解毒化瘀法联合前列腺素E1治疗慢性肾脏疾病2~4期合并急性肾损伤的临床研究

目的：观察具有解毒化瘀功效的经验方剂川黄方联合前列腺素 E1治疗脾肾气虚、毒瘀互结型慢性肾脏疾病（chronic kidney disease,CKD）2~4期合并急性肾损伤（acute kidney inj ury, AKI）的临床疗效。方法选择CKD 2~4期合并AKI患者60例分为川黄方联合前列腺素E1组（治疗组）29例,前列腺素 E1组（对照组）31例。2组患者均接受纠正水、电解质、酸碱平衡紊乱,控制血压等常规治疗。在常规治疗基础上2组均静脉给予前列腺素 E120μg/d；治疗组同时服用川黄方中药汤剂,每日1剂；疗程均为2周。观察2组治疗前后的血肌酐（SCr）、血尿素氮（BUN）、血尿酸（uric acid,UA）、血清胱抑素C（cystatin,Cys C）、24 h尿蛋白定量,并统计中医证候疗效。结果①与治疗前相比,2组治疗均能有效降低 SCr、BUN、UA,差异均有统计学意义（P0.05）,但均能改善患者中医证候,其中治疗组优于对照组（P〈0.01）。结论川黄方联合前列腺素E1能有效减轻CKD 2~4期合并AKI患者肾损伤、保护肾功能,并改善中医证候,优于单用前列腺素E1治疗。

Clinical study of detoxification and removing blood stasis method combined with prostaglandin E1 in trea- ting phase 2-4 chronic kidney disease associated with acute kidney injury

Objective To observe the clinical efficacy of Chuanhuang decoction,which has de-toxification and removing blood stasis function,combined with prostaglandin E1 in treating phase 2-4 chronic kidney disease （CKD）associated with acute kidney injury （AKI）.Methods Sixty patients with AKI on phase 2-4 CKD admitted on Shanghai Municipal Hospital of Traditional Chinese Medicine were randomly divided into 2 groups,including treatment group （29 cases）and control group （3 1 ca-ses）.All patients were given the same diet care and basic treatment.Treatment group was treated with Chuanhuang Fang decoction combined with prostaglandin E1 （20μg/day by intravenous adminis-tration）,and control group with 20μg/day prostaglandin E1 by intravenous administration.The pa-tients were observed for two weeks.Serum creatinine （SCr）,blood urea nitrogen （BUN）,uric acid （UA）,serum cystatin C （Cys C）,and 24-h urine protein were determined and compared before and after treatment.Furthermore,total efficiency based on TCM symptom scores was calculated and ana-lyzed.Results After two-week treatment,SCr,BUN,UA and Cys C were significantly reduced in both two groups （P0.05）.Treatment group achieved 96.6% of the total efficiency based on TCM symptom scores,higher than prostaglandin E1 group （77.4%）（P〈0.01）.Conclusions Treatment group can relieve TCM symptoms and protect renal function in AKI on phase 2-4 CKD more effectively than in control group.Chuanhuang decoction and detoxification and remo-ving blood stasis method might be a potentially useful method for CKD associated with AKI.