中医辨证治疗对慢性肾脏病3期患者肾小球滤过率和尿蛋白定量的影响  

Effects of Chinese Medicine on Glomerular Filtration Rate and Urinary Protein Excretion for Chronic Kidney Disease Stage 3

作　　者：陈继红[1] 孙伟[1] 魏连波[2] 刘旭生[3] 袁发焕[4] 周栋[1] 

机构地区：[1]江苏省中医院肾内科 [2]南方医科大学珠江医院中西医结合肾病中心 [3]广东省中医院肾内科 [4]第三军医大学新桥医院肾内科

出　　处：《中医杂志》2013年第4期299-302,共4页Journal of Traditional Chinese Medicine

基　　金："十一五"科技支撑计划资助项目(2006BAI04A07-3);江苏高校优势学科建设工程资助项目(PAPD)

摘　　要：目的评价中医辨证治疗对慢性肾脏病(CKD)3期患者的肾小球滤过率(eGFR)及蛋白尿的影响。方法采用多中心、双盲双模拟、随机对照试验设计方案,选择慢性肾小球肾炎的CKD 3期患者154例,分为中药组(中药颗粒剂+苯那普利模拟剂)、西药组(苯那普利+中药模拟剂)、中西组(中药颗粒剂+苯那普利),连续治疗24周。观察治疗后各组临床疗效,检测治疗前后不同时间患者eGFR、24小时尿蛋白定量的变化。结果中药组、西药组、中西组临床总有效率差异无统计学意义(P>0.05)。中药组从治疗后2周起,各时间点eGFR与治疗前比较差异均有统计学意义(P<0.05)。西药组各时间点eGFR与治疗前比较差异均无统计学意义(P>0.05)。中西组除治疗后2周、8周外,其余各时间点与治疗前比较差异均有统计学意义(P<0.05)。在治疗后4周、12周、20周,中药组eGFR均高于西药组(P<0.05)。中药组治疗后12周、24周24小时尿蛋白定量显著上升,与治疗前比较差异均有统计学意义(P<0.05)。中西组、西药组治疗期间与治疗前比较尿蛋白定量未见明显上升(P>0.05)。治疗后24周,中西组24小时尿蛋白定量最少,优于中药组和西药组(P<0.05)。结论中医辨证治疗可明显改善CKD 3期患者的肾功能状况,中西药联用效果更好。Objective To observe the effects of Chinese medicine(CM) on glomerular filtration rate(GFR) and urinary protein excretion for chronic kidney disease(CKD) stage 3.Methods A multi-center,double-blind,double-dummy and randomized controlled trial was conducted.Totally 154 CKD stage 3 patients with primary glomerulonephritis were randomized into the CM group,western medicine(WM) group and integrative medicine(IM) group.The CM group was given CM granules and benazepril analog agent.The WM group was given benazepril and CM granules analog agent.The IM group was given CM granules and benazepril.The treatment lasted for 24 weeks.The therapeutic effect,estimated GFR(eGFR) and 24 hour urine protein(24 hUpr) were observed.Results There was no significant difference between groups in the therapeutic effect(P>0.05).The eGFR in the CM group was significantly increased after treatment,with a significant difference between before treatment and after 2 weeks of treatment(P<0.05).There was no significant difference between before and after treatment in the WM group in eGFR(P>0.05).The eGFR in the IM group was significantly increased after treatment except the 2nd and 8th week(P<0.05).Comparing with the WM group,the eGFR was significantly increased in the CM group in the 4th,12th and 20th week(P<0.05).The 24 hUpr was significantly increased in the CM group after 12 and 24 weeks of treatment(P<0.05).There was no significant difference between before and after treatment in the WM group and IM group in 24 hUpr(P>0.05).Comparing with the CM group and WM group,the 24 hUpr was the lowest in the IM group after 24 weeks of treatment(P<0.05).Conclusion Chinese medicine can obviously improve the renal function for CKD stage 3 patients,especially reducing proteinuria and protecting renal function when combined with western medicine.

关 键 词：慢性肾脏病 肾小球滤过率 24小时尿蛋白定量 补益气血 活血祛瘀 清化湿热 祛风除湿 

分 类 号：R277.5[医药卫生—中医学]