大黄泄浊方对IgA肾病合并高尿酸血症患者肾小管功能的影响  

Effect of Dahuang Xiezhuo Prescription on Renal Tubular Function in Patients with IgA Nephropathy Complicated with Hyperuricemia

作　　者：张倩 杨凤文[1] 石蒙 刘锦长 王刚[1] 任美芳[1] 赵美姣 毛竞宇 檀金川[1] ZHANG Qian;YANG Fengwen;SHI Meng;LIU Jinchang;WANG Gang;REN Meifang;ZHAO Meijiao;MAO Jingyu;TAN Jinchuan(Hebei Provincial Hospital of Traditional Chinese Medicine(TCM),Shijiazhuang 050011,China;Yixian Hospital of TCM,Baoding 074200,China;Xiong County Hospital of TCM,Baoding 071800,China;Hebei University of Chinese Medicine,Shijiazhuang 050200,China)

机构地区：[1]河北省中医院,石家庄050011 [2]易县中医医院,河北保定074200 [3]雄县中医医院,河北保定071800 [4]河北中医学院,石家庄050200

出　　处：《中国实验方剂学杂志》2023年第12期135-141,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河北省中医药管理局科研计划课题(2021046)。

摘　　要：目的:观察大黄泄浊方对慢性肾脏病(CKD)1~2期免疫球蛋白A(IgA)肾病合并高尿酸血症(HUA)患者的临床症状、血尿酸及肾小管功能的影响。方法:将中医辨证为脾肾两虚浊瘀互结证的60例CKD1~2期IgA肾病合并HUA患者随机分为观察组和对照组各30例。对照组予基础治疗,氯沙坦钾片50~100 mg/次,1次/d及碳酸氢钠片0.5 g/次,3次/d口服,配合低盐低脂饮食、低嘌呤饮食;观察组在基础治疗基础上予以大黄泄浊方,每日1剂,分早晚2次温水冲服,2组患者均治疗2个月。分别于治疗前及治疗后2个月记录观察组和对照组患者的中医证候总积分、血压和24 h尿蛋白定量(UTP)、尿素氮(BUN)、血肌酐(SCr)[按慢性肾病流行病学合作研究(CKD-EPI)公式计算肾小球滤过率(eGFR)]、血尿酸(SUA)、肾小管功能指标[尿α1-微球蛋白(α_(1)-MG)、尿β_(2)-微球蛋白(β_(2)-MG)、尿液中的肾损伤分子-1(KIM-1)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)],并于治疗2个月评定2组患者的临床疗效。结果:治疗2个月后,观察组总有效率为81.48%(22/27),对照组的总有效率为50.00%(14/28),观察组明显高于对照组,差异具有统计学意义(χ^(2)=6.661,P<0.05)。与本组治疗前比较,观察组和对照组患者的中医证候总积分、UTP、SUA均明显降低(P<0.05);与对照组治疗后比较,观察组降低更明显(P<0.05)。与本组治疗前比较,观察组和对照组患者的血压均明显降低(P<0.05);与对照组治疗后比较,治疗后2组患者血压差异无统计学意义。与本组治疗前比较,2组患者尿α_(1)-MG、β_(2)-MG、KIM-1和NGAL水平均明显降低(P<0.05);与对照组治疗后比较,观察组患者降低更明显(P<0.05)。2组患者BUN、SCr、eGFR水平治疗前后组内和组间比较差异均无统计学意义。2组患者治疗前后血常规、肝功能、电解质均无明显异常,未出现过敏等不良反应。结论:大黄泄浊方可有效改善脾肾两虚浊瘀互结证Objective:To observe the effect of Dahuang Xiezhuo prescription on the clinical symptoms,blood uric acid,and renal tubular function of patients with immunoglobulin A(IgA) nephropathy in stages 1-2 of chronic kidney disease(CKD) complicated with hyperuricemia(HUA).Method:Sixty patients with IgA nephropathy in stages 1-2 of CKD complicated with HUA of spleen and kidney deficiency and combined turbidity and blood stasis syndromes were randomly divided into an observation group and a control group,with 30 cases in each group.The patients in the control group received basic treatment,i.e.,losartan potassium tablets 50-100 mg/time,once per day,and sodium bicarbonate tablets 0.5 g/time,three times per day by oral administration,combined with low-salt,low-fat,and low-purine diet.The patients in the observation group received Dahuang Xiezhuo prescription on the basis of basic treatment,one dose per day,twice a day in the morning and evening with warm water.Both groups were treated for two months.The total scores of traditional Chinese medicine(TCM)syndrome,blood pressure,24 h urinary protein(24 h UTP),blood urea nitrogen(BUN),serum creatinine(SCr) [glomerular filtration rate(eGFR) was calculated by CKDepidemiology collaboration(CKD-EPI) formula],serum uric acid(SUA),and renal tubular function indexes [urinary α1-microglobulin(α_(1)-MG),urinary β_(2)-microglobulin(β_(2)-MG),urinary kidney injury molecule-1(KIM-1),and neutrophil gelatinase-associated lipocalin(NGAL)] of the two groups before treatment and two months after treatment were recorded.The clinical efficacy of the two groups was evaluated two months after treatment.Result:After 2 months of treatment,the total effective rate in the observation group was 81.48%(22/27),higher than 50.00%(14/28) in the control group(χ^(2) =6.661,P<0.05).The total scores of TCM syndrome,24 h UTP,and SUA in the observation group and the observation group were lower than those before treatment(P<0.05),and compared with the control group after treatment,the observation group decrease

关 键 词：IGA肾病 高尿酸血症 脾肾两虚 浊瘀互结 大黄泄浊方 肾小管功能 

分 类 号：R242[医药卫生—中医临床基础] R2-031[医药卫生—中医学] R442.2R692