益肾降浊冲剂对维持性血液透析患者营养不良的临床研究  

Clinical Study of Soluble Granules of Yishen Jiangzhuo on Malnutrition in Patients with Maintenance Hemodialysis

作　　者：洪江淮[1] 王建挺[1] 郑素琴[2] 丘余良[1] 吴竞[1] 阮诗玮[1] 

机构地区：[1]福建中医药大学附属人民医院肾病科,福建福州350004 [2]福州职业技术学院,福建福州350108

出　　处：《中华中医药学刊》2014年第10期2400-2403,共4页Chinese Archives of Traditional Chinese Medicine

基　　金：福建省教育厅科研项目(JB09150);福建省卫生厅科研项目(wzzsb0905)

摘　　要：目的:探讨益肾降浊冲剂治疗维持性血液透析(MHD)患者营养不良的疗效,并试图探讨其作用机制。方法:60例入选的维持性血液透析患者随机分成治疗组30例,对照组30例。治疗组为常规治疗+益肾降浊冲剂,对照组应用常规治疗。干预治疗3个月,观察治疗前和治疗后的中医临床证候疗效、实验室检查、单室KT/V(spKT/V)、主观综合营养评估(SGA)以及人体测量指标进行分析比较。实验室检查包括血清白蛋白(Alb)、血清前白蛋白(PA)、血红蛋白(HGB)、C-反应蛋白(CRP)以及血清瘦素(Leptin)。人体测量指标包括体重指数(BMI)、三头肌皮褶厚度(Triceps skin fold,TSF)和上臂中部周径(MAC)。结果:1两组治疗前后比较,ALB、PA、HGB水平均有显著性升高(P<0.05,P<0.01),各项指标的升高水平治疗组均优于对照组(P<0.05,P<0.01)。2两组治疗后CRP水平均有显著性降低(P<0.01),治疗组优于对照组(P<0.05)。治疗组治疗后血清Leptin明显下降(P<0.01)。3与治疗前相比,治疗组治疗后BMI和MAC均有显著升高(P<0.05)。460例脾肾气虚型MHD营养不良患者中医证候积分与Alb、PA、BMI、TSF、MAC、HGB、spKT/V均负相关;与血清Leptin、CRP正相关。5两组治疗后中医临床症状明显改善,治疗组中医证候积分改善程度优于对照组(P<0.01);治疗组中医证候改善的总有效率83.33%,对照组总有效率为56.67%,治疗组明显优于对照组(P<0.01);治疗组治疗后SGA分级明显优于对照组(P<0.01)。结论:1益肾降浊冲剂配合西医常规治疗具有降低脾肾气虚型MHD营养不良患者血清Leptin的作用,能够更有效的改善MHD患者体内的慢性炎症状态、改善贫血、增加血清蛋白的合成。2中医证候积分与营养指标密切相关。益肾降浊冲剂配合西医常规治疗从整体上改善了脾肾气虚型MHD患者营养不良,临床疗效优于对照组。Objective：To observe the clinical efficacy of the soluble granules of Yishen Jiangzhuo on malnutrition of maintenance hemodialysis（MHD） and to study the mechanism. Methods Sixty uremia patients in hemodialysis were randomly assigned to the treatment group and the control group using random digit table,30 in each. On the basis of routine treatment,the patients in the treatment group were additionally given the soluble granules of Yishen Jiangzhuo. The treatment course was 3 months. The clinical efficacy,traditional Chinese medicine（TCM） syndrome integral,laboratory examinations,single room KT /V（spKT /V）,subjective global assessment（ SGA） and anthropometric measurements were observed before and after treatment. Laboratory examinations included serum albumin（Alb）,prealbumin（PA）,hemoglobin（HGB）,C-reactive protein（CRP） and Leptin were observed. Results：1After three months of treatment,the levels of ALB,PA and HGB were significantly increased in two groups before and after treatment（P〈0. 05,P〈0. 01）. Compared with the control group,the levels of ALB,PA and HGB increased more obviously in the treatment group（ P〈0. 05,P〈0. 01）. 2The CRP levels in two groups decreased significantly before and after treatment（P〈0. 01）. Compared with the control group,the levels of CRP and the serum Leptin decreased more obviously in the treatment group compared with the control group（P〈0. 05,P〈0. 01）. 3Compared with before treatment,the levels of BMI and MAC in the treatment group increased more obviously after treatment（P〈0. 05）. 4Correlation analyses showed that obvious negative correlation existed between the Chinese medicine syndrome integral and the levels of ALB,PA,BMI,TSF,MAC,HGB and spKT /V,and obvious positive correlation existed between the Chinese medicine clinical syndrome integral and the levels of serum Leptin and CRP. 5The Chinese medicine clinical symptoms in the treatment group were obviously improved after the treatment,showing statistical difference

关 键 词：维持性血液透析 营养不良 脾肾气虚 益肾降浊冲剂 

分 类 号：R285.6[医药卫生—中药学]