大黄泄浊颗粒保留灌肠对非透析CKD肾性骨病湿热证患者骨密度及血清BMP-7的影响
发布时间：2018-07-18 07:52
【摘要】：目的:本课题通过观察非透析慢性肾脏病(CKD)肾性骨病(ROD)湿热证患者腰椎骨密度、血清骨形成蛋白-7(BMP-7)水平的变化及大黄泄浊颗粒剂保留灌肠的干预作用,旨在探讨大黄泄浊颗粒对ROD的治疗作用及其可能机制。方法:选择64例符合纳入标准的非透析CKD3~5期湿热证患者,随机分为治疗组和对照组各32例,治疗过程中失访4例,其中治疗组和对照组各2例,最终实际完成60例。并设正常组20例。两组患者均予相应的降压、利尿、纠正肾性贫血、调节钙磷水平、抑制甲旁亢等对症治疗;治疗组加用大黄泄浊颗粒保留灌肠治疗,每天一次。两组疗程均为8周。观察两组患者湿热证证候、肾功能等指标变化及不良反应情况;并检测两组患者治疗前后血清钙(Ca)、磷(P)、碱性磷酸酶(ALP)、甲状旁腺激素(i PTH)、BMP-7水平、腰椎2~4椎体骨密度(L2~4BMD)及Z值的变化情况,同时检测正常组血清BMP-7、L2~4 BMD和Z值,根据实验结果进行疗效判定和统计学处理。结果:治疗组临床疾病疗效、湿热证证候及各主要临床症状疗效均显著优于对照组,差异具有统计学意义(P0.05或0.01)。治疗后两组患者的湿热证证候积分值随疗程的增加,下降愈显著(P0.05或0.01);同疗程比较,治疗组下降幅度均明显优于对照组(P0.01)。治疗组治疗后肾功能(Scr、BUN)及e GFR均较治疗前改善显著(P0.01),对照组除BUN改善明显(P0.05)外,其余改善均不明显(P0.05);治疗组治疗后上述诸项指标均较对照组改善显著(P0.01)。两组患者治疗前L2~4 BMD、Z值及BMP-7水平均明显低于正常组(P0.01),而两组患者之间比较均无明显差异(P0.05);治疗后两组患者L2~4 BMD、Z值及BMP-7水平较治疗前均明显升高(P0.05或P0.01),而治疗组均较对照组改善显著(P0.01)。采用Pearson法分析:两组患者治疗前的L2~4 BMD及BMP-7水平与e GFR、血Ca成正相关性,与血清BUN、Scr、P、i PTH呈显著负相关,均具有统计学意义(P0.01)。结论:非透析CKD肾性骨病湿热证患者L2~4 BMD、Z值及BMP-7水平均低于健康人群;大黄泄浊颗粒剂保留灌肠可通过改善非透析CKD合并ROD湿热证患者的临床症状及肾功能,升高血Ca、降低血P、i PTH、ALP水平,明显提高L2~4 BMD、Z值,从而达到有效防治ROD,改善CKD患者预后的目的,其机制可能与血清BMP-7含量升高密切相关。
[Abstract]:Objective: to observe the changes of bone mineral density (BMD) and serum bone morphogenetic protein-7 (BMP-7) level of lumbar vertebrae and bone morphogenetic protein (BMP-7) in patients with renal osteopathy (ROD) of non-dialysis chronic kidney disease (CKD) and the intervention effect of rhubarb Xiezhuo granule retention enema. To explore the therapeutic effect and possible mechanism of Rhubarb Xiezhuo granule on ROD. Methods: Sixty-four patients with non-dialysis CKD _ 3N _ 5 damp-heat syndrome were randomly divided into treatment group (n = 32) and control group (n = 32). 4 cases were lost in the course of treatment, including 2 cases in the treatment group and 2 cases in the control group, and 60 cases were actually completed. There were 20 cases in normal group. The two groups were given corresponding antihypertensive, diuretic, renal anemia correction, regulation of calcium and phosphorus levels, inhibition of hyperthyroidism and other symptomatic treatment; treatment group with rhubarb Xiezhuo granule retention enema treatment, once a day. The course of treatment was 8 weeks in both groups. Serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), parathyroid hormone (I PTH) and BMP-7 were measured before and after treatment. The changes of bone mineral density (L2BMD) and Z value of lumbar vertebrae were measured. The BMD and Z value of serum BMP-7 and L2C4BMD in normal group were determined and statistically analyzed according to the experimental results. Results: the curative effect of clinical disease, syndrome of dampness and heat and main clinical symptoms in the treatment group were significantly better than those in the control group, the difference was statistically significant (P0.05 or 0.01). After treatment, the score of dampness and heat syndrome in the two groups decreased significantly with the increase of the course of treatment (P0.05 or 0.01); compared with the course of treatment, the decrease of the treatment group was significantly better than that of the control group (P0.01). After treatment, the renal function (Scrn bun) and eGFR in the treatment group were significantly improved compared with those before treatment (P0.01), except bun in the control group, the other improvements were not significant (P0.05), and the above indexes in the treatment group were significantly improved compared with the control group (P0.01). Before treatment, the level of BMDZ and BMP-7 in the two groups were significantly lower than those in the normal group (P0.01), but there was no significant difference between the two groups (P0.05), and after treatment, the values of L24-BMD-Z and BMP-7 in the two groups were significantly higher than those before treatment (P0.05 or P0.01), while the level of BMP-7 in the treatment group was significantly higher than that before treatment (P0.05 or P0.01). Compared with the control group, the improvement was significant (P0.01). Pearson method was used to analyze: the levels of L2O4BMD and BMP-7 were positively correlated with eGFRand serum Ca, and negatively correlated with serum BUNG ScrP Pi PTH before treatment in both groups (P0.01). Conclusion: the values of L2O4BMD-Z and BMP-7 in non-dialysis CKD renal osteopathy with damp-heat syndrome are lower than those in healthy people, the retention enema of Rhubarb Xiezhuo granule can improve the clinical symptoms and renal function of non-dialysis CKD patients with ROD dampness and heat syndrome. Raising blood Ca, decreasing the level of serum Phi-PTHHfen ALP and increasing the value of L2O4BMDZ can effectively prevent and cure ROD and improve the prognosis of patients with CKD. The mechanism may be closely related to the increase of serum BMP-7 content.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R692;R681
本文编号：2131239
[Abstract]:Objective: to observe the changes of bone mineral density (BMD) and serum bone morphogenetic protein-7 (BMP-7) level of lumbar vertebrae and bone morphogenetic protein (BMP-7) in patients with renal osteopathy (ROD) of non-dialysis chronic kidney disease (CKD) and the intervention effect of rhubarb Xiezhuo granule retention enema. To explore the therapeutic effect and possible mechanism of Rhubarb Xiezhuo granule on ROD. Methods: Sixty-four patients with non-dialysis CKD _ 3N _ 5 damp-heat syndrome were randomly divided into treatment group (n = 32) and control group (n = 32). 4 cases were lost in the course of treatment, including 2 cases in the treatment group and 2 cases in the control group, and 60 cases were actually completed. There were 20 cases in normal group. The two groups were given corresponding antihypertensive, diuretic, renal anemia correction, regulation of calcium and phosphorus levels, inhibition of hyperthyroidism and other symptomatic treatment; treatment group with rhubarb Xiezhuo granule retention enema treatment, once a day. The course of treatment was 8 weeks in both groups. Serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), parathyroid hormone (I PTH) and BMP-7 were measured before and after treatment. The changes of bone mineral density (L2BMD) and Z value of lumbar vertebrae were measured. The BMD and Z value of serum BMP-7 and L2C4BMD in normal group were determined and statistically analyzed according to the experimental results. Results: the curative effect of clinical disease, syndrome of dampness and heat and main clinical symptoms in the treatment group were significantly better than those in the control group, the difference was statistically significant (P0.05 or 0.01). After treatment, the score of dampness and heat syndrome in the two groups decreased significantly with the increase of the course of treatment (P0.05 or 0.01); compared with the course of treatment, the decrease of the treatment group was significantly better than that of the control group (P0.01). After treatment, the renal function (Scrn bun) and eGFR in the treatment group were significantly improved compared with those before treatment (P0.01), except bun in the control group, the other improvements were not significant (P0.05), and the above indexes in the treatment group were significantly improved compared with the control group (P0.01). Before treatment, the level of BMDZ and BMP-7 in the two groups were significantly lower than those in the normal group (P0.01), but there was no significant difference between the two groups (P0.05), and after treatment, the values of L24-BMD-Z and BMP-7 in the two groups were significantly higher than those before treatment (P0.05 or P0.01), while the level of BMP-7 in the treatment group was significantly higher than that before treatment (P0.05 or P0.01). Compared with the control group, the improvement was significant (P0.01). Pearson method was used to analyze: the levels of L2O4BMD and BMP-7 were positively correlated with eGFRand serum Ca, and negatively correlated with serum BUNG ScrP Pi PTH before treatment in both groups (P0.01). Conclusion: the values of L2O4BMD-Z and BMP-7 in non-dialysis CKD renal osteopathy with damp-heat syndrome are lower than those in healthy people, the retention enema of Rhubarb Xiezhuo granule can improve the clinical symptoms and renal function of non-dialysis CKD patients with ROD dampness and heat syndrome. Raising blood Ca, decreasing the level of serum Phi-PTHHfen ALP and increasing the value of L2O4BMDZ can effectively prevent and cure ROD and improve the prognosis of patients with CKD. The mechanism may be closely related to the increase of serum BMP-7 content.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R692;R681
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