益气温阳活血利水方对心肾综合征患者临床疗效和肠道菌群的影响  

Clinical effect of Yiqiwenyang Huoxuelishui prescription on patients with cardiorenal syndrome and its influence on gut flora

作　　者：王琴[1] 林萍[1] 任谦[1] 李鹏[1] 冯莉[1] 谢晓枫 刘晓赟 张彬 Wang Qin;Lin Ping;Ren Qian;Li Peng;Feng Li;Xie Xiaofeng;Liu Xiaoyun;Zhang Bin(Department of Geriatrics, The Third Hospital of Hangzhou, Hangzhou 310009, Zhejiang, China)

机构地区：[1]杭州市第三人民医院老年科,浙江杭州310009

出　　处：《中国中西医结合急救杂志》2018年第6期581-585,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省中医药科技计划项目(2015ZB082);杭州市医药卫生科研项目(20140633B16);杭州市医疗卫生科研项目(20150633B13);杭州市卫生计生科技计划项目(2018A29).

摘　　要：目的观察益气温阳、活血利水方对心肾综合征(CRS)患者临床疗效及肠道菌群的影响。方法选择2015年1月至2016年12月在杭州市第三人民医院老年科住院确诊为CRS心肾阳虚证患者69例,将患者按是否接受中药治疗分为两组。对照组(33例)采用西医常规治疗,中西医结合组(32例)在西药常规治疗基础上加用益气温阳、活血利水方100mL、每日2次,两组疗程均为8周。观察两组治疗前后左室射血分数(LVEF)、血浆N末端B型钠尿肽前体(NT-proBNP)、糖类抗原-125(CA-125)、生长分化因子(GDF-11、15)、血肌酐(SCr)、血尿素氮(BUN)和肠道菌群的变化及不良反应发生率;比较两组患者治疗后的临床疗效。结果两组患者治疗后LVEF及肠道菌群中双歧杆菌、乳酸杆菌均较治疗前明显升高,NT-proBNP、GDF-15、GDF-11、CA-125、SCr、BUN及肠道中肠球菌和肠杆菌数均较治疗前明显降低,且中西医结合组治疗后上述指标的变化较对照组更显著〔LVEF:0.51±0.10比0.46±0.08,NT-proBNP(ng/L):658±45比814±57,GDF-15(ng/L):604±32比708±36,CA-125(U/L):4.50±0.33比5.10±0.37,GDF-11(ng/L):491±19比594±23,SCr(μmol/L):105±11比125±13,BUN(mmol/L):8.1±3.5比9.7±4.2,双歧杆菌(cfu/g):8.23±0.46比7.54±0.33,乳酸杆菌(cfu/g):7.96±0.31比7.09±0.23,肠球菌(cfu/g):6.32±0.19比7.15±0.28,肠杆菌(cfu/g):6.13±0.33比7.18±0.37,均P<0.05〕。中西医结合组有2例服药初期有轻度腹胀、恶心,1例轻度腹泻,均属正常现象,无须停药。两组患者均未出现低血压,未见肝肾功能损害。中西医结合组治疗后总有疗效率明显高于西医对照组〔87.5%(28/32)比60.6%(20/33),P<0.05〕。结论益气温阳、活血利水方治疗CRS安全有效,可提高患者临床疗效,改善患者肠道菌群。Objective To observe the clinical therapeutic effect of Yiqiwenyang Huoxuelishui [a traditional Chinese medicine (TCM) prescription] on patients with cardiorenal syndrome (CRS) and its influence on gut flora. Methods Sixty-nine patients with definite diagnosis of CRS accompanied by heart-kidney yang deficiency admitted to Department of Geriatrics of the Third People's Hospital of Hangzhou from January 2015 to December 2016 were enrolled, and the patients were divided into two groups according to whether they received traditional Chinese medicine (TCM) or not. The control group (33 cases) was treated with only western medicine; the combination group (32 cases) was treated with conventional western medicine in addition of 100 mL of Yiqiwenyang Huoxuelishui decoction oral administration, twice a day, and the therapeutic course of both groups was 8 weeks. Before and after treatment, the level changes of left ventricular ejection fraction (LVEF), plasma N-terminal pro-brain natriuretic peptide (NT-proBNP), carbohydrate antigen-125 (CA-125), growth differentiation factor-15 (GDF-15), growth differentiation factor-11 (GDF-11), blood creatinine (SCr), blood urea nitrogen (BUN), gut flora changes and the incidence of adverse reactions were observed in the two groups; after treatment, the clinical therapeutic effect of the two groups were compared. Results After treatment, the levels of LVEF and bifidobacteria, lactobacilli in intestinal tract of the two groups were significantly higher than those before treatment; while the levels of NT-proBNP, DGF-15, GDF-11, CA-125, SCr, BUN and enterococcus and enterobacter in the two groups were significantly lower than those before treatment, and the changes of the above indicators in combination group were more obvious than those in the control group [LVEF: 0.51±0.10 vs. 0.46±0.08, NT-proBNP (ng/L): 658±45 vs. 814±57, GDF-15 (ng/L): 604±32 vs. 708±36, CA-125 (U/L): 4.50±0.33 vs. 5.10±0.37, GDF-11 (ng/L): 491±19 vs. 594±23, SCr (μmol/L): 105±11 vs. 125±13, BUN (mmol/L):

关 键 词：心肾综合征 益气温阳 活血利水 疗效 肠道菌群 

分 类 号：R259.752[医药卫生—中西医结合]