CAJ | 학술논문

目的：探讨尿毒清颗粒对慢性肾脏病（CKD）3~5期钙、磷代谢及成纤维生长因子23（FGF23）水平的影响。方法：选择符合美国2002年K/DOQI CKD诊断标准3~5期患者54例，随机分为治疗组（尿毒清颗粒）和对照组，同时选取正常组20例。测定外周血中FGF23、全段甲状旁腺激素（iPTH）、尿素氮（BUN）、血肌酐（Scr）、Ca、P水平，以及尿肌酐水平；根据MDRD公式计算肾小球滤过率（GFR）。结果：随着GFR的下降，CKD3~5期患者的血P、FGF23、BUN、Scr较正常组均显著升高，血Ca较正常组显著下降，差异均有统计学意义（P<0.01）。CKD3~4期：与治疗前比较，治疗组Scr下降显著（P<0.05），P、FGF23均显著下降（P<0.01），GFR显著提高（P<0.01），BUN下降但无显著差异（P>0.05）；对照组FGF23显著下降（P<0.05），Scr下降、GFR提高，但均无显著差异（P>0.05）；两组Ca均提高，无统计学意义（P>0.05）；与对照组比较，治疗组的P、FGF23均显著下降（P<0.05或P<0.01）。CKD5期：与治疗前比较，治疗组GFR显著提高（P<0.01），Ca提高（P<0.05），两组的FGF23也下降（P<0.05或P<0.01），BUN、Scr、P也下降，但无明显差异（P>0.05），对照组GFR提高，但无明显差异（P>0.05）。结论：尿毒清颗粒具有改善患者钙、磷代谢以及FGF23水平的作用，且其可能通过改善血中钙、磷代谢水平，降低PTH、FGF23等因子的表达，从而延缓CKD-MBD的进展。
목적：탐토뇨독청과립대만성신장병（CKD）3~5기개、린대사급성섬유생장인자23（FGF23）수평적영향。방법：선택부합미국2002년K/DOQI CKD진단표준3~5기환자54례，수궤분위치료조（뇨독청과립）화대조조，동시선취정상조20례。측정외주혈중FGF23、전단갑상방선격소（iPTH）、뇨소담（BUN）、혈기항（Scr）、Ca、P수평，이급뇨기항수평；근거MDRD공식계산신소구려과솔（GFR）。결과：수착GFR적하강，CKD3~5기환자적혈P、FGF23、BUN、Scr교정상조균현저승고，혈Ca교정상조현저하강，차이균유통계학의의（P<0.01）。CKD3~4기：여치료전비교，치료조Scr하강현저（P<0.05），P、FGF23균현저하강（P<0.01），GFR현저제고（P<0.01），BUN하강단무현저차이（P>0.05）；대조조FGF23현저하강（P<0.05），Scr하강、GFR제고，단균무현저차이（P>0.05）；량조Ca균제고，무통계학의의（P>0.05）；여대조조비교，치료조적P、FGF23균현저하강（P<0.05혹P<0.01）。CKD5기：여치료전비교，치료조GFR현저제고（P<0.01），Ca제고（P<0.05），량조적FGF23야하강（P<0.05혹P<0.01），BUN、Scr、P야하강，단무명현차이（P>0.05），대조조GFR제고，단무명현차이（P>0.05）。결론：뇨독청과립구유개선환자개、린대사이급FGF23수평적작용，차기가능통과개선혈중개、린대사수평，강저PTH、FGF23등인자적표체，종이연완CKD-MBD적진전。
Objective:To explore the influence of Niaoduqing(NDQ) Particle on the calcium,phosphorus and fibroblast growth factor 23(FGF23) in patients with CKD stage 3-5.Method:According to the standard of NKF-K/DOQI proposed,fifty-four CKD patients were randomly divided into the treatment group(Niaoduqing Particle) and the control group,at the same time,20 cases were selected as the normal group.FGF23,iPTH,BUN,Scr,Ca,P levels and Ucr were determined,then GFR was calculated based on MDRD equation.Result:Compared with normal group,with the decline of GFR,the level of P, FGF23,BUN,Scr in the serum of the patients with CKD stage 3-5 were significantly increased,the level of Ca was significantly decreased,the differences were statistically significant(P<0.01).CKD stage 3-4:compared with the pretherapy,serum P, FGF23,Scr level were decreased(P<0.01 orP<0.05),GFR was increased(P<0.01) in the treatment group,there was no significant difference in BUN(P>0.05).In the control group,FGF23 level was decreased(P<0.05),Scr decreased and GFR increased,but there were no statistically significant differences(P>0.05).Ca of the two groups were increased,but there had no statistical significances(P>0.05).Compared with the control group,the P and FGF23 level of the treatment group were decreased significantly(P<0.05 orP<0.01).CKD stage 5:compared with the pretherapy,GFR and Ca of the treatment group were significantly increased(P<0.01 orP<0.05),FGF23 of the two groups were decreased(P<0.05 orP<0.01),BUN,Scr, P decreased,but there were no statistically significant differences(P>0.05).GFR of the control group was decreased,but there had no statistical significances(P>0.05).Conclusion:Niaoduqing Particle can improve the levels of calcium,phosphorus and FGF23 of the patients,and it may play an important role to delay the progression of CKD-MBD by improving the calcium and phosphorus metabolism,reducing the expression of PTH,FGF23 and other factors.