CAJ | 학술논문

目的：：观察慢性肾衰竭( CRF)急剧加重湿热证患者血清FGF-23水平变化与钙磷代谢的相关性及清肾颗粒的干预作用。方法：选择60例CRF急剧加重湿热证患者随机分为治疗组30例和对照组30例,并设正常对照组30例。均在西药常规治疗同时使用黄苓解毒泄浊颗粒保留灌肠,治疗组加用清肾颗粒,每次1袋(10 g),每日3次口服,疗程8周。检测两组临床疗效及治疗前后血清成纤维细胞生长因子23(FGF-23)、1,25-二羟基维生素D3[1,25(OH)2VitD3]、全段甲状旁腺激素(iPTH)、血钙(Ca2+)和血磷(P3-)水平变化情况,并与正常组比较。结果：治疗组临床疾病总有效率为86.67%,优于对照组73.33%(P<0.05)；治疗组中医证候总有效率为90.00%,明显高于对照组60.00%(P<0.01)。两组患者治疗前血清FGF-23水平明显高于正常对照组(P<0.01),血清1,25(OH)2VitD3水平明显低于于正常对照组(P<0.01)；治疗后两组血FGF-23水平均下降,血清1,25(OH)2VitD3水平均升高,且治疗组优于对照组(P<0.05或P<0.01)。两组治疗后血清iPTH和P3-水平较治疗前均明显降低(P<0.05),血Ca2+水平较治疗前明显升高(P<0.05)。结论：CRF急剧加重湿热证患者血清 FGF -23、iPTH 水平升高,1,25(OH)2VitD3水平下降,清肾颗粒可降低患者血清 FGF -23水平,升高1,25(OH)2VitD3水平,能改善肾功能,减轻临床症状,其机制之一可能与其降低患者血清FGF-23水平有关。
목적：：관찰만성신쇠갈( CRF)급극가중습열증환자혈청FGF-23수평변화여개린대사적상관성급청신과립적간예작용。방법：선택60례CRF급극가중습열증환자수궤분위치료조30례화대조조30례,병설정상대조조30례。균재서약상규치료동시사용황령해독설탁과립보류관장,치료조가용청신과립,매차1대(10 g),매일3차구복,료정8주。검측량조림상료효급치료전후혈청성섬유세포생장인자23(FGF-23)、1,25-이간기유생소D3[1,25(OH)2VitD3]、전단갑상방선격소(iPTH)、혈개(Ca2+)화혈린(P3-)수평변화정황,병여정상조비교。결과：치료조림상질병총유효솔위86.67%,우우대조조73.33%(P<0.05)；치료조중의증후총유효솔위90.00%,명현고우대조조60.00%(P<0.01)。량조환자치료전혈청FGF-23수평명현고우정상대조조(P<0.01),혈청1,25(OH)2VitD3수평명현저우우정상대조조(P<0.01)；치료후량조혈FGF-23수평균하강,혈청1,25(OH)2VitD3수평균승고,차치료조우우대조조(P<0.05혹P<0.01)。량조치료후혈청iPTH화P3-수평교치료전균명현강저(P<0.05),혈Ca2+수평교치료전명현승고(P<0.05)。결론：CRF급극가중습열증환자혈청 FGF -23、iPTH 수평승고,1,25(OH)2VitD3수평하강,청신과립가강저환자혈청 FGF -23수평,승고1,25(OH)2VitD3수평,능개선신공능,감경림상증상,기궤제지일가능여기강저환자혈청FGF-23수평유관。
Objective:To observe the changes of serum fibroblast growth factor -23(FGF-23)、1,25(OH)2VitD3、intact parathyroid hormon( iPTH) in sharp deterioration damp-heat syndrome( DHS) of chronic renal failure( CRF) and the curative effica-cy of Qingshen granule (QSG,清肾颗粒). Methods:Sixty cases were divided into treatment group(n=30) and control group(n=30). Normal control group(n=30) was set up too. All were treated with conventional western medical therapy combining with reten-tion enema of HuangLing Jiedu Xiezhuo( HLJDXZ) , but for patients in the treated group, QSG was given additionally, 1 bag thrice a day by oral intake. The therapeutic course for all was 8 weeks. The levels of serum FGF-23、1,25(OH)2VitD3、iPTH、Ca2+ and P3-were observed before and after treatment, and were compared with those in the normal control. Results:The total effective rate of clin-ical effect in the treatment group was 86. 67%, which was better than that in the control group 73. 33%(P<0. 05). The total effec-tive rate of syndrome of TCM in the treatment group was 90. 00%, and obviously higher than the control group’ s 60. 00%( P <0.01). Compared with the normal control group, the levels of serum FGF-23 in the treatment group were obviously higher(P<0. 01) and serum 1,25(OH)2VitD3 were obviously lower (P<0. 01). There were not significant diversity in these indexes between the treatment group and the control group before therapy(P>0. 05). The levels of serum FGF-23 decreased significantly (P<0. 01) and the levels of serum 1,25(OH)2VitD3 increased significantly(P<0. 05) in the treatment group after therapy with QSG, but the changes in control group are not so much (P<0. 05). There is significant diversity in the two groups after therapy(P<0. 05). The levels of serum iPTH and P3- decreased significantly (P<0. 05) and the levels of serum Ca2+ increased significantly (P<0. 05) after treatment. Conclusion:Patients with sharp deteriorated CRF of DHS show higher serum levels of FGF-23、iPTH and lower ser-um levels of 1,25(OH)2VitD3 in comparing with the normal control. QSD could reduce the levels of serum FGF-23 and iPTH, but increased the levels of 1,25(OH)2VitD3, can improve renal function, reduce clinical symptoms, its mechanism may be related with the lowering of serum FGF-23.