肾衰Ⅱ号方颗粒联合西医一体化方案治疗慢性肾脏病3~4期脾肾气虚证患者临床疗效及对肾脏微循环的影响  

Clinical Efficacy of ShenshuaiⅡPrescription Granules Combined with Western Medicine Integrated Treatment on Chronic Kidney Disease Stage 3-4 with Spleen and Kidney Qi Deficiency Syndrome and Its Effects on Renal Microcirculation

作　　者：张欣悦 杨婧[1] 陆方[1] 钱祎玲 王琛[1] ZHANG Xinyue;YANG Jing;LU Fang;QIAN Yiling;WANG Chen(Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院,上海201203

出　　处：《中国中医药信息杂志》2024年第7期156-161,共6页Chinese Journal of Information on Traditional Chinese Medicine

基　　金：国家自然科学基金(81973770);上海市浦东新区卫生系统重点学科群建设项目(PWZxq2017-07)。

摘　　要：目的观察肾衰Ⅱ号方颗粒对原发性肾小球肾炎(PGN)引起的慢性肾脏病(CKD)3~4期脾肾气虚证患者的临床疗效及肾脏微循环(RMC)的影响。方法采用随机、双盲的临床试验设计,将70例CKD 3~4期患者分为治疗组和对照组各35例。对照组予CKD一体化治疗联合安慰剂颗粒,治疗组予CKD一体化治疗联合肾衰Ⅱ号方颗粒。观察2组临床疗效,比较2组治疗前后中医症状总分、肾功能指标、RMC指标。监测2组安全性指标。结果治疗组总有效率为82.86%(29/35),对照组为54.29%(19/35),2组比较差异有统计学意义(P<0.05)。与本组治疗前比较,2组治疗后各项中医症状评分均降低(P<0.05,P<0.01);2组治疗后比较,治疗组5项脾肾气虚证症状评分及总分均低于对照组(P<0.05)。与本组治疗前比较,治疗组治疗后肾皮质、肾髓质血流均值均升高(P<0.05,P<0.01);2组治疗后比较,治疗组肾皮质、肾髓质血流均值均高于对照组(P<0.05,P<0.01)。与本组治疗前比较,治疗组治疗后血清一氧化氮(NO)含量升高(P<0.01),内皮素-1(ET-1)、血管内皮生长因子(VEGF)含量下降(P<0.01);2组治疗后比较,治疗组NO含量高于对照组(P<0.05),ET-1、VEGF含量低于对照组(P<0.01)。与本组治疗前比较,治疗组治疗后血肌酐(SCr)、血尿素氮(BUN)、24 h尿蛋白定量(24 hUP)下降,估算肾小球滤过率(e GFR)上升(P<0.05,P<0.01);2组治疗后比较,治疗组SCr、BUN、24 hUP低于对照组,eGFR高于对照组(P<0.01)。与本组治疗前比较及治疗后组间比较,2组血清尿酸比较差异无统计学意义(P>0.05)。2组安全性指标无异常变化(P>0.05)。结论肾衰Ⅱ号方颗粒联合西医一体化治疗可有效改善CKD 3~4期脾肾气虚证患者临床症状及肾功能相关指标,增加肾血流量、改善RMC障碍,提高临床疗效。Objective To observe the effect on clinical efficacy and renal microcirculation(RMC)of ShenshuaiⅡPrescription Granules in the treatment of patients with stage 3-4 chronic kidney disease(CKD)caused by primary glomerulonephritis(PGN)with deficiency of spleen and kidney qi syndrome.Methods Using a randomized,double-blind clinical trial design,70 patients with CKD stage 3-4 were divided into the treatment group and the control group,with 35 cases in each group.The control group was given CKD integrated treatment combined with placebo granules,and the treatment group was given CKD integrated treatment combined with ShenshuaiⅡPrescription Granules.The clinical efficacy of both groups was observed.TCM symptom scores,renal function indexes and RMC indexes before and after treatment of the two groups were compared.Safety indexes of both groups were monitored.Results The total effective rate was 82.86%(29/35)in the treatment group and 54.29%(19/35)in the control group,with statistical significance(P<0.05).Compared with before treatment,all the TCM symptom scores of the 2 groups were reduced after treatment(P<0.05,P<0.01);after treatment,the 5 spleen and kidney qi deficiency symptom scores and the total score of the treatment group were lower than those of the control group(P<0.05).The mean values of renal cortical and medullary blood flow were elevated in the treatment group after treatment compared with the pre treatment period in this group(P<0.05,P<0.01);the mean values of renal cortical and medullary blood flow were elevated in the treatment group compared with the control group in the post-treatment period(P<0.05,P<0.01).Compared with before treatment,the serum content of NO increased(P<0.01),ET-1 and VEGF decreased(P<0.01);after treatment,the serum content of NO in the treatment group was higher than that in the control group(P<0.05),and ET-1 and VEGF in the treatment group were lower than those in the control group(P<0.01).Compared with before treatment,SCr,BUN,24 hUP decreased and eGFR increased in the treatmen

关 键 词：慢性肾脏病 肾衰Ⅱ号方颗粒 肾脏微循环 动脉自旋标记成像 肾血流 

分 类 号：R277.52[医药卫生—中医学]