世界中医药

作者	单位
咸伟1，董吉2，张灿强1	1 河南医学高等专科学校附属医院,郑州,451191 2 河南省医学高等专科学校内科教研室,郑州,451191

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中文摘要:

目的:探究加味六君子汤辅治慢性肾衰急性加重期患者临床疗效,及对患者血液流变学、微炎性反应状态的影响,分析加味六君子汤治疗慢性肾衰急性加重期患者可能的疗效机制。方法:选取2016年1月至2018年1月河南医学高等专科学校附属医院收治的慢性肾衰急性加重期患者106例作为研究对象,按照就诊顺序编号,采用数字随机表法将其分为对照组和观察组,每组53例。2组患者均进行慢性肾衰常规西医治疗及急性期病因对症治疗,观察组在此基础上再予以加味六君子汤治疗,2组患者均连续治疗8周为1个疗程。收集2组患者治疗过程中药物不良反应/不良反应并比较。比较2组患者治疗前后血液流变学指标(全血黏度、血浆黏度、红细胞聚集指数)、微炎性反应状态指标［C反应蛋白(CRP)、白细胞介素-1(IL-6)、肿瘤坏死因子-ɑ(TNF-ɑ)］、营养状况［血清白蛋白(Alb)、血红蛋白(Hb)、前白蛋白(PA)］。比较2组患者治疗前后生命质量评分(SF-36)。完成治疗后评价2组临床疗效并比较。结果:治疗4周后,1)研究临床总有效率明显高于对照组(P<0.05);2)2组患者全血黏度、血浆黏度、红细胞聚集指数均较治疗前下降,且观察组低于对照组(P<0.05)。3)2组患者血清CRP、IL-6、TNF-α均较治疗前下降,且观察组低于对照组(P<0.05)。4)2组患者Alb、Hb、PA均较治疗前升高,且观察组高于对照组(P<0.05);4)2组患者治疗前SF-36各维度评分比较，差异无统计学意义(P>0.05);完成治疗后2组患者SF-36各维度均较治疗前有明显下降,且研究评分低于对照组(P<0.05);5)2组患者治疗过程药物不良反应发生率比较，差异无统计学意义(P>0.05)。结论:加味六君子汤可有效提升慢性肾衰急性加重期患者血液流变学指标,降低患者血清微炎性反应状态,从而提升患者营养吸收,促进临床治疗效果,改善患者生命质量,且并未增加药物不良反应/不良反应,对此类患者具有较高的临床价值。

English Summary:

To explore the clinical effects of Jiawei Liujunzi Decoction on acute exacerbation of chronic renal failure (CRF) and its effects on hemorheology and micro-inflammation，and to analyze the possible therapeutic mechanism of Jiawei Liujunzi Decoction on acute exacerbation of CRF.Methods:A total of 106 patients with acute exacerbation of chronic renal failure who were treated in Affiliated Hospital of Henan Medical College from January 2016 to January 2018 were selected as the subjects.According to the order of visiting，they were divided into the control group and the observation group by random number table method，with 53 cases in each group.Two groups of patients with chronic renal failure were treated with conventional western medicine and symptomatic treatment of acute phase，and the observation group was added modified Liujunzi Decoction treatment.Both groups of patients were treated for 8 weeks as a course of treatment.The adverse drug reactions / side effects of the 2 groups were collected and compared.Hemorheological parameters (whole blood viscosity，plasma viscosity，erythrocyte aggregation index)，microinflammatory state［CRP，interleukin-1 (IL-6)，tumor necrosis factor-ɑ (TNF-ɑ)］，nutritional status (serum albumin (Alb)，hemoglobin (Hb)，prealbumin (PA) were compared between the 2 groups before and after treatment.The quality of life scores (SF-36) were compared between the 2 groups before and after treatment.After completion of treatment，the clinical efficacy of the 2 groups was evaluated and compared.Results:After 4 weeks of treatment，1) the total effective rate of the observation group was significantly higher than that of the control group (P<0.05). 2) The whole blood viscosity，plasma viscosity and erythrocyte aggregation index of the 2 groups were lower than those of the control group (P<0.05).3) The levels of CRP，IL-6 and TNF-α in the 2 groups were lower than those before treatment，and those in the observation group were lower than those in the control group (P<0.05). 4) Alb，Hb，PA of the 2 groups were higher than those before treatment，and the observation group was higher than that of the control group (P>0.05). 5) There was no significant difference in the scores of SF-36 before treatment between the 2 groups (P>0.05); after treatment，SF-36 of the 2 groups were significantly lower than those before treatment，and the study score was lower than that of the control group (P<0.05). 6) There was no significant difference in the rate of adverse drug reactions / side effects between the 2 groups (P<0.05).Conclusion:Jiawei Liujunzi Decoction can effectively improve the hemorheological indexes of patients with acute exacerbation of chronic renal failure，reduce the state of serum micro-inflammation，so as to enhance the nutritional absorption of patients，promote clinical therapeutic effect，improve the quality of life of patients，and does not increase adverse drug reactions / toxic side effects，with higher clinical value for such patients.

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