益肾泻浊方对慢性肾脏病3~4期患者肠道屏障及黏膜免疫功能的影响  

Effect of Yishen Xiezhuo Decoction on intestinal barrier and mucosal immune function in patients with chronic kidney disease of stage 3-4

作　　者：王祎熙[1] 李霞 岑洁 须冰[1] WANG Yixi;LI Xia;CEN Jie;XU Bing(Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China;Integrated Traditional Chinese and Western Medicine Hospital of Minhang District, Shanghai 200241, China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院,上海200437 [2]上海市闵行区中西医结合医院,上海200241

出　　处：《现代中西医结合杂志》2021年第28期3079-3083,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：上海市卫生和计划生育委员会中医药科研课题(2018LQ019);上海市进一步加快中医药事业发展三年行动计划中医重点专科培育项目。

摘　　要：目的探讨益肾泻浊方治疗脾肾阳虚证慢性肾脏病3~4期患者的临床疗效及对肠道屏障、黏膜免疫功能的影响。方法选择2019年7月—2020年8月上海中医药大学附属岳阳中西医结合医院及上海市闵行区中西医结合医院收治的脾肾阳虚证慢性肾脏病3~4期患者60例,随机分为对照组及治疗组,每组30例。2组均予低盐、低磷、优质低蛋白、低嘌呤饮食,控制血压、血糖、血脂,补充必需氨基酸等一般治疗。对照组同时予药用炭片口服,治疗组予益肾泻浊方口服,2组疗程均为6周。观察2组治疗后中医症状积分、肝肾功能[肾小球滤过率(eGFR)、肌酐(SCr)、尿素氮(BUN)、尿酸(UA)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)]、血电解质、血浆内毒素及D-乳酸、粪便分泌型IgA(sIgA)变化及临床疗效。结果治疗后,治疗组畏寒肢冷、倦怠乏力、腰膝酸软积分和对照组腰膝酸软积分及2组中医症状总积分均明显降低(P均<0.05),且治疗组腰膝酸软积分及中医症状总积分明显低于对照组(P均<0.05);治疗组BUN、SCr、UA、内毒素、D-乳酸水平及对照组UA水平均明显降低(P均<0.05),2组eGFR均明显升高(P均<0.05),2组治疗后各指标比较差异均无统计学意义(P均>0.05)。治疗组总有效率为66.7%(20/30),对照组总有效率为46.7%(14/30),组间比较差异无统计学意义(P>0.05)。结论益肾泻浊方能显著改善脾肾阳虚证慢性肾脏病3~4期患者的中医症状,降低血浆内毒素及D-乳酸水平,改善肠道黏膜屏障功能,能通过调节“肠-肾轴”从而起到改善肾功能的作用。Objective It is to evaluate the clinical efficacy of Yishen Xiezhuo Decoction on chronic kidney disease(CKD)of stage 3-4 with spleen and kidney Yang deficiency and its influence on intestinal barrier and mucosal immune function.Methods Sixty patients with CKD of stage 3-4 with spleen and kidney Yang deficiency treated in Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine and Integrated Traditional Chinese and Western Medicine Hospital of Minhang District from July 2019 to August 2020 were randomly divided into treatment group and control group,30 patients in each group.Both group were given low-salt,low-phosphorus,high-quality,low-protein and low-purine diet and were treated with normal therapy such as controlling blood pressure,blood sugar,blood lipids and supplementing essential amino acids.In addition,the control group received medicinal charcoal tablets and the treatment group was treated with Yishen Xiezhuo Decotion.Both groups were treated for 6 weeks.The changes of the scores of TCM symptoms,liver and kidney functions[glomerular filtration rate(eGFR),creatinine(SCr),urea nitrogen(BUN),uric acid(UA),alanine aminotransferase(ALT),Aspartate aminotransferase(AST)],blood electrolytes,plasma endotoxin and D-lactic acid,fecal secretory IgA(sIgA)were observed and clinical efficacy was assessed after treatment in the two groups.Results After treatment,the scores of aversion to cold and cold limb,fatigue,soreness and weakness of waist and knees in the treatment group and the scores of soreness and weakness of waist and knees in the control group,and the total score of TCM syndrome in both groups were decreased(all P<0.05),the scores of soreness and weakness of waist and knees and the total score of TCM syndrome were significantly lower in the treatment group than those in the control group after treatment(all P<0.05).After treatment,the levels of BUN,SCr,UA,endotoxin,D-lactic acid in the treatment group and the UA level of the con

关 键 词：慢性肾脏病 益肾泻浊方 肠-肾轴 肠道屏障 肠道黏膜免疫 

分 类 号：R692[医药卫生—泌尿科学]