CAJ | 학술논문

目的：观察具有解毒化瘀功效的经验方剂川黄方联合前列腺素 E1治疗脾肾气虚、毒瘀互结型慢性肾脏疾病(chronic kidney disease,CKD)2~4期合并急性肾损伤(acute kidney inj ury, AKI)的临床疗效。方法选择CKD 2~4期合并AKI患者60例分为川黄方联合前列腺素E1组(治疗组)29例,前列腺素 E1组(对照组)31例。2组患者均接受纠正水、电解质、酸碱平衡紊乱,控制血压等常规治疗。在常规治疗基础上2组均静脉给予前列腺素 E120μg/d；治疗组同时服用川黄方中药汤剂,每日1剂；疗程均为2周。观察2组治疗前后的血肌酐(SCr)、血尿素氮(BUN)、血尿酸(uric acid,UA)、血清胱抑素C(cystatin,Cys C)、24 h尿蛋白定量,并统计中医证候疗效。结果①与治疗前相比,2组治疗均能有效降低 SCr、BUN、UA,差异均有统计学意义(P<0.01,P<0.05)；2组血清Cys C治疗前后组内比较,差异均有统计学意义(P<0.05)；②分别统计2组治疗前后 SCr、BUN、UA的差值,获得2组在上述指标改善幅度,然后进行组间比较,除 UA外,治疗组 SCr、BUN 改善幅度均大于对照组(P<0.01或P<0.05)；③2组24 h 尿蛋白定量治疗前后比较差异无统计学意义(P>0.05),但均能改善患者中医证候,其中治疗组优于对照组(P<0.01)。结论川黄方联合前列腺素E1能有效减轻CKD 2~4期合并AKI患者肾损伤、保护肾功能,并改善中医证候,优于单用前列腺素E1治疗。
목적：관찰구유해독화어공효적경험방제천황방연합전렬선소 E1치료비신기허、독어호결형만성신장질병(chronic kidney disease,CKD)2~4기합병급성신손상(acute kidney inj ury, AKI)적림상료효。방법선택CKD 2~4기합병AKI환자60례분위천황방연합전렬선소E1조(치료조)29례,전렬선소 E1조(대조조)31례。2조환자균접수규정수、전해질、산감평형문란,공제혈압등상규치료。재상규치료기출상2조균정맥급여전렬선소 E120μg/d；치료조동시복용천황방중약탕제,매일1제；료정균위2주。관찰2조치료전후적혈기항(SCr)、혈뇨소담(BUN)、혈뇨산(uric acid,UA)、혈청광억소C(cystatin,Cys C)、24 h뇨단백정량,병통계중의증후료효。결과①여치료전상비,2조치료균능유효강저 SCr、BUN、UA,차이균유통계학의의(P<0.01,P<0.05)；2조혈청Cys C치료전후조내비교,차이균유통계학의의(P<0.05)；②분별통계2조치료전후 SCr、BUN、UA적차치,획득2조재상술지표개선폭도,연후진행조간비교,제 UA외,치료조 SCr、BUN 개선폭도균대우대조조(P<0.01혹P<0.05)；③2조24 h 뇨단백정량치료전후비교차이무통계학의의(P>0.05),단균능개선환자중의증후,기중치료조우우대조조(P<0.01)。결론천황방연합전렬선소E1능유효감경CKD 2~4기합병AKI환자신손상、보호신공능,병개선중의증후,우우단용전렬선소E1치료。
Objective To observe the clinical efficacy of Chuanhuang decoction,which has de-toxification and removing blood stasis function,combined with prostaglandin E1 in treating phase 2-4 chronic kidney disease (CKD)associated with acute kidney injury (AKI).Methods Sixty patients with AKI on phase 2-4 CKD admitted on Shanghai Municipal Hospital of Traditional Chinese Medicine were randomly divided into 2 groups,including treatment group (29 cases)and control group (3 1 ca-ses).All patients were given the same diet care and basic treatment.Treatment group was treated with Chuanhuang Fang decoction combined with prostaglandin E1 (20μg/day by intravenous adminis-tration),and control group with 20μg/day prostaglandin E1 by intravenous administration.The pa-tients were observed for two weeks.Serum creatinine (SCr),blood urea nitrogen (BUN),uric acid (UA),serum cystatin C (Cys C),and 24-h urine protein were determined and compared before and after treatment.Furthermore,total efficiency based on TCM symptom scores was calculated and ana-lyzed.Results After two-week treatment,SCr,BUN,UA and Cys C were significantly reduced in both two groups (P<0.05 or P<0.01),more effective in treatment group (P<0.05).24 h urine protein was not reduced in both two groups (P>0.05).Treatment group achieved 96.6% of the total efficiency based on TCM symptom scores,higher than prostaglandin E1 group (77.4%)(P<0.01).Conclusions Treatment group can relieve TCM symptoms and protect renal function in AKI on phase 2-4 CKD more effectively than in control group.Chuanhuang decoction and detoxification and remo-ving blood stasis method might be a potentially useful method for CKD associated with AKI.