川黄方联合前列腺素E1方案治疗慢性肾脏病合并急性肾损伤的疗效及对患者NLRP3的影响  

Effects of Chuanhuang Formula combined with prostaglandin E1 in treating patients of chronic kidney disease complicated with acute kidney injury and its influence on NLRP3

作　　者：龚学忠[1] 叶紫 徐向南[3] 陈陵 徐映茹 原道川 王丹军 刘建联 李同路 GONG Xuezhong;YE Zi;XU Xiangnan;CHEN Ling;XU Yingru;YUAN Daochuan;WANG Danjun;LIU Jianlian;LI Tonglu(Department of Nephrology,Shanghai Municipal Hospital of Fradilional Chinese Medicine,Shanghai University oi Traditional Chinese Medicine,Shanghai 200071,China;Xujing Town Community Health Service Center of Qingpu District,Shanghai 201702,China;Department of Thoracic Surgery,Shanghai General Hospital,Shanghai 200080,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]上海市青浦区徐泾镇社区卫生服务中心,上海201702 [3]上海市第一人民医院胸外科,上海200080

出　　处：《上海中医药大学学报》2021年第6期12-16,共5页Academic Journal of Shanghai University of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(82074387,81873280);上海市科委医学创新研究专项项目(20Y21902200)。

摘　　要：目的:观察川黄方联合前列腺素E1方案治疗慢性肾脏病(CKD)合并急性肾损伤(AKI)患者的临床疗效,并从Nod样受体蛋白3(NLRP3)炎症小体角度探讨其疗效机制。方法:将103例符合纳入标准的CKD合并AKI(A on C)患者随机分为治疗组52例和对照组51例。所有患者均给予西医基础治疗,对照组患者在基础治疗同时给予前列腺素E1注射液静脉滴注,治疗组患者在对照组基础上给予川黄方口服加灌肠治疗,两组疗程均为2周。评估两组患者的临床疗效及中医证候积分;治疗前后检测所有患者的血肌酐(Scr)、血尿素氮(BUN)、血尿酸(UA)、肾小球滤过率估计值(eGFR)、24 h尿蛋白定量(24 h UPro)及血清NLRP3、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)的水平。结果:(1)临床疗效:治疗后,治疗组患者的临床总有效率为73.1%,对照组为33.3%,治疗组的疗效优于对照组(P<0.01)。(2)中医证候积分:治疗后,两组患者的中医证候总积分较治疗前均显著降低(P<0.01),且治疗组患者的总积分低于对照组(P<0.05)。(3)肾功能指标:治疗后,两组患者的Scr、UA水平较治疗前均降低(P<0.05,P<0.01),eGFR水平均升高(P<0.05,P<0.01),治疗组患者的BUN水平较治疗前亦降低(P<0.01),且治疗组患者的Scr、BUN、UA水平低于对照组(P<0.05),eGFR水平高于对照组(P<0.05)。(4)24 h UPro:治疗后,治疗组患者的24 h UPro水平较治疗前明显降低(P<0.01),且明显低于对照组(P<0.05)。(5)炎症指标:治疗后,两组患者的IL-6、TNF-α、hs-CRP水平较治疗前均降低(P<0.05,P<0.01),治疗组患者的NLRP3水平较治疗前亦降低(P<0.01),且治疗组患者的IL-6、TNF-α及NLRP3水平低于对照组(P<0.05)。结论:与单用前列腺素E1治疗相比,川黄方联合前列腺素E1治疗能更好地减轻A on C患者的肾脏损伤,其疗效机制可能与调节患者的炎症状态有关。Objective: To observe the clinical efficacy of Chuanhuang Formula combined with prostaglandin E1 regimen in treating patients of chronic kidney disease(CKD) complicated with acute kidney injury(AKI), and explore its therapeutic mechanisms from the perspective of Nod-like receptor protein 3(NLRP3) inflammasome. Methods: A total of 103 patients of CKD complicated with AKI(Aon C)who met the inclusion criteria were randomly divided into the treatment group(52 cases) and control group(51 cases). All patients were treated with basic therapy of western medicine. The patients in the control group were intravenously treated with prostaglandin E1 injection based on the basic treatment, and the patients in the treatment group were treated with Chuanhuang Formula by oral administration and 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 in both groups were evaluated. Before and after treatment, the levels of serum creatinine(Scr), blood urea nitrogen(BUN), blood uric acid( UA), estimated glomerular filtration rate( eGFR), 24-hour urinary protein(24 h UPro) and serum NLRP3, interleukin-6(IL-6),tumor necrosis factor-α ( TNF-α) and high sensitive C-reactive protein(hs-CRP) were detected.Results:(1)Clinical efficacy: After treatment, the total clinical effective rates of the treatment group and the control group were 73.1% and 33.3% respectively, and the efficacy of the treatment group was better than that of the control group(P<0.01).(2) Chinese medical syndrome score: After treatment, the total score of Chinese medical syndrome in both groups was significantly decreased compared with that before treatment(P<0.01), and the total score of the treatment group was lower than that of the control group(P<0.05).(3)Indexes of renal function: After treatment, the levels of Scr and UA in both groups were decreased compared with those before treatment(P<0.05,P<0.01), the level of eGFR was increased(P<0.05,P<0.01), t

关 键 词：慢性肾脏病 急性肾损伤 川黄方 前列腺素E1 NLRP3炎症小体 

分 类 号：R692[医药卫生—泌尿科学]