温阳活血法治疗阳虚血瘀型3-4期CKD患者临床疗效观察及其对血清ADMA影响

发布时间：2018-07-14 19:00

【摘要】：目的：观察温阳活血法对阳虚血瘀型3-4期慢性肾脏病(CKD)患者临床疗效及其对血清不对称二甲基精氨酸(ADMA)的影响,运用《伤寒论》经方真武汤合桃核承气汤为基础方治疗,以血清ADMA为观察指标,运用氧化应激反应理论阐明阳虚血瘀型3-4期慢性肾脏病患者的发病机制,进一步探讨中药干预治疗慢性肾脏病的可能途径,为中医药延缓肾功能进展的治疗奠定基础。方法：①将确诊为3-4期慢性肾脏病同时中医辨证为阳虚血瘀证型的80例患者,运用简单随机划分法分为治疗组、对照组；②对照组予单纯西药进行治疗,治疗组在对照组的基础上予以温阳活血方治疗,疗程均为3个月；③检测治疗前后其肾小球滤过率(eGFR)、血清尿素氮(BUN)、血清肌酐(Scr)、血清ADMA的数值变化。结果：①两组经治疗后,在临床疗效比较上,两者有统计学差异(P0.05),表明温阳活血法结合西药治疗慢性肾脏病的临床疗效优于单用西药治疗。②两组经治疗后,在临床证候疗效比较上,两者有统计学差异(P0.05),表明温阳活血法结合西药治疗慢性肾脏病的临床证候疗效优于单用西药治疗。③经统计学处理后,比较两组同组治疗前后症状变化,表明对照组除恶心、大便不实无明显改善外,其余症状均有明显改善作用(P0.05或P0.01)；治疗组除大便不实无明显改善外,其余临床症状均有明显改善作用(P0.01)。治疗组和对照组进行组间比较,治疗组在腰膝酸软、畏寒肢冷、恶心、夜尿清长等症状的改善明显优于对照组,有显著性统计学意义(P0.05或P0.01)；其余各症状均有一定改善,但两组组间比较不具有显著性统计学意义(P0.05)。④治疗后,同组比较,两组较治疗前均能降低Scr、BUN、血清ADMA水平,升高eGFR,均具有统计学意义(P0.05),其中治疗组对降低血清ADMA水平具有高度统计学意义(P0.01)；⑤治疗后,治疗组血肌酐、血清ADMA水平低于对照组,治疗组eGFR高于对照组,有统计学意义(P0.05),而治疗组与对照组比较,血尿素氮水平两组相比无统计学意义(P0.05)。⑥相关性分析：患者血清ADMA与Scr呈正相关(P0.01),与BUN亦呈正相关(P0.01),与eGFR呈负相关(P0.01)。结论：①温阳活血法治疗3-4期慢性肾脏病阳虚血瘀证型疗效确切。②入组的3-4期阳虚血瘀型CKD患者血清ADMA水平与健康组相比,可见显著升高。③温阳活血法能显著改善3-4期阳虚血瘀型CKD患者的临床症状,其疗效高于单纯西药治疗。④温阳活血法可显著降低3-4期阳虚血瘀型CKD患者血清ADMA水平,提示其在抗氧化反应方面有明显的优势。⑤温阳活血法可使3-4期阳虚血瘀型CKD患者血肌酐水平降低并提高eGFR水平,疗效高于单纯西药治疗,表明其对肾功能具有改善作用,从而使肾小球滤过率得以提高,进一步延缓慢性肾脏病病情进展,达到临床症状的改善及疗效的提高。
[Abstract]:Objective: to observe the clinical effect of warming yang and activating blood circulation method on chronic kidney disease (CKD) of phase 3-4 of Yang deficiency and blood stasis type and its effect on serum asymmetric dimethyl arginine (ADMA). Taking serum ADMA as the observation index, using the theory of oxidative stress reaction to elucidate the pathogenesis of chronic kidney disease in phase 3-4 of Yang-deficiency and blood-stasis type, and to further explore the possible ways of Chinese medicine intervention in the treatment of chronic kidney disease. It lays a foundation for the treatment of delaying the progress of renal function with traditional Chinese medicine. Methods 80 cases of chronic kidney disease with syndrome differentiation of yang deficiency and blood stasis were divided into treatment group and control group by simple randomized method. Control group was treated with western medicine. The treatment group was treated with Wenyang Huoxue recipe on the basis of the control group. The course of treatment was 3 months to detect the changes of glomerular filtration rate (eGFR), serum urea nitrogen (bun), serum creatinine (SCR) and serum ADMA before and after treatment. Results there was a significant difference between the two groups in clinical efficacy after treatment (P0.05). The results showed that the therapeutic effect of warming yang and activating blood circulation method combined with western medicine in treating chronic kidney disease was better than that of western medicine alone in the treatment of chronic kidney disease. There was statistical difference between the two groups (P0.05), which indicated that the therapeutic effect of warming Yang and activating Blood Circulation combined with Western Medicine in treating chronic Kidney Disease was better than that in treating chronic Kidney Disease with only Western Medicine (P 0.05), and the curative effect of warming Yang and activating Blood Circulation combined with Western Medicine was better than that of western medicine alone. The changes of symptoms before and after treatment in the two groups were compared. The results showed that the control group had significant improvement except nausea, stool unreality, and other symptoms (P0.05 or P0.01), while the treatment group had no significant improvement except defecation. The other clinical symptoms were obviously improved (P0.01). Compared with the control group, the improvement of symptoms in the treatment group was significantly better than that in the control group (P0.05 or P0.01), and the other symptoms were improved to some extent. However, there was no significant statistical significance between the two groups (P0.05) after treatment, compared with the same group, both groups could reduce the levels of Scr-BUNand serum ADMA. After treatment, the serum creatinine and serum ADMA levels in the treatment group were lower than those in the control group, and the eGFR in the treatment group was higher than that in the control group. Compared with the control group, there was no significant correlation between the two groups (P0.05). The serum ADMA was positively correlated with SCR (P0.01), bun was positively correlated (P0.01), and negatively correlated with eGFR (P0.01). Conclusion the therapeutic effect of the method of warming Yang and activating Blood Circulation at stage 3 to 4 in treating chronic kidney disease with yang deficiency and blood stasis syndrome is exact .2 the serum ADMA level of CKD patients with CKD of 3 to 4 stages of yang deficiency and blood stasis is higher than that of healthy group. It can be seen that the treatment of warming yang and activating blood circulation can significantly improve the clinical symptoms of CKD patients with Yang deficiency and blood stasis syndrome in phase 3-4, and its curative effect is higher than that of western medicine alone. The treatment of warming yang and activating blood circulation method can significantly reduce the level of serum ADMA in patients with CKD with Yang deficiency and blood stasis type in phase 3-4. It is suggested that the method of warming yang and activating blood circulation can decrease the level of creatinine and increase the level of eGFR in CKD patients with Yang deficiency and blood stasis syndrome in 3-4 stages, and the curative effect is higher than that of western medicine alone, which indicates that it can improve renal function. Thus, the glomerular filtration rate can be increased, and the progress of chronic kidney disease can be further delayed, and the clinical symptoms and curative effects can be improved.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.5

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