肾衰六君子方联合阿托伐他汀对维持性血液透析患者营养不良-炎症-动脉粥样硬化综合征的影响

目的探讨肾衰六君子方联合阿托伐他汀对维持性血液透析(MHD)患者营养不良-炎症-动脉粥样硬化综合征(MIAS)的影响。方法将2017年1月—2019年4月河北省沧州中西医结合医院诊治的64例MHD伴MIAS患者随机分为2组,每组32例。对照组给予常规干预及阿托伐他汀钙片(20 mg/d)治疗,观察组在对照组基础上加用肾衰六君子方治疗,疗程12周。比较2组干预前后营养不良-炎症评分(MIS)、营养学指标、炎性指标及动脉粥样相关指标,并统计2组临床疗效。结果与治疗前比较,治疗后2组MIS评分均明显降低(P均<0.05),且治疗后观察组低于对照组(P<0.05);治疗后2组血清白蛋白(ALB)、血红蛋白(Hb)、转铁蛋白(TRF)、上臂围(MAC)、肱三头肌皮褶厚度(TSF)均明显增加(P均<0.05),且治疗后观察组上述指标均高于对照组(P均<0.05)。治疗后2组血清高敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平及颈动脉分叉内膜中层厚度、颈总动脉内膜中层厚度、粥样斑块形成检出率均降低(P均<0.05),且治疗后观察组上述指标均低于对照组(P均<0.05)。观察组治疗总有效率为87.5%(31/34),明显高于对照组的65.6%(24/34)(P<0.05)。结论肾衰六君子方联合阿托伐他汀治疗MHD伴MIAS可明显改善机体营养状况,缓解机体微炎症反应,抑制或逆转动脉粥样硬化,效果优于单纯西医治疗。

Effect of Shenshuai Liujunzi Decoction combined with atorvastatin on malnutrition-inflammation-atherosclerosis syndrome in maintenance hemodialysis patients

Objective It is to investigate the effect of Shenshuai Liujunzi Decoction combined with atorvastatin on malnutrition-inflammation-atherosclerosis syndrome(MIAS)in maintenance hemodialysis(MHD)patients.Methods A total of 64 patients with MHD and MIAS who were diagnosed and treated in Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2017 to April 2019 were randomly divided into 2 groups,with 32 cases in each group.The control group was treated with conventional intervention and atorvastatin calcium tablets(20 mg/d),and the observation group was treated with Shenshuai Liujunzi Decoction based on the control group,both groups were treated for 12 weeks.The changes in malnutrition-inflammation score(MIS),nutritional indicators,inflammatory indicators and atherosclerosis-related indicators before and after the intervention were compared between the two groups,and the clinical efficacy of the two groups was calculated.Results Compared with before treatment,the MIS scores of the two groups were significantly reduced after treatment(all P<0.05),and the observation group was lower than the control group after treatment(P<0.05);compared with before treatment,the levels of serum albumin(ALB),hemoglobin(Hb),transferrin(TRF),upper arm circumference(MAC),and triceps skinfold thickness(TSF)were significantly increased in the two groups after treatment(P<0.05),and the above indicators in the observation group were higher than those in the control group(all P<0.05).Compared with before treatment,the levels of serum high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6),and intima-media thickness of the carotid artery bifurcation and common carotid artery,and the detection rate of atherosclerotic plaque formation were all decreased in the two groups(all P<0.05),and the above indicators in the observation group after treatment were lower than those in the control group(all P<0.05).The total effective rate of treatment in the observation group was 87.5%(31/34),which was significantly higher than 65.6%(24/34)in the control group(P<0.05).Conclusion Shenshuai Liujunzi Decoction combined with atorvastatin can significantly improve the nutritional status of the body,relieve the micro-inflammatory response,inhibit or reverse atherosclerosis,and its effect is better than that of western medicine alone.