益肾疏利方对慢性肾脏病3-4期脾肾亏虚、瘀浊内阻证患者微炎症状态的影响

张正春; 周恩超; 金晨

doi:10.14148/j.issn.1672-0482.2022.0404

益肾疏利方对慢性肾脏病3-4期脾肾亏虚、瘀浊内阻证患者微炎症状态的影响

doi: 10.14148/j.issn.1672-0482.2022.0404

张正春^1,,
周恩超^2, ,,
金晨¹

1.
泰州市姜堰中医院肾病科, 江苏泰州 225500
2.
南京中医药大学附属医院, 江苏南京 210029

基金项目:

江苏省中医药管理局科技项目 LZ13208

泰州市科技支撑计划社会发展(指导性)项目 2018-20

详细信息

作者简介:
张正春, 男, 副主任中医师, E-mail: zhzhchuse@163.com

通讯作者:
周恩超, 男, 主任中医师, 主要从事肾脏病临床及基础研究, E-mail: zhouernchao@njucm.edu.cn

中图分类号: R259
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- 被引次数: 0
出版历程
- 收稿日期: 2021-09-13
- 发布日期: 2022-05-10

Effect of Yishen Shuli Formula on Microinflammatory State in Patients of 3rd-4th Stage Chronic kidney Disease with Syndromes of Spleen-Kidney Deficiency Combined with Internal Stasis and Turbidity Obstruction

1.
Department of Nephropathy, Taizhou Jiangyan TCM Hospital, Taizhou 225500, China
2.
The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China

摘要

摘要: 目的观察益肾疏利方对脾肾亏虚、瘀浊内阻型慢性肾脏病(Chronic kidney disease, CKD)3-4期患者的疗效及微炎症状态的影响。方法收集脾肾亏虚、瘀浊内阻型CKD 3-4期患者61例, 随机分为治疗组31例, 对照组30例(脱落1例); 对照组给予西医基础治疗, 治疗组在对照组治疗基础上加用益肾疏利方, 连续干预24周。治疗前后观察2组患者中医证候积分, 检测肾功能指标[血肌酐(Serum creatinine, Scr)、尿素氮(Blood urea nitrogen, BUN)、肾小球滤过率(Estimated glomerular filtration rate, eGFR)]及微炎症指标[超敏C反应蛋白(Hypersensitive C-reactive protein, hs-CRP)、白介素-6(Interleukin-6, IL-6)、肿瘤坏死因子α(Tumor necrosis factor-α, TNF-α)]水平变化情况。结果治疗后, 2组患者中医证候总积分均有改善(P < 0.01), 治疗组优于对照组(P < 0.05);治疗组中医证候及临床综合疗效优于对照组(P < 0.05，P < 0.01);2组肾功能指标均显著改善(P < 0.01), 治疗组优于对照组(P < 0.05);2组患者血清微炎症指标均显著降低(P < 0.01), 治疗组低于对照组(P < 0.05, P < 0.01)。结论益肾疏利方联合西医常规治疗能改善CKD 3-4期脾肾亏虚、瘀浊内阻证患者中医证候，提高临床总疗效, 其疗效机制可能与调节患者微炎症状态有关。
- 慢性肾脏病 /
- 益肾疏利方 /
- 脾肾亏虚、瘀浊内阻证 /
- 微炎症状态
Abstract: OBJECTIVE To observe the effect of Yishen Shuli Formula on microinflammatory state in patients of 3rd-4th stage chronic kidney disease (CKD) with syndromes of spleen-kidney deficiency and internal stasis and turbidity obstruction. METHODS A total of 61 3rd-4th stage CKD patients with syndromes of spleen-kidney deficiency and internal stasis and turbidity obstruction were randomly divided into 31 cases in the treatment group and 30 cases in the control group (with 1 case dropped out). The control group was given basic western medicine treatment, while the treatment group was treated with Yishen Shuli Formula on top of the therapies in the control group. The intervention course lasted for 24 weeks. Before and after treatment, to both groups, we observed the traditional Chinese medicine (TCM) syndrome scores, and measured the renal function indexes [Serum creatinine (Scr), blood urea nitrogen (BUN), Estimated glomerular filtration rate (eGFR)], microinflammation indexes [Changes in the levels of hypersensitive C-reactive protein (hs-CRP), Interleukin-6 (IL-6), as well as tumor necrosis factor-α (TNF-α). RESULTS After treatment, the total TCM syndrome scores showed improved tendency in both groups (P < 0.01), but the results in the treatment group were better than those in the control group (P < 0.05). in addition, the TCM syndromes and clinical comprehensive efficacy of the treatment group were better than those of the control group (P < 0.05, P < 0.01). The renal function indexes of both groups showed significantly improved tendency (P < 0.01), while the results in the treatment group were better than those in the control group (P < 0.05). Besides, the serum microinflammation indexes of both groups were decreased significantly (P < 0.01), but the results in the treatment group were lower than those in the control group (P < 0.05, P < 0.01). CONCLUSION The combination of Yishen Shuli Formula with conventional western medicine treatment can relieve the TCM syndromes and improve overall clinical efficacy in 3rd-4th stage CKD patients with syndromes of spleen-kidney deficiency and internal stasis and turbidity obstruction, and its efficacy mechanism may be related to the amelioration of patients' microinflammatory state.
- chronic kidney disease /
- Yishen Shuli Formula /
- spleen-kidney deficiency, internal stasis and turbidity obstruction /
- microinflammatory state

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表 1 2组患者性别、年龄、CKD分期比较(x±s)

Table 1. Comparison of gender, age and CKD stage between 2 groups (x±s)

组别	例数	男	女	年龄/岁	CKD 3期	CKD 4期
对照组	29	20	9	60.86±13.32	18	11
治疗组	31	16	15	60.90±11.42	12	19

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表 2 2组患者原发病分布情况比较

Table 2. Comparison of primary disease distribution between 2 groups

组别	例数	慢性肾小球肾炎	糖尿病肾病	高血压肾病	IgA肾病	高尿酸血症肾病	狼疮性肾炎	多囊肾	病因不明
对照组	29	5	6	9	2	2	1	2	2
治疗组	31	5	8	11	1	5	0	0	1

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表 3 2组患者治疗前后中医证候积分比较(x±s)

Table 3. Comparison of symptom scores of TCM between 2 groups before and after treatment (x±s)

组别	时间	面色晦暗	倦怠乏力	腰膝酸软	食少纳呆	夜尿清长	肌肤甲错	肢体麻木	脘腹胀满	总积分
对照组	治疗前	0.97±0.32	3.93±0.19	3.45±0.20	2.83±0.29	2.90±0.25	0.97±0.29	1.52±0.31	0.76±0.23	17.31±3.26
n=29	治疗后	0.62±0.25^*	2.07±0.12^**	2.14±0.20^**	1.45±0.26^**	2.55±0.22^*	0.83±0.23	0.83±0.23^*	0.34±0.17^*	10.83±3.32^**
治疗组	治疗前	1.16±0.30	3.94±0.20	3.48±0.23	3.03±0.29	2.77±0.24	0.71±0.20	1.10±0.24	1.41±0.28	17.61±3.56
n=31	治疗后	0.45±0.15^**	2.06±0.20^**	1.81±0.14^**	1.42±0.19^**	1.87±0.23^*#	0.45±0.15^*##	0.52±0.16^*	0.32±0.16^*#	8.90±2.06^**#
注: 组内比较, ^P < 0.05, ^{ *}P < 0.01;组间比较, ^#P < 0.05, ^##P < 0.01。

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表 4 2组患者治疗后中医证候疗效比较

Table 4. Comparison of the efficacy of TCM symptoms between 2 groups before and after treatment

组别	例数	显效	有效	无效	总有效率/%
对照组	29	1	16	12	58.62
治疗组	31	3	25	3	90.32^**
注: 组间比较, χ²=8.031, ^{* *}P < 0.01。

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表 5 2组患者治疗前后肾功能指标比较(x±s)

Table 5. Comparison of renal function indexes between 2 groups before and after treatment (x±s)

组别	时间	例数	BUN/(mmol·L^-1)	Scr/(μmmol·L^-1)	eGFR/(mL·min^-1·1.73 m^-2)
治疗组	治疗前	31	15.50±4.88	194.14±63.84	31.62±12.22
	治疗后	31	10.06±3.34^**#	139.69±49.33^**#	48.00±20.31^**#
对照组	治疗前	29	13.41±3.49	190.59±71.06	34.23±10.51
	治疗后	29	11.97±3.83^**	180.02±68.90^**	36.85±11.69^**
注: 组内比较, ^{* *}P < 0.01;组间比较, ^#P < 0.05。

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表 6 2组患者临床综合疗效比较

Table 6. Comparison of clinical comprehensive efficacy between 2 groups

组别	例数	显效	有效	稳定	无效	总有效率/%
对照组	29	1	9	13	6	79.31
治疗组	31	19	9	2	1	96.77^*
注: 组间比较, χ²=4.434, ^*P < 0.05。

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表 7 2组患者治疗前后微炎症指标比较(x±s)

Table 7. Comparison of micro-inflammation indexes between 2 groups before and after treatment (x±s)

组别	时间	例数	hs-CRP/(mg·L^-1)	IL-6/(pg·mL^-1)	TNF-α/(pg·mL^-1)
治疗组	治疗前	31	6.67±1.58	43.05±6.73	43.73±11.13
	治疗后	31	4.31±1.42^**##	33.47±5.10^**##	33.31±5.69^**#
对照组	治疗前	29	6.57±1.67	44.15±6.12	42.30±10.31
	治疗后	29	5.71±1.36^**	39.83±5.51^**	37.26±6.06^**
注: 组内比较, ^{* *}P < 0.01;组间比较, ^#P < 0.05, ^##P < 0.01。

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参考文献(16)

[1]	MOORHEAD JF, EL-NAHAS M, CHAN MK, et al. Lipid nephrotoxicity in chronic progressive glomerular and tubulo-interstitial disease[J]. Lancet, 1982, 320(8311): 1309-1311. doi: 10.1016/S0140-6736(82)91513-6
[2]	沈文清, 邢艳芳, 黄丽, 等. 微炎症及氧化应激对慢性肾脏病患者肾功能的影响[J]. 中国临床医学, 2012, 19(5): 500-501. doi: 10.3969/j.issn.1008-6358.2012.05.018 SHEN WQ, XING YF, HUANG L, et al. Micro-inflammation and oxidative stress in patients with chronic kidney disease[J]. Chin J Clin Med, 2012, 19(5): 500-501. doi: 10.3969/j.issn.1008-6358.2012.05.018
[3]	王畅, 杨泽慧. 微炎症状态对慢性肾脏病患者的临床影响及中医治疗进展[J]. 中国中医药现代远程教育, 2020, 18(3): 66-68. doi: 10.3969/j.issn.1672-2779.2020.03.027 WANG C, YANG ZH. Clinical influence of micro inflammation status on patients with chronic kidney disease and progress of therapy of traditional Chinese medicine[J]. Chin Med Mod Distance Educ China, 2020, 18(3): 66-68. doi: 10.3969/j.issn.1672-2779.2020.03.027
[4]	胡美玲, 蒙如庆. 维持性血液透析患者微炎症状态的治疗进展[J]. 医学综述, 2019, 25(1): 87-92. doi: 10.3969/j.issn.1006-2084.2019.01.017 HU ML, MENG RQ. Progress in treatment of microinflammatory state in maintenance hemodialysis patients[J]. Med Recapitul, 2019, 25(1): 87-92. doi: 10.3969/j.issn.1006-2084.2019.01.017
[5]	郑艳. 肾衰方及其拆方对慢性肾衰竭模型大鼠微炎症状态影响的实验研究[D]. 沈阳: 辽宁中医药大学, 2019. ZHENG Y. Experimental study on the effect of Shenshuai formula and its removal on microinflammation in rats with chronic renal failure[D]. Shenyang: Liaoning University of Traditional Chinese Medicine, 2019.
[6]	沈文清, 邢艳芳, 钱捷, 等. 益肾化湿颗粒对慢性肾脏病患者微炎症和氧化应激状态的影响[J]. 中国中西医结合肾病杂志, 2014, 15(12): 1097-1099. https://www.cnki.com.cn/Article/CJFDTOTAL-JXSB201412023.htm SHEN WQ, XING YF, QIAN J, et al. Effects of Yishenhuashi Granules on micro-inflammation and oxidative stress in patients with chronic kidney disease[J]. Chin J Integr Tradit West Nephrol, 2014, 15(12): 1097-1099. https://www.cnki.com.cn/Article/CJFDTOTAL-JXSB201412023.htm
[7]	黄萍, 刘晓静, 苏佩清, 等. 补虚泄浊活血方对慢性肾脏病3、4期患者肾功能及微炎症状态的影响[J]. 实用临床医药杂志, 2018, 22(21): 95-97. doi: 10.7619/jcmp.201821029 HUANG P, LIU XJ, SU PQ, et al. Effect of Buxu Xiezhuo Huoxue Recipe on renal function and micro-inflammatory state of chronic renal failure patients in stage 3 and 4[J]. J Clin Med Pract, 2018, 22(21): 95-97. doi: 10.7619/jcmp.201821029
[8]	张正春. 益肾疏利方治疗慢性肾衰竭的远期疗效观察和用药规律探讨[J]. 世界最新医学信息文摘, 2019, 19(92): 238, 242. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201992145.htm ZHANG ZC. Observation on the long-term curative effect of Yishenshuli Recipe in the treatment of chronic renal failure[J]. World Latest Med Inf, 2019, 19(92): 238, 242. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201992145.htm
[9]	ADLER S, BROWN F, EKNOYAN G, et al. KDIGO clinical practice guideline for anemia in chronic kidney disease[J]. Kidney Int Suppl, 2012, 2(4): 1-335.
[10]	何立群. 慢性肾衰竭的诊断、辨证分型及疗效评定(试行方案)[J]. 上海中医药杂志, 2006, 40(8): 8-9. doi: 10.3969/j.issn.1007-1334.2006.08.004 HE LQ. Diagnosis, syndrome differentiation and curative effect evaluation of chronic renal failure[J]. Shanghai J Tradit Chin Med, 2006, 40(8): 8-9. doi: 10.3969/j.issn.1007-1334.2006.08.004
[11]	中药新药临床研究指导原则: 试行[M]. 北京: 中国医药科技出版社, 2002: 156-161. Guiding Principles for Clinical Research of New TCM Drugs: Trial[M]. Beijing: China medico-pharmaceutical science and technology publishing house, 2002: 156-161.
[12]	周恩超, 易岚, 李华伟, 等. 邹燕勤教授治疗慢性肾功能衰竭心法[J]. 四川中医, 2010, 28(11): 10-12. https://www.cnki.com.cn/Article/CJFDTOTAL-SCZY201011006.htm ZHOU EC, YI L, LI HW, et al. Professor Zou Yanqin heart method for treatment of chronic renal failure[J]. J Sichuan Tradit Chin Med, 2010, 28(11): 10-12. https://www.cnki.com.cn/Article/CJFDTOTAL-SCZY201011006.htm
[13]	于敏, 王姣, 史耀勋, 等. 慢性肾衰竭微炎症状态发生机制的研究进展[J]. 中华医院感染学杂志, 2010, 20(10): 1498-1500. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201010068.htm YU M, WANG J, SHI YX, et al. Research progress on the mechanism of micro-inflammatory state in chronic renal failure[J]. Chin J Nosocomiology, 2010, 20(10): 1498-1500. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY201010068.htm
[14]	ECE A, GURKAN F, KERVANCIOGLU M, et al. Oxidative stress, inflammation and early cardiovascular damage in children with chronic renal failure[J]. Pediatr Nephrol, 2006, 21(4): 545-552. doi: 10.1007/s00467-006-0039-0
[15]	何莲, 陈邵燕, 唐雯, 等. 慢性肾脏病与高脂血症关系的研究[J]. 中国实用内科杂志, 2008, 28(5): 355-357. doi: 10.3969/j.issn.1005-2194.2008.05.014 HE L, CHEN SY, TANG W, et al. Clinical study of hyperlipidemia and chronic kidney disease[J]. Chin J Pract Intern Med, 2008, 28(5): 355-357. doi: 10.3969/j.issn.1005-2194.2008.05.014
[16]	李雪军, 卢振飞, 蔡大勇. 微炎症状态对慢性肾功能不全进展的影响[J]. 临床荟萃, 2010, 25(14): 1259-1260. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFC201014032.htm LI XJ, LU ZF, CAI DY. Effect of microinflammatory state on the progression of chronic renal insufficienc[J]. Clin Focus, 2010, 25(14): 1259-1260. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFC201014032.htm