肾衰宁颗粒对维持性血液透析患者蛋白结合类尿毒症毒素及排便影响的随机对照研究  

Effects of Shenshuaining Granule on Levels of Protein-Binding Uremic Toxins and Defecation Frequency in Patients Receiving Maintenance Hemodialysis:A Randomized Controlled Trial

作　　者：白田丽 王志鹏 恽芸蕾 朱冰冰[1,3] 姚兴梅 王杰 王润华[1] 王浩 BAI Tianli;WANG Zhipeng;YUN Yunlei(Department of Nephrology,Putuo Hospital Affiliated to Shanghai University Traditional Chinese Medicine,Shanghai 200062;不详)

机构地区：[1]上海中医药大学附属普陀医院肾内科,上海200062 [2]海军军医大学第二附属医院药剂科,上海200003 [3]安徽医科大学上海普陀中心临床学院,上海200062

出　　处：《中国中西医结合肾病杂志》2025年第3期218-222,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：上海市卫生健康委员会中医药科研项目(No.2024QN080);上海市普陀区卫生健康系统临床特色专科(肾内科)项目(No.2021tszk02)。

摘　　要：目的:观察肾衰宁颗粒对维持性血液透析(MHD)患者血清蛋白结合类尿毒症毒素(IS、L-KYN、KYNA、HA、4-OHHA、IAA、MLT)、排便及血清生化指标(Cr、BUN、UA、CysC、Hb、CRP、Alb、Ca^(2+)、P^(3-)、PTH、LDL-C、TC、HDL-C、TG、Kt/V、URR)的影响效果。方法:将64例MHD患者按随机数字表法分为对照组和观察组各32例。两组患者均进行3次/周血液净化,4 h/次,同时给予控制血压、血糖、血脂,改善贫血及钙磷代谢等相关指标的基础治疗。对照组采用以上常规治疗,观察组在对照组基础上加用肾衰宁颗粒,5 g/次,3次/日,餐后口服,疗程12周。检测治疗前后血清白蛋白结合类尿毒症毒素硫酸吲哚酚(IS)、L-犬尿氨酸(L-KYN)、犬尿喹啉酸(KYNA)、马尿酸(HA)、4-羟基马尿酸(4-OH HA)、^(3-)吲哚乙酸(IAA)、褪黑激素(MLT)的变化;记录治疗前后排便频率、Bristol粪便形态量表(BSFS)评分的变化;检测治疗前后血清肌酐(Cr),尿素氮(BUN),尿酸(UA),胱抑素C(CysC),血红蛋白(Hb),C反应蛋白(CRP),血清白蛋白(Alb),血钙(Ca^(2+)),血磷(P^(3-)),甲状旁腺素(PTH),低密度脂蛋白(LDL-C),三酰甘油(TC),高密度脂蛋白(HDL-C),胆固醇(TG),尿素清除指数(Kt/V),尿素清除率(URR)及安全性指标变化。结果:共60例患者完成了随访,每组各30例。观察组血清L-KYN水平较同组治疗前及对照组治疗后显著偏低(P<0.05);每周排便次数观察组较同组治疗前及对照组治疗后增加(P<0.05),BSFS评分提高(P<0.05);治疗后观察组较对照组三酰甘油偏低。两组均没有严重副作用报道。结论:口服肾衰宁颗粒可有效降低MHD患者血清蛋白结合类尿毒症毒素L-KYN的血清含量,改善排便,降低血清三酰甘油水平,值得在血透患者中推广应用。Objective:To explore influence of Shenshuaining Granule on the serum protein-bound uremic toxins(IS,L-KYN,KYNA,HA,4-OHHA,IAA,MLT),bowel movements,and serum biochemical indicators(Cr,BUN,UA,CysC,Hb,CRP,Alb,Ca^(2+),P^(3-),PTH,LDL-C,TC,HDL-C,TG,Kt/V,URR)of patients receiving maintenance hemodialysis(MHD).Methods:64 HD patients were randomly divided into a control group and an observation group of 32 cases each by random number table.Both groups of patients got blood purification 3 times/week,4 hours/time,and were given basic treatment to control blood pressure,blood sugar,blood lipids,improve anemia,calcium and phosphorus metabolism and other related indicators.The control group received the above conventional treatment,while the observation group received Shenshuaining granules on the basis of the control group,5 g/time,3 times/day,orally after meals,for a 12-week course of treatment.Serum protein-bound uremic toxins(IS,L-KYN,KYNA,HA,4-OHHA,IAA,MLT),defecation frequency,Bristol stool form scale,and serum biochemical indicators(Cr,BUN,UA,CysC,Hb,CRP,Alb,Ca^(2+),P^(3-),PTH,LDL-C,TC,HDL-C,TG,Kt/V,URR),safety indices were detected.Results:A total of 60 patients completed follow-up,with 30 cases in each group.The serum L-KYN level in the observation group was significantly lower than before treatmentand after treatment in the control group(P<0.05);the frequency of bowel movements per week in the observation group was increased compared with before treatment and after treatment in the control group(P<0.05),and the BSFS score was improved(P<0.05);after treatment,the triglyceride in the observation group was lower than that in the control group(P<0.05).No reports of severe side effects were noted in the two groups.Conclusion:Shenshuaining Granules can effectively reduce the serum levels of protein-bound uremic toxin L-KYN in MHD patients,significantly improve bowel movements,and reduce serum triglyceride levels,which is worthy of clinical promotion and application in hemodialysis patients.

关 键 词：肾衰宁颗粒 维持性血液透析 蛋白结合类尿毒症毒素 便秘 中药 

分 类 号：R259[医药卫生—中西医结合] R277.5[医药卫生—中医内科学]