清肾颗粒治疗慢性肾衰竭急剧加重湿热证营养不良患者的临床研究  

Effect of Qingshen granule （清肾颗粒） for treatment in patients with malnutrition caused by damp-heat syndrome （湿热证） sharp deterioration of chronic renal failure

作　　者：王天义[1] 王亿平[2] 王东[2] 程皖[2] 胡顺金[2] 吕勇[2] 刘玲[2] 

机构地区：[1]安庆市第一人民医院,安徽安庆246004 [2]安徽中医学院第一附属医院,安徽合肥230031

出　　处：《中国中西医结合急救杂志》2011年第2期78-81,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：安徽省科技厅重点资助项目（05023087）

摘　　要：目的 观察清肾颗粒治疗慢性肾衰竭（CRF）急剧加重湿热证营养不良患者的疗效.方法 采用前瞻性随机对照研究方法,将60例CRF急剧加重湿热证营养不良患者按随机数字表法分为治疗组和对照组,每组30例;并设健康对照组20例.治疗组与对照组患者均在西药常规治疗时使用中药解毒泄浊Ⅱ号颗粒剂保留灌肠,治疗组加用清肾颗粒（组方：白花蛇舌草、丹参、茵陈蒿、益母草、薏苡仁、黄连、白豆蔻仁、猪苓、茯苓、扁豆、泽泻、车前草、白术、生大黄）10 g,每日3次口服,两组均以4周为1个疗程.比较治疗组与对照组临床疗效及中医证候疗效,并检测两组治疗前后血清游离胰岛素样生长因子-1（IGF-1）、纤维连接蛋白（FN）、肾功能指标及主观综合营养评估（SGA）评分.结果 治疗组临床疗效总有效率（90.0%）及中医证候总有效率（86.7%）明显优于对照组（66.7%及63.3%,均P＜0.05）.对照组、治疗组CRF急剧加重湿热证患者治疗前血清游离IGF-1、FN水平及SGA评分均明显低于健康对照组[IGF-1（μg/L）：2.14±0.47、2.07±0.26比4.77±0.62,FN（mg/L）：148.37±11.59、151.90±14.12比321.58±12.39,SGA评分（分）：2.90±1.20、2.80±1.32比7.21±1.16,均P〈0.01];治疗后两组血清游离IGF-1、FN水平及SGA评分均有所上升,血清肌酐（SCr）降低,肾小球滤过率（GFR）升高,且治疗组各指标改善程度较对照组更为显著[IGF-1（μg/L）：2.95±0.45比2.42±0.42,FN（mg/L）：182.10±18.95比151.77±11.40,SGA评分（分）：4.60±1.58比3.50±1.25,SCr（μmol/L）：281.51±121.96比368.67±202.34,GFR（ml/min）：35.51±13.94比27.04±17.71,P＜0.05或P＜0.01].结论 清肾颗粒可以通过降低CRF急剧加重湿热证患者血清游离IGF-1、FN水平,改善患者的营养状况和肾功能,减轻临床症状.Objective To studythe efficacy of Qingshen granule （QSG, 清肾颗粒） for the treatment of malnutrition caused by damp-heat syndrome （DHS, 湿热证） sharp deterioration of chronic renal failure （CRF）. Methods The prospective randomized control study was conducted. Sixty cases of DHS of CRF were randomly divided into treatment group （30 cases） and control group （30 cases）, and healthy control group （20 cases） was set up. The treatment group and control group were treated with western conventional therapy combined with traditional Chinese medicine Jiedu Xiezhuo Ⅱ （解毒泄浊Ⅱ号） through enema. Simultaneously QSG （Herba hedyotis diffusae （白花蛇舌草）, Radix salviae miltiorrhizae （丹参）, Herba artemisiae scopariae （茵陈蒿）, Herba leonuri （益母草）, Semen eoicis （薏苡仁）, Rhizoma eoptidis （黄连）, Fructus amomi rotundus （ 白豆蒄）, Polyporus （猪苓）, Poria （茯苓）, Hyacinth bean （扁豆）, Rhizoma alismatis （泽泻）, Herba plantaginis （车前草）, Rhizoma atractylodis macrocephalae （白术）, Radix et rhizoma rhei （生大黄） 10 g was additionally administered orally in the treatment group, 3 times a day. The course of treatment was 4 weeks in both groups. The levels of serum free insulin-like growth factor-1 （IGF-1）, fibronectin （FN） and subjective global assessment （SGA） were observed in all cases before and after therapy, and compared with those in the healthy control group. Results The total effective rate of clinical effect in the treatment group was 90. 0%, which was better than that in the control group 66.7%（P〈0.05）. The total effective rate of syndrome of traditional Chinese medicine in the treatment group was 86.7%, and obviously higher than that in the control group 63.3% （P〈0.05）. Before treatment, the levels of serum free IGF-1, FN and SGA score in patients with DHS sharp deterioration of CRF in control group and treatment group were obviously lower than those of the hea

关 键 词：肾衰竭 慢性 急剧加重 湿热证 游离胰岛素样生长因子-1 纤维连接蛋白 营养不良 清肾颗粒 中医药 

分 类 号：R285.6[医药卫生—中药学] R256.5[医药卫生—中医学]