补肾健脾方保护腹膜透析患者残余肾功能的前瞻性随机对照研究  

A prospective randomized control study of Bushen Jianpi herb formula protecting residual renal function in patients with peritoneal dialysis

作　　者：罗健华[1] 邓跃毅[1] 钟逸斐[1] 张先闻[1] 张春菘[1] 李交[1] 

机构地区：[1]上海中医药大学附属龙华医院肾病科

出　　处：《临床肾脏病杂志》2015年第8期461-464,共4页Journal Of Clinical Nephrology

基　　金：上海市卫生局科研计划课题资助项目(NO.2009165);陈以平上海市名老中医学术经验研究工作室建设项目(NO.ZYSNXD-CC-MZY040);陈以平全国名中医工作室建设项目;上海市中发办中医药事业发展三年行动计划《丁氏内科传人徐嵩年学术思想研究基地建设与发展规划》(NO.ZYSNXD-CC-HPGC-JD-003)

摘　　要：目的探讨我科自拟补肾健脾方是否可保护腹膜透析（peritoneal dialysis，PD）患者残余肾功能（residual renal function，RRF）。方法选择2010年1月1日后开始接受PD治疗的慢性肾衰竭患者70例，随机分为对照组及中药组，每组35例。对照组采用传统方法保护RRF，中药组在对照组治疗基础上加用补肾健脾方。记录2组患者基线、24周及48周时的尿量、透析液用量及腹膜透析超滤量，检测血清、24h腹膜透析液及尿液肌酐、尿素；计算尿素清除指数（Kt／V）、肌酐清除率（creatinine clearance rate，Ccr）、尿素清除率（urea clearance，UCL）及残肾肾小球滤过率（residual glomerular filtration rate，rGFR），rGFR以残肾Ccr及UCL的算数平均数（Ccr＋UCL）／2计算。结果24周时中药组及对照组的尿量、残肾Kt／V、残肾Ccr及rGFR均较基线水平明显降低（P〈0．05或P〈0．01）；与中药组相比，对照组残肾Ccr以及rGFR的降低更显著（P〈0．05），尿量、残肾Kt／V的降低数值更大，但未达到统计学差异（P〉0．05）。48周时2组的尿量、残肾Kt／V、残肾Ccr及rGFR均较基线水平明显降低（P〈0．05或P〈0．01），与中药组相比，对照组尿量、残肾Kt／V、残肾Ccr以及残肾rGFR的降低更显著（P〈0．05或P〈0．01）。组间比较，24周及48周时中药组及对照组的总Kt／V、总Ccr均无显著性差异，但24周及48周时中药组的每日腹透液用量均少于对照组，且在48周达到统计学差异（P〈0．01）。结论补肾健脾方对于维持性腹膜透析患者的RRF具有保护作用，并且可能会减少达到充分透析所需的每日腹透液用量。Objective To explore whether Bushen Jianpi herb formula can protect the residual renal function （RRF） in patients with peritoneal dialysis. Methods Patients with chronic renal failure started PD after 1 January 2010 were randomly divided into control group （C group） and traditional Chinese medicine group （TCM group）. RRF was protected with traditional method in the C group and TCM group, and the TCM group was given the Bushen Jianpi herb formula additionally. The urine volume （UV）, the daily dialysate dosage and uhrafihration volume were observed, the urea and creatinine of serum, 24-h urine and peritoneal dialysis fluid were determined, the residual and total Kt/V, residual and total Ccr and residual renal glomerular filtration rate （rGFR） represented as arithmetic average of creatinine clearance rate （Ccr） and urea clearance （UCL） of residual renal at baseline, 24th week and 48th week were measured. Results In TCM group and C group, the UV （966 ±490 vs. 809 ±580 mL）, residual Kt/V, residual Ccr, residual （Ccr＋ UCL）/2 （2. 66 ± 1.83 vs. 1.72 ±1.22 mL/ min） at 24 th week were significantly decreased as compared with those at baseline （P〈0. 05, P〈 0. 01 ）. As compared with the TCM group, the residual Ccr and residual （Ccr ＋ UCL）/2 at 24th week were decreased significantly in the C group （P〈0. 05）, the UV and residual Kt/V at 24th week decreased more, but showed no statistically significant difference （P〉0. 05）. In the TCM group and C group, the UV （860 ＋ 708 vs. 525 ＋ 550 mL）, residual Kt/V, residual Ccr, and residual （Ccr ＋ UCL）/2 （1.94 ＋ 1.64 vs. O. 94 ＋ 1.06 mL/min） at 48 th week were significantly decreased as compared with those at baseline （P〈0. 05, P〈0. 01）. As compared with the TCM group, the UV, residual Kt/V, residual Ccr and residual （Ccr＋ UCL）/2 at 48th week were decreased significantly in the C group （P〈0. 05, P〈0. 01）. Between the TCM group and C group, the total Kt/V and total Cer at 24

关 键 词：腹膜透析 残余肾功能 补肾健脾方 

分 类 号：R459.5[医药卫生—治疗学]