百令胶囊联合前列地尔注射液...者肾功能、微炎症状态的影响_胡甲丰.pdf

新中医2023年2月第55卷第4期NEW CHINESE MEDICINEFebruary 2023 Vol.55 No.4收稿日期 2022-05-07修回日期 2022-11-25作者简介胡甲丰（1984-），男，主治医师，E-mail：。百令胶囊联合前列地尔注射液治疗对慢性肾衰竭患者肾功能、微炎症状态的影响胡甲丰杭州市临平区第一人民医院肾内科，浙江 杭州 311199摘要目的：观察百令胶囊联合前列地尔注射液治疗肺肾阴虚型慢性肾衰竭（CRF）的临床疗效，以及对患者肾功能、微炎症状态的影响。方法：按随机数字表法将 62 例肺肾阴虚型 CRF 患者分为治疗组与对照组，每组 31 例。对照组采用前列地尔注射液治疗，治疗组在对照组基础上给予百令胶囊治疗，2 组均治疗2 周。治疗前后评定 2 组患者的中医证候积分，检测肾功能指标、炎症指标，比较 2 组临床疗效及治疗期间的不良反应发生率。结果：治疗后，治疗组临床疗效总有效率 96.77%，高于对照组 77.42%（P0.05）。2 组干咳少痰、腰酸膝软、五心烦热、潮热盗汗积分均较治疗前降低（P0.05），治疗组干咳少痰、腰酸膝软、五心烦热、潮热盗汗积分均低于对照组（P0.05）。2 组血尿素氮（BUN）、血肌酐（SCr）水平及尿蛋白/尿肌酐值均较治疗前降低（P0.05），治疗组 BUN、SCr 水平及尿蛋白/尿肌酐值均低于对照组（P0.05）。2 组血清C-反应蛋白（CRP）、白细胞介素-6（IL-6）水平均较治疗前降低（P0.05），治疗组血清 CRP、IL-6 水平均低于对照组（P0.05）。2 组不良反应发生率比较，差异无统计学意义（P0.05）。结论：百令胶囊联合前列地尔注射液治疗肺肾阴虚型 CRF 疗效较佳，可有效缓解临床症状，提高患者的肾功能，抑制炎症反应，安全性好。关键词慢性肾衰竭；肺肾阴虚型；百令胶囊；前列地尔注射液；中医证候；肾功能；炎症因子中图分类号R692.5文献标志码A文章编号0256-7415（2023）04-0073-05DOI：10.13457/ki.jncm.2023.04.016Effects of Bailing Capsules Combined with Alprostadil Injection on Kidney Functionand Micro-Inflammatory State in Patients with Chronic Renal FailureHU JiafengAbstract：Objective：To observe the clinical effect of Bailing Capsules combined with AlprostadilInjection on chronic renal failure(CRF)of lung-kidney yin deficiency type，and its effect on the kidneyfunction and micro-inflammatory state of patients.Methods：A total of 62 patients with CRF of lung-kidneyyin deficiency type were divided into the treatment group and the control group by the random number tablemethod，with 31 cases in each group.The control group was treated with Alprostadil Injection，and thetreatment group was additionally given Bailing Capsules based on the treatment of the control group.The two groups were treated for 2 weeks.Before and after treatment，the traditional Chinesemedicine syndrome scores，levels of serum inflammatory indexes including C-reactive protein(CRP)andinterleukin-6(IL-6)，and levels of kidney function indexes including blood urea nitrogen(BUN)，serum 73新中医2023年2月第55卷第4期NEW CHINESE MEDICINEFebruary 2023 Vol.55 No.4慢性肾衰竭（CRF）是指各种肾脏疾病引起的缓慢进行性肾功能损害，可由高血压病、尿路梗阻、肾小球肾炎、糖尿病等引起，严重者会导致尿毒症和肾功能完全丧失1。前列地尔是一种血管活性药物，其主要成分前列腺素 E1 具有扩张血管、改善肾功能的作用，但单一用药的总体疗效还有提升空间2。CRF 归属于中医学溺毒、关格等范畴，中医学认为，肺肾亏虚为本病的根本病机，湿热、瘀血、痰饮等可进一步加重肺肾亏虚，治疗原则为补肺肾、益精气3。百令胶囊是具有补肺肾、益精气功效的中成药，能保护肾功能免受损伤，适用于治疗肺肾阴虚型 CRF4。有研究表明，CRF 患者体内通常存在慢性微炎症反应5。临床从微炎症角度探讨百令胶囊联合前列地尔注射液治疗肺肾阴虚型 CRF 的相关报道相对较少，本研究观察 2 种药物联合使用治疗肺肾阴虚型 CRF 的临床疗效，以及对患者肾功能、微炎症状态的影响，结果报道如下。1临床资料1.1诊断标准符合肾脏病学6中 CRF 的诊断标准，内生肌酐清除率（CCr）80 mL/min，血肌酐（SCr）133 mol/L。1.2辨证标准参照 中药新药临床研究指导原则（试行）7中 CRF 的辨证标准辨为肺肾阴虚证。主症：腰酸膝软，潮热盗汗，五心烦热，干咳少痰或无痰、痰不易咳出；次症：遗精、滑精或月经失调，气短眩晕，口淡不渴；舌脉象：舌质红或偏红、苔少或光剥，脉细或弱。1.3纳入标准符合上述诊断及辨证标准；CRF 分期属 23 期；患者知晓研究内容，并签署知情同意书。1.4排除标准既往有急性心力衰竭病史或急性感染等并发症；妊娠期或哺乳期妇女；既往有本研究所用药物过敏史；伴心、脑、肝等功能障碍者。1.5剔除标准未按医嘱服药者；中途退出研究者。1.6一般资料选取 2021 年 112 月在杭州市临平creatinine(SCr)as well as the value of urinary protein/urinary creatinine，in the two groups were compared.The clinical effects and the incidence of adverse reactions during treatment in both groups were alsocompared.Results：After treatment，the total clinical effective rate was 96.77%in the treatment group，higher than that of 77.42%in the control group(P0.05).The scores of dry cough with less phlegm，soreness and weakness of waists and knees，vexing heat in the five centers and hot flush and night sweatin both groups were decreased when compared with those before treatment(P0.05)，and the abovescores in the treatment group were lower than those in the control group(P0.05).The levels of BUN andSCr，and the value of urinary protein/urinary creatinine in the two groups were decreased when comparedwith those before treatment(P0.05)，and the levels of BUN and SCr，and the value of urinary protein/urinary creatinine in the treatment group were lower than those in the control group(P0.05).The levels ofserum CRP and IL-6 were decreased when compared with those before treatment(P0.05)，and thelevels of serum CRP and IL-6 in the treatment group were lower than those in the control group(P0.05).During treatment，there was no significant difference being found in the comparison of the incidence ofadverse reactions between the two groups(P0.05).Conclusion：Bailing Capsules combined withAlprostadil Injection has a better curative effect on CRF of lung-kidney yin deficiency type，which caneffectively mitigate the clinical symptoms，improve the kidney function of patients，and inhibit theinflammatory responses，with good safety.Keywords：Chronicrenalfailure；Lung-kidneyyindeficiencytype；BailingCapsules；AlprostadilInjection；Traditional Chinese medicine syndrome；Kidney function；Inflammatory factor 74新中医2023年2月第55卷第4期NEW CHINESE MEDICINEFebruary 2023 Vol.55 No.4区第一人民医院治疗的 62 例肺肾阴虚型 CRF 患者，按随机数字表法均分为 2 组。对照组男 19 例，女12 例；平均年龄（52.484.86）岁；平均病程（3.750.82）年；CRF 分期：2 期 22 例，3 期 9 例；平均体质量指数 23.682.35；原发病：慢性肾小球肾炎15 例，糖尿病肾病 10 例，高血压肾病 6 例。治疗组男 18 例，女 13 例；平均年龄（52.554.91）岁；平均病程（3.690.78）年；CRF 分期：2 期 20 例，3 期11 例；平均体质量指数 23.712.42；原发病：慢性肾小球肾炎 16 例，糖尿病肾病 10 例，高血压肾病5 例。2 组一般资料比较，差异均无统计学意义（P0.05），具有可比性。本研究经杭州市临平区第一人民医院医学伦理委员会审核批准（2021004）。2治疗方法2.1对照组给予前