综合疗法治疗4~5期慢性肾脏病31例临床观察

目的:观察综合疗法治疗慢性肾脏病(CKD)4~5期脾肾亏虚证的效果。方法:将CKD4~5期脾肾亏虚证患者62例随机分为2组,其中治疗组31例,对照组30例(剔除1例)。对照组予基础治疗合中药、骨化三醇及碳酸钙D3片治疗,治疗组予基础治疗合中药、骨化三醇及益肾泄浊汤保留灌肠治疗,观察时间为4周。比较2组血肌酐(Scr)、肾小球滤过率(e GFR)、尿素氮(BUN)、血钙、血磷、碱性磷酸酶(ALP)、甲状旁腺激素(i PTH)及中医证候疗效。结果:中医证候总有效率治疗组为83.87%(26/31),对照组为73.33%(22/30),组间比较,差异有统计学意义(P<0.05);2组Scr、e GFR、BUN、血磷治疗前后组内比较及治疗后组间比较,差异均有统计学意义(P<0.01或P<0.05);2组血钙、i PTH、ALP治疗前后组内比较,差异均有统计学意义(P<0.01),但治疗后组间比较,差异无统计学意义(P>0.05)。结论:综合疗法治疗慢性肾脏病4~5期脾肾亏虚证效果确切,安全可靠。

Clinical effect of combined therapy for stage 4-5 chronic kidney disease:An analysis of 31 cases

Objective:To investigate the clinical effect of combined therapy for stage 4-5 chronic kidney disease(CKD)with spleen and kidney deficiency.Methods:A total of 62 patients with stage 4-5 CKD with spleen and kidney deficiency were randomly divided into treatment group with 31 patients and control group with 31 patients(among whom 1 patient was excluded).The patients in the control group were given basic treatment combined with traditional Chinese medicine(TCM),calcitriol,and calcium carbonate D3 tablets,and those in the treatment group were given basic treatment combined with TCM,calcitriol,and retention enema with Yishen Xiezhuo decoction.Both groups were observed for 4 weeks.The two groups were compared in terms of serum creatinine(SCr),estimated glomerular filtration rate(eGFR),blood urea nitrogen(BUN),blood calcium,serum phosphate,alkaline phosphatase(ALP),intact parathyroid hormone(i PTH),and outcome of TCM syndrome.Results:There was a significant difference in the overall response rate of TCM syndrome between the two groups83.87%(26/31)vs73.33%(22/30),P<0.05].Both groups had significant changes in SCr,eGFR,BUN,and serum phosphate after treatment,and there were significant differences in these indices between the two groups after treatment(P<0.01 or P<0.05).Both groups had significant changes in blood calcium,i PTH,and ALP after treatment(P<0.01),while there were no significant differences between the two groups after treatment(P>0.05).Conclusion:Combined therapy has a good clinical effect and is safe and reliable in the treatment of stage 4-5 CKD with spleen and kidney deficiency.