复方积雪草组方联合中药结肠透析对CKD4~5期患者的临床疗效及肠道菌群的影响  

Clinical Effects and Influence of Intrinal Microflora of Compound Centella Asiatica Combined with Traditional Chinese Medicine Colon Dialysis in Patients with Chronic Kidney Disease Stages 4~5

作　　者：周柳沙[1] 姜飞[1] 俞东容[1] 倪军[1] 卫彦辰 杨亚珍[1] ZHOU Liusha;JIANG Fei;YU Dongrong(Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University,Hangzhou 310007)

机构地区：[1]浙江中医药大学附属杭州市中医院肾病科,杭州310007

出　　处：《中国中西医结合肾病杂志》2023年第4期300-303,I0003,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：杭州市卫生计生科技计划一般项目(No.2017A61);浙江省中医药科技计划科研基金项目(No.2019ZA087,2023ZL111)。

摘　　要：目的:观察复方积雪草组方联合中药结肠透析治疗CKD4~5期患者的临床疗效及对肠道菌群的影响。方法:将48例CKD4~5期非透析且属肾虚血瘀浊毒证的患者随机分为两组,在基础治疗上,治疗组予复方积雪草组方并联合中药结肠透析;对照组予酪酸梭菌活菌片,治疗12周,观察两组治疗前后的中医证候积分,肾小球滤过率(eGFR),血肌酐(Scr),尿素氮(BUN),血尿酸(UA),血白蛋白(Alb),总胆固醇(TC)等指标,同时粪便标本行细菌16S扩增子测序分析肠道菌群组成及丰度。结果:与治疗前相比,治疗组的Scr及BUN水平未见明显上升(P>0.05);而对照组的Scr及BUN水平均明显升高(P<0.01),两组的eGFR变化率差异有统计学意义(P<0.05)。治疗后,治疗组的Alb水平明显升高,TC水平明显下降;UA水平、中医证候积分显著低于治疗前及对照组,差异均有统计学意义(P<0.05~0.01)。治疗组的临床总有效率81.8%;对照组的总有效率42.3%;两组间比较差异有统计学意义(P<0.01)。两组治疗前优势菌门构成有厚壁菌门、拟杆菌门、变形菌门,两组在治疗前后优势菌群组成均有变化,但差异无统计学意义(P>0.05)。但两组间治疗后菌群组成比较,差异有统计学意义(P<0.05)。结论:通过复方积雪草组方联合中药结肠透析干预后,患者的Scr及eGFR水平稳定,Alb上升,UA及TC水平、中医证候积分较治疗前有明显改善,部分有益菌群的丰度增加。Objective:To observe the clinical efficacy and influence of intestinal microflora of patients with CKD stages 4~5 treated by Compound Centella asiatica combined with TCM colonic dialysis.Methods:A total of 48 patients with CKD Stages 4~5(Non-dialysis state)and TCM syndrome differentiation with kidney qi deficiency,blood stasis and turbidity toxin were randomly divided into two groups,both of them based on the foundation treatment.The treatment group with compound centella asiatica combined with TCM colonic dialysis,and the control group was given Clostridium butyricum live tablet orally.Both groups were treated for 12 weeks.The TCM syndrome score,glomerular filtration rate(eGFR),serum creatinine(Scr),blood urea nitrogen(BUN),serum uric acid(UA),serum albumin(Alb)level,total cholesterol(TC)level and other laboratory indexes of the two groups were observed.Meanwhile,the fecal samples were tested for bacterial 16S amplification sequencing to analyze the composition and abundance of intestinal flora.Results:There were no significant changes in the level of Scr and BUN in the treatment group(P>0.05).But those in the control group were significantly increased after treatment(P<0.01),and the change rate of eGFR between the two groups was statistically significant(P<0.05).The Alb level and Tch level in the treatment group were significantly higher than pretherapy(P<0.05~0.01).The UA level and the TCM syndrome scores in the treatment group was lower than that pretherapy and the control group(P<0.05~0.01).The total effective rate of the treatment group(81.8%)was better than the control group was(42.3%)(P<0.01).Firmicutes,Bacteroidetes and Proteobacteria are the the most abundant types in phyla level in both two groups,they all have changed but the difference was not statistically significant(P>0.05).However,there was a significant difference in the composition of the bacterial community between the two groups after treatment(P<0.05),and the beneficial bacterial species in the treatment group increased.Conclusion:After the

关 键 词：慢性肾脏病 肠道菌群 复方积雪草 结肠透析 

分 类 号：R692[医药卫生—泌尿科学]