黄连解毒汤加减治疗脓毒症相关性急性肾损伤的临床观察  

Clinical Observation of Modified Huanglian Jiedu Decoction for the Treatment of Sepsis-Associated Acute Kidney Injury

作　　者：植晓彤 吴思慧[2] 王怡欣 翁书和[2] ZHI Xiao-Tong;WU Si-Hui;WANG Yi-Xin;WENG Shu-He(Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;The Affiliated TCM Hospital of Guangzhou Medical University,Guangzhou 510145 Guangdong,China)

机构地区：[1]广州中医药大学,广东广州510405 [2]广州中医药大学第一附属医院,广东广州1510405 [3]广州医科大学附属中医医院,广东广州510145

出　　处：《广州中医药大学学报》2023年第3期609-614,共6页Journal of Guangzhou University of Traditional Chinese Medicine

摘　　要：【目的】观察黄连解毒汤加减辅助治疗脓毒症相关性急性肾损伤(SA-SKI)的临床疗效。【方法】将26例SA-AKI热毒炽盛证患者随机分为观察组和对照组,每组各13例。对照组给予常规西医治疗,观察组在对照组常规西医治疗基础上辅助使用黄连解毒汤加减治疗,疗程为7 d。观察2组患者治疗前后外周血降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)、血肌酐(SCr)、尿素氮(BUN)、胱抑素C(sCysC)、血β2微球蛋白(β2-MG)及肾小球滤过率(e GFR)的变化情况,比较2组患者治疗后急性生理与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分、序贯器官功能衰竭评估(SOFA)评分及ICU住院时间和死亡情况。【结果】(1)住院天数及临床转归方面:治疗后,观察组死亡1例(7.7%),对照组死亡2例(15.4%),差异无统计学意义(P>0.05);观察组的ICU住院天数为(11.00±4.04)d,较对照组的(13.23±4.94)d有所缩短,但差异无统计学意义(P>0.05);预后评估方面,观察组治疗后的APACHE Ⅱ评分、SOFA评分均明显低于对照组(P<0.05)。(2)肾功能指标方面:治疗后,观察组的SCr、BUN、sCysC水平较治疗前降低(P<0.05),eGFR水平较治疗前升高(P<0.05),而对照组仅SCr水平较治疗前降低(P<0.05),sCysC水平甚至较治疗前明显升高(P<0.05);组间比较,观察组对SCr、BUN、sCysC水平的降低作用及对eGFR水平的升高作用均明显优于对照组(P<0.05);而2组β2-MG比较,差异无统计学意义(P>0.05)。(3)炎症指标方面:治疗后,2组患者的CRP、PCT、WBC水平均较治疗前降低,除WBC外,差异均有统计学意义(P<0.05);组间比较,观察组对CRP、PCT水平的降低作用明显优于对照组(P<0.05),而2组WBC比较,差异无统计学意义(P>0.05)。【结论】黄连解毒汤加减辅助治疗SA-AKI热毒炽盛证患者疗效确切,可有效抑制炎症反应,改善患者肾功能。Objective To observe the clinical efficacy of modified Huanglian Jiedu Decoction for the treatment of sepsis-associated acute kidney injury(SA-AKI). Methods Twenty-six patients with SA-AKI of abundance of heat toxin syndrome were randomly divided into the observation group and the control group,with 13 patients in each group. The control group was given conventional western medical treatment, while the observation group was treated with modified Huanglian Jiedu Decoction plus the conventional western medical treatment for the control group. Both groups were treated for 7 days. The changes in peripheral blood procalcitonin(PCT), C-reactive protein(CRP), white blood cell(WBC) count, serum creatinine(SCr), blood urea nitrogen(BUN), serum cystatin C(sCysC),blood β2 microglobulin(β2-MG)and estimated glomerular filtration rate(eGFR)of the two groups before and after treatment were observed. The Acute Physiological and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,Sequential Organ Failure Assessment(SOFA)score,the length of stay in ICU and death rate in the two groups were compared after treatment. Results(1)After treatment,there was one death(7.7%)in the observation group and two deaths(15.4%)in the control group,and the difference was not statistically significant(P>0.05). The duration of ICU stay in the observation group was 11.00 ± 4.04 days,which was shorter than that in the control group(13.23 ± 4.94 days),but the difference was not statistically significant(P>0.05). In terms of prognostic assessment,the APACHE Ⅱ score and SOFA score in the observation group were significantly lower than those in the control group after treatment(P<0.05).(2)After treatment,the renal function parameters of SCr,BUN and sCysC levels were decreased(P<0.05)and the e GFR level was increased in the observation group compared with those before treatment(P<0.05), while in the control group only the SCr level was decreased(P<0.05)and the sCysC level was even significantly increased compared with that before treatment(P<0.05). The int

关 键 词：黄连解毒汤 脓毒症 急性肾损伤 热毒炽盛证 炎症反应 肾功能 

分 类 号：R269.31[医药卫生—中西医结合]