加味益肾活血方对慢性肾脏病5期患者肠道微生态的影响
Effects of Yishen Huoxue Decoction on Intestinal Microecology in Patients with Chronic Kidney Disease Stage Ⅴ
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摘要: 目的 观察加味益肾活血方对慢性肾脏病（CKD）患者肠道菌群微生态紊乱的影响。方法 以本院收治的CKD 5期中医辨证属于脾肾气虚、湿浊瘀血内阻的非透析患者为研究对象，随机分为2组，治疗组45例，对照组38例。对照组采用常规治疗，治疗组常规治疗加用加味益肾活血方口服。8周后采集CKD患者的血标本和粪便标本，采用PCR测定粪便中乳酸杆菌、双歧杆菌、大肠杆菌、粪肠球菌的菌群浓度；应用全自动生化仪检测常规生化指标，包括血红蛋白（Hb）、总蛋白（TP）、白蛋白（Alb）、肌酐（Scr）、尿素氮（BUN）等；ELISA法检测微炎症指标浓度。分析2组治疗前后主要症状积分、肾功能、微炎症指标、肠道微生态的变化。结果 治疗后治疗组Scr、BUN水平有所下降，超敏C反应蛋白（hs-CRP）、白介素-6（IL-6）、肿瘤坏死因子（TNF-α）浓度下降(P<0.05)，与对照组比较有显著性差异（P<0.05~0.01）。2组主要证候积分均有下降(P＜0.05)，但治疗组优于对照组(P＜0.05~0.01)。治疗组肠道内有益菌群如乳酸杆菌、双歧杆菌属细菌浓度显著升高(P＜0.05)，而肠道内有害菌如大肠杆菌和粪肠球菌属浓度均显著降低(P＜0.05)，与对照组比较有显著性差异（P<0.05~0.01）。结论 加味益肾活血方可明显改善CKD患者肠道微生态紊乱状态，同时可改善CKD患者的临床症状、保护肾脏功能、改善微炎症状态，效果显著。Abstract: OBJECTIVE To observe the effects of Yishen Huoxue decoction on intestinal microecology in patients with chronic kidney disease stage Ⅴ (CKD5). METHODS The non-dialysis patients in Lishui People's Hospital with deficiency of spleen and kidney qi and obstruction of dampness and blood stasis were randomly divided into two groups: 45 cases for the treatment group and 38 cases for the control group. The control group received routine treatment while the treatment group was given modified Yishen Huoxue decoction on the basis of routine treatment. After 8 weeks， blood samples and fecal samples of CKD patients were collected， and lactobacillus， bifidobacterium and escherichia coli， bacterial concentration of enterococcus faecalis in feces were detected by PCR. Routine biochemical parameters， including hemoglobin (Hb)， total protein (TP)， albumin (Alb)， serum creatinine (Scr)， blood urea nitrogen (BUN) and so forth were measured by automatic biochemical analyzer. ELISA method was used to detect the concentration of microinflammatory indexes. The changes of main symptom scores， renal function， microinflammatory indexes and intestinal microecology before and after treatment in the two groups were analyzed. RESULTS After treatment， the level of Scr and BUN in the treatment group decreased， along with the concentrations of hypersensitive c-reactive protein (hs-CRP)， interleukin-6 (IL-6) and tumor necrosis factor (TNF-α) (P<0.05)， which were significantly different from those in the control group (P<0.05， P<0.01). Main symptom scores in the two groups both decreased (P<0.05)， but the treatment group was superior to the control group (P<0.05，P<0.01). In the treatment group， the concentration of beneficial bacteria such as lactobacillus and bifidobacterium significantly increased (P<0.05)， while the harmful bacteria in the intestinal tract such as escherichia coli and enterococcus faecalis significantly decreased (P<0.05)， which were significantly different from those in the control group (P<0.05， P<0.01). CONCLUSION Tonifying the spleen and kidney and unblocking the bowels and discharging turbidity on intestinal microecology can conspicuously improve CKD patients' intestinal microecological disorder and their clinical symptoms， protect the renal function and improve the microinflammatory state with remarkable effects.
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