川黄方对2~4期慢性肾脏病合并急性肾损伤患者肾功能及氧化应激的影响  

Effects of Chuanhuang Decoction on renal function and oxidative stress in patients of chronic kidney disease at stage 2-4 complicated with acute kidney injury

作　　者：龚学忠[1] 段怡汝 王怡[2] 叶紫 郑君丽[1] 陆文[3] 徐映茹 吕岚 GONG Xuezhong;DUAN Yiru;WANG Yi;YE Zi;ZHENG Junli;LU Wen;XU Yingru;LYU Lan(Department of Nephrology,Shanghai Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese M edicine,Shanghai 200071,China;Department of Nephrology,Yueyang Hospital of Integrated Traditional Chinese and W estern Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China;Department of Nephrology,Baoshan Branch of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201900,China;Department of Laboratory,Shanghai Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200071,China)

机构地区：[1]上海中医药大学附属市中医医院肾内科,上海200071 [2]上海中医药大学附属岳阳中西医结合医院肾内科,上海200437 [3]上海中医药大学附属曙光医院宝山分院肾内科,上海201900 [4]上海中医药大学附属市中医医院检验科,上海200071

出　　处：《上海中医药大学学报》2020年第1期11-16,共6页Academic Journal of Shanghai University of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(81873280,81573936);上海市科委中医引导类项目(17401933800);上海申康医院发展中心新兴前沿项目(SHDC12015126).

摘　　要：目的:观察川黄方对2~4期慢性肾脏病(CKD)合并急性肾损伤(AKI)患者的临床疗效,并从氧化应激角度探讨其疗效机制。方法:纳入84例CKD合并AKI患者,随机分为治疗组42例和对照组42例。所有患者均给予基础治疗(纠正水、电解质、酸碱平衡紊乱,控制血压等),对照组患者在此基础上给予前列腺素E1注射液静脉滴注,治疗组在对照组治疗基础上给予川黄方汤剂口服及浓煎剂灌肠,两组疗程均为2周。评价并比较两组患者的临床疗效及中医证候积分,检测并比较两组患者的血肌酐(Scr)、血尿素氮(BUN)、血尿酸(UA)、24 h尿蛋白定量(24 h U-pro)、估算的肾小球滤过率(eGFR)及血清血红素加氧酶-1(HO-1)、丙二醛(MDA)、超氧化物歧化酶(SOD)的水平。结果:①治疗后,治疗组的临床总有效率为71.4%,对照组为45.2%,两组间比较差异有统计学意义(P<0.01),治疗组的疗效优于对照组。②治疗后,两组患者的中医证候积分较治疗前均显著降低(P<0.01),且治疗组患者的积分下降程度较对照组更明显(P<0.05)。③治疗后,两组患者的Scr、BUN、UA水平较治疗前均明显降低(P<0.05,P<0.01),eGFR水平较治疗前显著升高(P<0.05,P<0.01),且治疗组患者的Scr、BUN水平降低程度及eGFR水平升高程度较对照组更明显(P<0.05,P<0.01);两组患者的24 h U-pro较治疗前均降低(P<0.05),且治疗组患者的24 h U-pro降低程度较对照组更明显(P<0.05)。④治疗后,两组患者的血清HO-1、SOD水平较治疗前显著升高(P<0.05),MDA水平较治疗前显著降低(P<0.05,P<0.01),且治疗组患者的HO-1、SOD水平升高程度及MDA水平降低程度较对照组更明显(P<0.05)。结论:川黄方能有效减轻CKD合并AKI患者的肾损伤、保护肾功能,改善患者的中医证候,其机制可能与抑制氧化应激有关。Objective:To observe the clinical efficacy of Chuanhuang Decoction in treating patients of chronic kidney disease(CKD) at stage 2-4 complicated with acute kidney injury(AKI), and explore its mechanisms from the aspect of oxidative stress. Methods:Eighty-four patients of CKD complicated with AKI were enrolled and randomly divided into the treatment group(42 cases) and the control group(42 cases). All the patients were treated with basic therapy, including correcting the disorder of water, electrolyte and acid-base balance, controlling the blood pressure and so on. Based on above, the patients in the control group were treated with intravenous drip of prostaglandin E1 injection, and the patients in the treatment group were treated with Chuanhuang Decoction by oral administration and concentrated Chuanhuang Decoction by coloclysis based on the treatment for the control group. The treatment course of both groups was 2 weeks. The clinical efficacy and the score of Chinese medical syndrome were evaluated and compared, and the levels of serum creatinine(Scr), blood urea nitrogen(BUN), serum uric acid(UA), 24-hour urinary protein(24 h U-pro), estimated glomerular filtration rate(eGFR), heme oxygenase-1(HO-1), malondialdehyde(MDA) and superoxide dismutase(SOD) were detected and compared. Results: ①After treatment, the total clinical effective rates of the treatment group and the control group were 71.4% and 45.2% respectively, with statistically significant difference between the two groups(P<0.01), and the efficacy of the treatment group was better than that of the control group. ②After treatment, the score of Chinese medical syndrome was significantly decreased in the two groups compared with treatment before(P<0.01), and the decrease of the score in the treatment group was greater than that in the control group(P<0.05). ③After treatment, the levels of Scr, BUN and UA were significantly decreased in the two groups compared with treatment before(P<0.05,P<0.01), the level of eGFR was significantly increased compared

关 键 词：慢性肾脏病 急性肾损伤 川黄方 前列腺素E1 氧化应激 解毒化瘀法 

分 类 号：R277.5[医药卫生—中医学]