中药结肠洗液联合基础疗法对慢性肾功能衰竭患者BUN、SCr、UA及IS的影响

目的 评价中药结肠洗液对慢性肾功能衰竭(CRF)患者血肠源性尿毒素的清除作用和安全性，为进一步优化CRF中医综合疗法的方案提供基础。方法 采用非随机同期对照试验设计方法，将96例2010年3—12月广东省中医院肾病科住院CRF患者按照其意愿分为灌肠治疗组(治疗组，56例)和对照组(40例)。两组均按照CRF非透析期临床治疗方案给予基础治疗，治疗组加用中药结肠洗液灌肠治疗，每天1次，疗程2周。观察两组治疗前后临床症状、血清肠源性尿毒素水平［硫酸吲哚酚(IS)、BUN、UA］及SCr水平，监测治疗期间不良反应，评价该疗法的临床疗效及安全性。结果 最终完成观察研究84例，治疗组48例，对照组36例。治疗组治疗后SCr、BUN、IS水平均较治疗前明显降低，差异有统计学意义(P<0.01)；而对照组各指标治疗前后比较，差异无统计学意义(P>0.05)。治疗组治疗后IS较对照组降低，差异有统计学意义(P<0.05)。两组患者治疗后疲倦乏力、腰膝酸软、大便干结以及水肿比例均降低 (P<0.05, P<0.01)，治疗组治疗后纳差呕恶比例降低(P<0.05)，且治疗组患者在灌肠治疗期间均能保持每日排便1次以上，以软烂便为主。治疗过程中无严重不良事件发生。结论 中药结肠洗液联合基础疗法治疗CRF可使血清肠源性尿毒素(IS、BUN)水平在短期内降低。

Effects of Chinese Herbal Enema Therapy Combined Basic Treatment on BUN,SCr,UA,and IS in Chronic Renal Failure Patients

Objective To assess the clearance role and safety of Chinese herbal enema therapy(CHET) in clearing enterogenic uremic toxins in chronic renal failure(CRF) patients,thus providing evidence for further optimizing the comprehensive treatment.Methods Using nonrandomized concurrent control trial,96 CRF inpatients of Department of Nephropathy,Guangdong Provincial Hospital of Traditional Chinese Medicine,from March 2010 to December 2010 were assigned to the treatment group and the control group according to their willingness.All patients were treated with basic treatment referring to clinical plans in the non-dialysis phase,while those in the treatment group were additionally treated with CHET,once daily,2 weeks as one therapeutic course.The symptoms,serum enterogenic uremic toxin levels [including indoxyl sulfate(IS),blood urea nitrogen(BUN),and uric acid(UA)],and serum creatinine(SCr) were observed in the two groups between and after treatment.The adverse reactions were also monitored during the treatment period.The clinical efficacy and safety were also assessed.Results Totally 84 patients completed this clinical observation,48 in the treatment group and 36 in the control group.The levels of SCr,BUN,and IS were obviously lower in the treatment group after treatment,showing statistical difference when compared with before treatment(P<0.01).There was no statistical difference in each index in the control group between before and after treatment(P>0.05).The post-treatment the IS level was lower in the treatment group than in the control group with statistical difference(P<0.05).Symptoms like fatigue,soreness of waist and knees,constipation and edema were partially relieved in both groups(P<0.05,P<0.01).The ratios of anorexia and nausea in patients of the treatment group was lowered after treatment(P<0.05).Besides,patients in the treatment group could defecate for more than once daily during the enema treatment period,dominated as rotten and soft feces.No severe adverse event occurred during the treatment period.Conclusion CHET combined basic treatment could lower the serum levels of enterogenic uremic toxins(IS and BUN) of CRF patients in a short period.