分等级增高,病死率也逐渐升高,HELENICC评分等级与病死率存在线性相关性(OR=3.17,95%CI:0.46~0.67,P<0.05)。APACHEⅡ评分的AUC是0.729(95%CI:0.630~0.827,P<0.01),SOFA评分的AUC是0.638(95%CI:0.521~0.754,P=0.019),SAPS3评分的AUC是0.819(95%CI:0.737~0.901,P<0.01),HELENICC评分的AUC是0.828(95%CI:0.743~0.914,P<0.01)。结论HELENICC评分可较好地预测ICU中S-AKI行CRRT的患者的早期病死率。

吕宏生教授中医药辨治慢性肾衰竭经验

吕宏生教授长期从事肾脏病临床诊疗工作,运用中医药辨治慢性肾衰竭经验丰富,认为慢性肾衰竭病机方面以正虚为本、邪实为标,虚实之间相互影响;病情迁延,变证百出;急性加重者,热毒为患显著。治疗过程中,注重辨证分型,兼顾标本;内外合治,综合调护;注重调养,减负护肾;关注变证,及时处理;药毒伤肾,使用禁忌,取得较好临床效果。