Clinical Study on Modified Huanglian Yishen Decoction Assisting Treatment for Acute Kidney Injury of Spleen- Kidney Qi Deficiency and Internal Obstruction of Stasis and Toxin Type
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摘要:
目的:观察黄连益肾汤加减辅助治疗脾肾气虚、瘀毒内阻型急性肾损伤(AKI) 的临床疗效。方 法:采用随机数字表法将62 例脾肾气虚、瘀毒内阻型患者分为治疗组与对照组各31 例。对照组给予常规西药 治疗,治疗组在对照组基础上加用黄连益肾汤加减治疗。比较2 组治疗前后中医证候积分、尿相关指标(24 h 总尿量、24 h 尿蛋白量、24 h 尿蛋白排泄率)、肾功能指标[尿素氮(BUN)、肌酐(SCr)、胱抑素-C(CysC)、 肾小球滤过率(eGFR) ]、肾损伤指标[肾损伤分子1 (KIM-1)、中性粒细胞明胶酶相关脂质运载蛋 白(NGAL)、血乳酸(LAC)、降钙素原(PCT) ]、免疫应激指标[血红素加氧酶1(HO-1)、丙二醛(MDA)、 超氧化物歧化酶(SOD) ]水平,并评估2 组临床疗效及不良反应发生情况。结果:治疗后,治疗组总有效率 93.55%,高于对照组74.19% (P<0.05)。治疗后,2 组中医证候积分、24 h 尿蛋白量、24 h 尿蛋白排泄率、 BUN、SCr、CysC 及血清KIM-1、NGAL、LAC、PCT、MDA 水平均较治疗前降低(P<0.05),且治疗组治疗 后中医证候积分、肾损伤指标、24 h 尿蛋白量、24 h 尿蛋白排泄率及血清MDA 水平均低于对照组(P< 0.05)。2 组治疗后24 h 总尿量、eGFR 及血清HO-1、SOD 水平均高于治疗前(P<0.05),治疗组治疗后上述 指标均高于对照组(P<0.05)。2 组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:黄连益肾汤 加减辅助治疗脾肾气虚、瘀毒内阻型AKI 疗效确切,能够减轻患者肾损伤程度,改善肾功能,降低免疫应激 反应,安全性较高。
Abstract:
Abstract: Objective: To observe the clinical effect of modified Huanglian Yishen Decoction assisting treatment for acute kidney injury (AKI) of spleen-kidney qi deficiency and internal obstruction of stasis and toxin type. Methods:A total of 62 patients of spleen-kidney qi deficiency and internal obstruction of stasis and toxin type were divided into the treatment group and the control group,with 31 cases in each group. The control group was treated with conventional western medicine,and the treatment group was treated with modified Huanglian Yishen Decoction based on the treatment of the control group. The traditional Chinese medicine (TCM) syndrome scores,urine related indicators (24-hour total urine volume,24-hour urine protein quantity, and 24- hour urine protein excretion rate), kidney function indexes [blood urea nitrogen (BUN), creatinine (SCr), cystatin C (CysC), and estimated glomerular filtration rate (eGFR)], kidney injury indicators [kidney injury molecule- 1 (KIM- 1), neutrophil gelatinase- associated lipocalin (NGAL),blood lactate (LAC),and procalcitonin (PCT) ],and immune stress indicators [heme oxygenase-1 (HO- 1), malondialdehyde (MDA), and superoxide dismutase (SOD)] levels were compared before and after treatment in two groups. The clinical effects and incidence of adverse reactions were evaluated in the two groups. Results:After treatment,the total effective rate was 93.55% in the treatment group,higher than that of 74.19% in the control group (P<0.05). After treatment,the TCM syndrome scores,24-hour urine protein quantity, 24- hour urine protein excretion rates, BUN, SCr, CysC, and serum KIM- 1, NGAL,LAC,PCT,and MDA levels in the two groups were decreased when compared with those before treatment (P<0.05),the TCM syndrome score,kidney injury indicators,24-hour urine protein quantity, 24-hour urine protein excretion rate,and serum MDA level in the treatment group were lower than those in the control group (P<0.05). After treatment,the 24-hour total urine volume,eGFR,and serum HO-1 and SOD levels in the two groups were higher than before treatment (P<0.05);the above indicators in the treatment group were higher than those in the control group (P<0.05). There was no significant difference being found in the comparison of incidence of adverse reactions between the two groups (P>0.05). Conclusion:Modified Huanglian Yishen Decoction has a definite curative effect in the auxiliary treatment of AKI of spleen-kidney qi deficiency and internal obstruction of stasis and toxin type,which can reduce the degree of kidney injury in patients, improve kidney function, reduce immune stress response, and has high safety.