慢性肾衰竭急剧加重湿热证患者血清FGF23水平变化与钙磷代谢的相关性及清肾颗粒的干预作用  

The Variations of Serum FGF23 and 1,25( OH)_2 VitD_3 in Sharp Deterioration Damp-heat Syndrome of Chronic Renal Failure and the Intervention Effect of Qingshen Granule

作　　者：王亿平[1] 丁仁华[1] 王东[1] 茅燕萍[1] 吕勇[1] 刘玲[1] 王立媛[1] 

机构地区：[1]安徽中医药大学第一附属医院,合肥230031

出　　处：《中国中西医结合肾病杂志》2015年第8期687-690,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：安徽省科技攻关项目(No.12010402117)

摘　　要：目的:观察慢性肾衰竭(CRF)急剧加重湿热证患者血清FGF-23水平变化与钙磷代谢的相关性及清肾颗粒的干预作用。方法:选择60例CRF急剧加重湿热证患者随机分为治疗组30例和对照组30例,并设正常对照组30例。均在西药常规治疗同时使用黄苓解毒泄浊颗粒保留灌肠,治疗组加用清肾颗粒,每次1袋(10 g),每日3次口服,疗程8周。检测两组临床疗效及治疗前后血清成纤维细胞生长因子23(FGF-23)、1,25-二羟基维生素D3[1,25(OH)2Vit D3]、全段甲状旁腺激素(i PTH)、血钙(Ca2+)和血磷(P3-)水平变化情况,并与正常组比较。结果:治疗组临床疾病总有效率为86.67%,优于对照组73.33%(P<0.05);治疗组中医证候总有效率为90.00%,明显高于对照组60.00%(P<0.01)。两组患者治疗前血清FGF-23水平明显高于正常对照组(P<0.01),血清1,25(OH)2Vit D3水平明显低于于正常对照组(P<0.01);治疗后两组血FGF-23水平均下降,血清1,25(OH)2Vit D3水平均升高,且治疗组优于对照组(P<0.05或P<0.01)。两组治疗后血清i PTH和P3-水平较治疗前均明显降低(P<0.05),血Ca2+水平较治疗前明显升高(P<0.05)。结论:CRF急剧加重湿热证患者血清FGF-23、i PTH水平升高,1,25(OH)2Vit D3水平下降,清肾颗粒可降低患者血清FGF-23水平,升高1,25(OH)2Vit D3水平,能改善肾功能,减轻临床症状,其机制之一可能与其降低患者血清FGF-23水平有关。Objective： To observe the changes of serum fibroblast growth factor - 23 （ FGF - 23 ）, 1,25 （OH） 2 VitD3, intact parathyroid hormon（iPTH） in sharp deterioration damp -heat syndrome（DHS） of chronic renal failure（CRF） and the curative efficacy of Qingshen granule （QSG,清肾颗粒）. Methods：Sixty cases were divided into treatment group（ n = 30） and control group（ n = 30）. Normal control group （n = 30） was set up too. All were treated with conventional western medical therapy combining with retention enema of HuangLing Jiedu Xiezhuo（ HLJDXZ）, but for patients in the treated group, QSG was given additionally, 1 bag thrice a day by oral intake. The therapeutic course for all was 8 weeks. The levels of serum FGF -23,1,25 （OH）2 VitD3 ,iPTH, Ca2 ＋ and p3- were observed before and after treatment, and were compared with those in the normal control. Results ：The total effective rate of clinical effect in the treatment group was 86.67%, which was better than that in the control group 73.33% （P 〈0.05）. The total effective rate of syndrome of TCM in the treatment group was 90.00%, and obviously higher than the control group＇ s 60.00% （ P 〈 0. 01 ）. Compared with the normal control group, the levels of serum FGF - 23 in the treatment group were obviously higher （ P 〈 0.01 ） and serum 1,25 （OH） 2 VitD3 were obviously lower （P 〈 0. 01 ）. There were not significant diversity in these indexes between the treatment group and the control group before therapy （ P 〉 0.05 ）. The levels of serum FGF - 23 decreased significantly （ P 〈 0. 01 ） and the levels of serum 1,25 （OH） 2 VitD3 increased significantly （ P 〈 0. 05 ） in the treatment group after therapy with QSG, but the changes in control group are not so much （P 〈 0.05）. There is significant diversity in the two groups after therapy （ P 〈 0. 05 ）. The levels of serum iPTH and p3 - decreased significantly （ P 〈 0.05 ） and the levels of serum Ca2 ＋ increased sig

关 键 词：慢性肾衰竭 急剧加重 湿热证 成纤维细胞生长因子23 清肾颗粒 

分 类 号：R692.5[医药卫生—泌尿科学]