基于“肾主骨生髓”理论探讨肾衰Ⅱ号方对慢性肾脏病3~5期伴MBD患者骨代谢的影响  

Effect of ShenshuaiⅡFormula on bone metabolism in patients with CKD at stages 3-5 complicated with MBD based on theory of"kidney governs bone and generates marrow"

作　　者：洪琪 闫国良[1] 王馨璐[1] 王琛[2,3] 周圆[2,3] HONG Qi;YAN Guoliang;WANG Xinlu;WANG Chen;ZHOU Yuan(Department of Emergency and Critical Care Medicine,Shanghai Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200071,China;Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Nephrology Research Institute of Traditional Chinese Medicine,Key Laboratory of Liver and Kidney Diseases of Ministry of Education,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属市中医医院急诊与重症医学科,上海200071 [2]上海中医药大学附属曙光医院,上海201203 [3]上海中医药大学中医肾病研究所,肝肾疾病病证教育部重点实验室,上海201203

出　　处：《上海中医药大学学报》2024年第6期26-31,共6页Academic Journal of Shanghai University of Traditional Chinese Medicine

基　　金：国家自然科学基金资助项目(81973770);上海市进一步加快中医药事业发展三年行动计划项目[ZY(2018-2020)-FWTX-7005];上海市卫计委科研课题项目(20184Y0028)。

摘　　要：目的:观察肾衰Ⅱ号方对慢性肾脏病(CKD)3~5期伴矿物质和骨异常(MBD)患者骨代谢的影响。方法:纳入202例CKD 3~5期伴MBD患者,随机分成对照组100例和实验组102例。对照组患者予以西医一体化治疗+骨化三醇软胶囊口服,实验组患者在对照组治疗基础上予以肾衰Ⅱ号方口服,两组疗程均为3个月。治疗前后,检测并比较两组患者的肾功能及骨代谢指标水平,具体指标包括维生素D(VD)、25羟维生素D2(25OH-VD2)、25羟维生素D3(25OH-VD3)、甲状旁腺激素(PTH)、β-骨胶原序列(β-Crossl Laps)、白蛋白(Alb)、碱性磷酸酶(ALP)、总钙、校正钙、血清无机磷(IP)、血肌酐(Scr)、血尿素氮(BUN)、肾小球滤过率(eGFR)。结果:治疗过程中,对照组2例患者被剔除,实验组1例患者脱落,最终纳入统计分析者对照组98例、实验组101例。(1)治疗后,两组患者的Scr、BUN水平较治疗前均显著降低(P<0.05),eGFR水平较治疗前明显升高(P<0.05),且实验组患者的Scr、BUN水平低于对照组(P<0.05),eGFR水平高于对照组(P<0.05)。(2)治疗后,两组患者的25OH-VD2、25OH-VD3、ALP、总钙、校正钙水平较治疗前均明显升高(P<0.05),PTH、β-Crossl Laps、IP水平较治疗前明显降低(P<0.05),实验组患者的Alb水平较治疗前亦升高(P<0.05),且实验组患者的25OH-VD2、ALP、总钙水平高于对照组(P<0.05),PTH、IP水平低于对照组(P<0.05)。结论:与西医常规疗法比较,肾衰Ⅱ号方结合西医常规疗法能更显著改善CKD 3~5期伴MBD患者的肾功能,显著调节CKD中晚期患者的骨代谢功能,从而改善患者的预后。Objective:To observe the effect of ShenshuaiⅡFormula on bone metabolism in patients with chronic kidney disease(CKD)at stages 3-5 complicated with mineral and bone disorder(MBD).Methods:202 patients with CKD at stages 3-5 complicated with MBD were included and randomly divided into the control group(100 cases)and experimental group(102 cases).The patients in the control group were treated with integrated western medicine and calcitriol soft capsules orally,and the patients in the experimental group were treated with ShenshuaiⅡFormula orally based on the treatment of the control group.The treatment course of both groups was 3months.Before and after treatment,the levels of indexes of renal function and bone metabolism in the two groups were detected and compared,and the specific indexes included vitamin D(VD),25-hydroxyvitamin D2(25OH-VD2),25-hydroxyvitamin D3(25OH-VD3),parathyroid hormone(PTH),β-bone collagen sequence(β-Crossl Laps),albumin(Alb),alkaline phosphatase(ALP),total calcium,corrected calcium,serum inorganic phosphorus(IP),serum creatinine(Scr),blood urea nitrogen(BUN),and glomerular filtration rate(eGFR).Results:During the treatment,two patients in the control group were removed,and one patient in the experimental group fell out.Finally,98 cases in the control group and 101 cases in the experimental group were included in the statistical analysis.(1)After treatment,the levels of Scr and BUN in the two groups were significantly decreased compared with those before treatment(P<0.05),the level of eGFR was significantly increased compared with that before treatment(P<0.05),and the levels of Scr and BUN in the experimental group were lower than those in the control group(P<0.05),the level of eGFR was higher than that in the control group(P<0.05).(2)After treatment,the levels of 25OH-VD2,25OH-VD3,ALP,total calcium and corrected calcium in the two groups were significantly increased compared with those before treatment(P<0.05),the levels of PTH,β-Crossl Laps and IP were significantly decreased compared

关 键 词：慢性肾脏病 矿物质和骨异常 肾衰Ⅱ号方 肾功能 骨代谢 

分 类 号：R277.5[医药卫生—中医学]