中药结肠透析联合保留灌肠治疗非透析慢性肾脏病临床观察

目的观察中药结肠透析联合保留灌肠治疗非透析慢性肾脏病(chronic kidney disease,CKD)3~5期患者的临床疗效以及相关指标的变化,探讨其治疗的作用机制。方法选取62例非透析CKD 3~5期患者,随机分为对照组31例和观察组31例,实际完成对照组29例,观察组30例。对照组采用每日1次保留灌肠,观察组采用每周3次结肠透析联合每周3次保留灌肠,两组同时予以基础治疗,疗程12周。采用血尿素氮(blood urea nitrogen,BUN)、血清肌酐(serum creatinine,Scr)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、胱抑素C(cystatin C,CysC)、同型半胱氨酸(homocysteine,Hcy)评价肾功能,采用血清超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、血清淀粉样蛋白A(serum amyloid A protein,SAA)、α₁-酸性糖蛋白(α₁-acid glycoprotein,AAG)评价炎症状态,采用血清白蛋白(albumin,Alb)、前白蛋白(prealbumin,PAB)、血红蛋白(hemoglobin,Hb)、红细胞(red blood cell,RBC)计数评价营养情况,采用血清钙(Ca)、磷(P)、甲状旁腺激素(parathyroid hormone,PTH)评价钙磷代谢紊乱等指标的变化。结果治疗后两组患者乏力、纳差、腹胀、恶心、口干、口苦中医症状积分均较治疗前降低(P<0.05),且观察组优于对照组(P<0.05)。治疗后两组患者血清BUN、Scr、、CysC、Hcy、hs-CRP、SAA、AAG、P、PTH水平均较治疗前降低(P<0.05),血清Alb、Hb、RBC、Ca、eGFR水平均较治疗前升高(P<0.05),观察组降低或升高幅度大于对照组(P<0.05)。结论中药结肠透析联合保留灌肠可以减轻CKD 3~5期患者炎症状态,纠正营养不良,改善贫血及钙磷代谢紊乱,进而减轻患者的临床症状并保护肾功能。

Clinical Effect of Traditional Chinese Medicine Colon Dialysis Combined with Retention Enema in Treatment of Non-dialysis Chronic Kidney Disease

Objective To investigate the clinical effect of traditional Chinese medicine(TCM)colon dialysis combined with retention enema in the treatment of patients with stage 3-5 non-dialysis chronic kidney disease(CKD),the changes of related indices,and its mechanism of action.Methods A total of 62 patients with stage 3-5 non-dialysis CKD were enrolled and randomly divided into control group and observation group,with 31 patients in each group,and 29 patients in the control group and 30 in the observation group completed the study.In addition to basic treatment,the patients in the control group were given retention enema once a day,and those in the observation group were given colon dialysis 3 times a week and retention enema 3 times a week;the course of treatment was 12 weeks for both groups.Blood urea nitrogen(BUN),serum creatinine(SCr),estimated glomerular filtration rate(eGFR),cystatin C(CysC),and homocysteine(Hcy)were measured to evaluate renal function;hypersensitive C-reactive protein(hs-CRP),serum amyloid A protein(SAA),andα₁-acid glycoprotein(AAG)were measured to evaluate inflammatory state;albumin(Alb),prealbumin,hemoglobin(Hb),and red blood cell(RBC)were measured to evaluate nutrition;serum calcium(Ca),serum phosphorus(P),and parathyroid hormone(PTH)were measured to evaluate calcium/phosphorus metabolism disorders.Results After treatment,both groups had significant reductions in the TCM symptom scores of weakness,poor appetite,abdominal distension,nausea,dry mouth,and bitter taste(P<0.05),and the observation group had significantly greater reductions than the control group(P<0.05).After treatment,both groups had significant reductions in the levels of BUN,SCr,CysC,Hcy,hs-CRP,SAA,AAG,P,and PTH(P<0.05)and significant increases in the levels of Alb,Hb,RBC,Ca,and eGFR(P<0.05),and the observation group had significantly greater reductions or increases than the control group(P<0.05).Conclusion For patients with stage 3-5 CKD,TCM colon dialysis combined with retention enema can alleviate inflammatory state,correct malnutrition,and improve anemia and calcium/phosphorus metabolism disorders,thereby alleviating clinical symptoms and protecting renal function.