肾衰乙方治疗慢性肾脏病4期合并慢性心力衰竭的临床观察  

Clinical observation of Shenshuaiyi Formula in treatment of chronic kidney disease at stage 4 combined with chronic heart failure

作　　者：段连香 翁涛涛 刘子洋 刘文瑞[1] 廖琳[1] 胡静[1,2] 沈玛丽 曹玉 DUAN Lianxiang;WENG Taotao;LIU Ziyang;LIU Wenrui;LIAO Lin;HU Jing;SHEN Mali;CAO Yu(Department of Nephrology,the Seventh People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200137,China;Inheritance Studio of Ye Jinghua National Famous Doctor of Traditional Chinese Medicine,Shanghai 200137,China;Yidan Nursing Home,Shanghai 201822,China)

机构地区：[1]上海中医药大学附属第七人民医院肾病科,上海200137 [2]叶景华全国名老中医传承工作室,上海200137 [3]上海颐丹护理院,上海201822

出　　处：《上海中医药大学学报》2023年第3期13-18,29,共7页Academic Journal of Shanghai University of Traditional Chinese Medicine

基　　金：上海市浦东新区“国家中医药发展综合改革试验区”建设项目(PDZY-2021-0302);上海市第七人民医院“七院新星(中医类)”人才培养计划项目(XX2020-25)。

摘　　要：目的:探讨肾衰乙方治疗慢性肾脏病(CKD)4期合并慢性心力衰竭(CHF)的临床疗效。方法:将80例CKD 4期合并CHF(脾肾气虚、瘀血阻滞证)患者随机分为对照组和治疗组,每组各40例。对照组患者给予西医常规治疗,治疗组患者给予西医常规治疗结合肾衰乙方口服,两组疗程均为8周。评价两组患者的临床疗效;治疗前后,比较两组患者的中医证候总积分及主症评分的变化,检测所有患者的血清肌酐(SCr)、尿素氮(BUN)、估算肾小球滤过率(eGFR)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、超敏C反应蛋白(hsCRP)、N末端B型脑钠肽前体(NT-proBNP)水平,比较两组患者的左心室射血分数(LVEF),评估两组患者的纽约心脏学会(NYHA)心功能分级情况。结果:治疗过程中,对照组1例患者剔除,治疗组1例患者脱落,最终纳入统计分析者对照组39例、治疗组39例。①治疗后,治疗组的临床总有效率为84.62%,对照组为56.41%,治疗组的疗效优于对照组(P<0.05)。②治疗后,两组患者的中医证候总积分均显著降低(P<0.05),且治疗组患者的积分低于对照组(P<0.05);两组患者的主症评分较治疗前均降低(P<0.05),且治疗组患者的倦怠乏力、气短懒言、食少纳呆、腰膝酸软症状评分低于对照组(P<0.05)。③治疗后,两组患者的SCr、BUN、TNF-α、IL-6、hsCRP、NT-proBNP水平较治疗前均降低(P<0.05),eGFR、LVEF水平较治疗前均升高(P<0.05),且治疗组患者的SCr、BUN、TNF-α、IL-6、hsCRP、NT-proBNP水平低于对照组(P<0.05),eGFR、LVEF水平高于对照组(P<0.05)。④治疗后,两组患者的NYHA心功能分级情况均改善(P<0.05),且治疗组患者的改善情况优于对照组(P<0.05)。结论:肾衰乙方结合西医常规疗法可更好地改善CKD 4期合并CHF(脾肾气虚、瘀血阻滞证)患者的肾功能、心功能,降低患者的血清炎症因子水平,提高临床疗效。Objective:To investigate the clinical efficacy of Shenshuaiyi Formula in the treatment of chronic kidney disease(CKD)at stage 4 combined with chronic heart failure(CHF).Methods:Eighty patients of CKD at stage 4 combined with CHF(spleen and kidney qi deficiency and blood stasis syndrome)were randomly divided into the control group and the treatment group,40 cases in each group.The patients in the control group were treated with routine western medicine,and the patients in the treatment group were treated with routine western medicine combined with Shenshuaiyi Formula orally,with a course of 8 weeks.The clinical efficacy of the two groups was evaluated.Before and after treatment,the changes of the total scores of traditional Chinese medicine(TCM)syndrome and the main symptom scores were compared between the two groups,and the levels of serum creatinine(SCr),urea nitrogen(BUN),estimated glomerular filtration rate(eGFR),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),hypersensitive C-reactive protein(hsCRP)and N-terminal B-type brain natriuretic peptide precursor(NT-proBNP)of all the patietns were detected,the left ventricular ejection fraction(LVEF)was compared between the two groups,and the New York Heart Association(NYHA)cardiac function grading of the patients in the two groups was evaluated.Results:During the course of treatment,1 patient in the control group was removed and 1 patient in the treatment group was shed off,finally 39 cases in the control group and 39 cases in the treatment group were included in the statistical analysis.①After treatment,the total clinical effective rate was 84.62%in the treatment group and 56.41%in the control group,and the effect of the treatment group was better than that of the control group(P<0.05).②After treatment,the total scores of TCM syndrome in the two groups were significantly decreased(P<0.05),and the score of the treatment group was lower than that of the control group(P<0.05).The main symptom scores in the two groups were decreased compared with those before

关 键 词：慢性肾脏病 慢性心力衰竭 肾衰乙方 炎症因子 中西医结合 

分 类 号：R277.5[医药卫生—中医学] R259