针刺联合药物对CKD患者行MHD治疗钙磷代谢及并发症的影响研究

发布时间：2018-05-24 12:00

本文选题：针刺 + 慢性肾脏疾病　；参考：《济南大学》2017年硕士论文

【摘要】：目的:评价针刺双侧曲池和足三里穴位联合阿法骨化醇对慢性肾脏疾病(CKD)患者行维持性血液透析(MHD)治疗钙磷代谢及并发症的影响。方法:连续选择2016年01月至12月入济南医科园肾病医院诊断CKD患者行MHD治疗并发皮肤瘙痒或者不安腿综合征共50例,采用随机数字法将其分为对照组和观察组各25例,其中对照组采用单纯西药阿法骨化醇治疗,观察组同时联合针刺双侧曲池和足三里穴位,每周3次,共计4周。对比治疗前、治疗后2周和4周的中医症状临床积分改善情况,治疗有效率和不良反应,生化指标包括外周血钙、磷及甲状旁腺激素(iPTH)水平,炎症指标包括外周血IL-6、TNF-α和CRP水平,生活质量采用健康状况问卷(SF-36)评分。结果:两组治疗后2周和4周的中医症状临床积分均较治疗前明显降低,且观察组低于对照组,差异有统计学意义(P0.05)。观察组的治疗效果明显优于对照组,差异有统计学意义(P0.05)。两组均未发生严重不良反应。两组治疗后2周和4周的血钙水平较治疗前明显升高,血磷及PTH水平明显降低,且观察组改善程度大于对照组,差异有统计学意义(P0.05)。对照组治疗后2周和4周的血IL-6、TNF-α和CRP水平与治疗前比较,差异无统计学意义(P0.05);而观察组治疗后2周和4周的血IL-6、TNF-α和CRP水平较治疗前明显降低,且明显低于对照组,差异有统计学意义(P0.05)。两组治疗后2周和4周的生理健康总评(PCS)和心理健康总评(MCS)得分均逐渐提高,且观察组高于对照组,差异有统计学意义(P0.05)。结论:针刺联合阿法骨化醇可进一步提高CKD患者行MHD治疗伴发皮肤瘙痒或不安腿综合征的临床效果,与改善血钙、磷和PTH代谢及炎症反应有关,改善生活质量。
[Abstract]:Objective: to evaluate the effect of acupuncture at Zusanli acupoint and Zusanli acupoint on calcium and phosphorus metabolism and complications in patients with chronic renal disease treated with maintenance hemodialysis (MHD). Methods: from January to December 2016, 50 patients with CKD diagnosed in Jinan Medical Garden Nephropathy Hospital were treated with MHD for skin pruritus or restless leg syndrome. The patients were divided into control group (n = 25) and observation group (n = 25) by random number method. The control group was treated with simple western medicine Alfa osciferol, and the observation group was combined with acupuncture on both sides of zhuchi and Zusanli acupoints, three times a week, for a total of 4 weeks. Before treatment, 2 weeks and 4 weeks after treatment, the clinical scores of TCM symptoms, the effective rate and adverse reactions, the biochemical indexes including the levels of calcium, phosphorus and parathyroid hormone iPTHs in peripheral blood, and the levels of IL-6 TNF- 伪 and CRP in peripheral blood were compared. The quality of life (QOL) was assessed by health status questionnaire (SF-36). Results: the clinical scores of TCM symptoms in the two groups were significantly lower than those in the control group at 2 and 4 weeks after treatment, and the difference between the two groups was statistically significant (P 0.05). The therapeutic effect of the observation group was significantly better than that of the control group, and the difference was statistically significant (P 0.05). There were no serious adverse reactions in both groups. After 2 and 4 weeks of treatment, the levels of serum calcium and serum phosphorus and PTH in the two groups were significantly increased, and the improvement degree of the observation group was higher than that of the control group, the difference was statistically significant (P 0.05). The levels of serum IL-6 TNF- 伪 and CRP in the control group at 2 and 4 weeks after treatment were not significantly different from those before treatment, but the levels of IL-6 TNF- 伪 and CRP in the observation group were significantly lower than those in the control group at 2 and 4 weeks after treatment, and were significantly lower than those in the control group. The difference was statistically significant (P 0.05). Two and four weeks after treatment, the scores of PCS and MCSs of the two groups increased gradually, and the scores of the observation group were higher than those of the control group, and the difference was statistically significant (P 0.05). Conclusion: acupuncture combined with Alfarin can further improve the clinical effect of MHD in patients with CKD associated with skin pruritus or restless leg syndrome, which is related to the improvement of blood calcium, phosphorus, PTH metabolism and inflammatory reaction, and the improvement of quality of life.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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