世界中医药
文章摘要
引用本文:王永钧1 何立群2 孙 伟3 鲁 盈1 王小琴4 张佩青5 魏连波6 曹式丽7 杨霓芝8 马红珍9 高 菁10 李 平11 陶筱娟12 袁发焕13 李 靖10 姚 晨14 刘旭生8.中药辨证组方对慢性肾脏病3期的肾保护作用——315例多中心、前瞻性、双盲、随机对照试验[J].世界中医药,2013,8(09):.  
中药辨证组方对慢性肾脏病3期的肾保护作用——315例多中心、前瞻性、双盲、随机对照试验
Clinical Research of Traditional Chinese Medicine Combined with Renal Protective Effects of Traditional Chinese Medicine Formula for Patients with Chronic Kidney Disease Stage 3: A Multi-center, Prospective, Double-blinded, Randomized Controlled Trials of 315 Cases
投稿时间:2013-09-22  
DOI:10.3969/j.issn.1673-7202.2013.09.004
中文关键词:  慢性肾脏病  肾功能  中药辨证组方
English Keywords:Chronic kidney disease  Kidney function  Chinese medical formula by symptom differentiation
基金项目:“十一五”国家科技支撑计划(编号:2006BAI04A07)
作者单位
王永钧1 何立群2 孙 伟3 鲁 盈1 王小琴4 张佩青5 魏连波6 曹式丽7 杨霓芝8 马红珍9 高 菁10 李 平11 陶筱娟12 袁发焕13 李 靖10 姚 晨14 刘旭生8 1 浙江中医药大学广兴医院(杭州市中医院)杭州310007 2 上海中医药大学曙光医院上海200021 3 江苏省中医院南京210029 4 湖北省中医院武汉430061 5 黑龙江省中医研究院哈尔滨150036 6 南方医科大学珠江医院广州510280 7 天津中医药大学第一医院天津300193 8 广东省中医院广州510120 9 浙江省中医院杭州310006 10 北京中医药大学东直门医院北京100700 11 北京中日友好医院北京100029 12 杭州市红十字会医院杭州310003 13 第三军医大学新桥医院重庆400037 14 北京大学第一医院统计室北京100034 
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中文摘要:
      目的:观察中药辨证组方对慢性肾小球肾炎CKD3期患者的肾保护作用及安全性。方法:对入组人群采用前瞻、双盲、随机对照的研究方法,将符合方案集(Per-protocol.PP)的315例患者分成中药辨证组(158例)和西药苯那普利组(157例)。中药组按肾气阴两虚、肾络瘀痹、风湿扰肾、湿热内蕴四证予中药辨证组方+苯那普利模拟剂+基础治疗;西药组予西药苯那普利10 mg/d+中药组方模拟剂+基础治疗,观察24 h尿蛋白定量(u-pr/24 h)、尿白蛋白/肌酐比值(U-Alb/Cr)、血肌酐(Scr)、尿素氮(Bun)、尿酸(UA)、钾(K+)、估测肾小球滤过率(eGFR·MDRD公式)、CKD分期、中医证候与症状积分值、综合疗效分析及安全性。疗程24周。结果:中药组治后Scr下降,eGFR升高(P<0.05~0.01),不良反应少,但尿蛋白却较基线有所增高。西药组治后尿蛋白有减少(P>0.05),但Scr增高(P<0.01),其中31例(19.7%)增幅>30%,8例(5.10%)增幅>50%,eGFR降低,有27例(17.2%)由CKD3期进展至CKD4期。结论:中药辨证组方对慢性肾脏病具有不依赖于减少尿蛋白的肾保护作用,且安全性好。
English Summary:
      To investigate the efficacy and safety of Chinese medical formula by symptom differentiation and signs on patients with chronic Stage 3 kidney disease. Methods:This is a prospective, double blinded, randomized, controlled trial enrolling a total of 315 patients in per-protocol data set assigned to traditional Chinese medicine group (TCM group, 158 cases) or western medicine (benazepril) group (WM group, 157 cases). TCM group received general therapy, benazepril placebo and Chinese medical formula according to the four Chinese medicine patterns including qi yin/xue deficiency patterns, blood stasis in the kidney patterns, wind-dampness interfering in the kidney patterns, endoretention of damp heat patterns. WM group received 10 mg/d of benazepril, placebo of Chinese medicine formula and general therapy. Finally, 24 h proteinuria, ratio of urinary albumin versus creatinine, serum creatinine, urea nitrogen, uric acid, potassium, evaluated glomerular filtration rate (eGFR), stage of chronic kidney disease, score of Chinese patterns and syndromes, evaluation of composite effects and safety were assessed. Patients were followed up for 24 weeks. Results: In TCM group, serum creatinine was decreased while eGFR was increased at week 24 as compared with baseline (P<0.05-0.01) with little side effects, whereas proteinuria was increased a bit compared with baseline. In WM group, proteinuria was decreased (P>0.05), whereas serum creatinine was increased (P<0.01) as compared with baseline. Of the WM group, serum creatinine in 31 cases (19.7%) increased >30%, 8 cases (5.10%) increased >50%. eGFR was decreased with 27 (17.2%) cases developed CKD Stage 4 from Stage 3.Conclusion: Chinese medicine formula by differentiation of symptoms and signs had renal protective effects independent of reducing proteinuria with safety.
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