芪归升降散对慢性肾衰脂质代谢紊乱作用的临床研究
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摘要
慢性肾衰是多种肾脏疾病发展的最终结局，是临床的常见疑难症。研究包括中医药治疗措施在内的慢性肾衰非透析疗法以延缓病情进展具有十分重要的意义。
本论文主要包括文献综述和临床研究两部分。
文献综述分两篇。第一篇“慢性肾功能衰竭及其脂质代谢紊乱现代研究进展”主要介绍了现代医学对慢性肾功能衰竭的有关认识，尤其是对慢性肾功能衰竭脂质代谢紊乱的认识和慢性肾功能衰竭非透析治疗的临床现状。第二篇“中医药治疗慢性肾功能衰竭及其脂质代谢紊乱概述”主要介绍了中医对慢性肾衰的认识、中医临床治疗慢性肾衰现状和有关中药作用机理研究的进展。
临床观察研究中，纳入63例慢性肾衰早、中期患者，采用随机对照研究方法，将病例分为芪归升降散治疗组和洛汀新对照组，其中治疗组共32例，对照组31例。两组患者均给予基础治疗(包括饮食及对症治疗)。治疗组在此基础上给予芪归升降散颗粒剂口服，对照组予ACEI制剂-洛汀新口服，疗程为12周，观测血红蛋白、肾功能和血脂变化情况。结果显示：治疗组病例，血红蛋白水平和肌酐清除率显著提高(p＜0.01)，血肌酐和血尿素水平显著降低(p＜0.01)；对照组病例，血红蛋白水平显著下降(p＜0.01)，血尿素水平显著降低(p＜0.01)；治疗组病例，TC、TG和LDL水平显著降低(p＜0.01)，HDL水平显著升高(p＜0.05)，载脂蛋白A1和载脂蛋白B水平无显著变化；对照组病例治疗后各项血脂指标均无显著变化；在改善患者临床症状、体征方面，两组在治疗后症状积分都明显降低(p＜0.01)，但治疗组较对照组作用更为显著(p＜0.01)。
研究结果说明：中药芪归升降散能够显著改善慢性肾衰早、中期患者临床症状和体征，纠正贫血，并具有调整慢性肾衰患者脂质代谢紊乱的作用，显著延缓病程进展。其调整脂质代谢紊乱的作用可能是其保护肾功能的重要机制之一。
Chronic renal failure (CRF) is a kind of common questioned disease as the end stage of many renal pathological changes. To study on a synthetic therapy including Chinese medicine and without hemodialysis to delay the development of CRF is of great importance.
The thesis includes two parts, review and clinical research.
The review part includes 2 papers. The first one reviewed the modern study on CRF. It introduced pathogenesis of CRF, especially which of the disorder of blood lipid metabolism during the development of CRF, and the non-hemodialysis therapy. The second one was about the modern Chinese medicine study on CRF, including general knowledge of CRF in Chinese medicine, the current awareness on treating CRF with Chinese medicine and the mechanism of the action of Chinese herb.
In clinical study part, we selected 63 patients who were all in the early or middle stages of CRF, and divided them into 2 groups randomly and comparably, 32 cases were in subject group, 31 in control group. The subject group patients were treated by basic treatment (including diet control and presCRFbing medicine according to the symptom) and the powder consists of QIGUISHENGJIANGSAN, the control group patients were given basic treatment and Lotensin. To observe the change of HGB, renal function, blood lipid and scores of Chinese medicine symptom, evaluate the curative effect after 12 weeks. Results: In SUBJECT GROUP group, HGB, Ccr and HDL were raised while Scr , BUN, TC,TG and LDL were lowered significantly, in control group, HGB and BUN were lowered significantly, while no remarkable change in blood lipid indexes. In both groups, there were significant improvement in symptom scores, but the effect was better in subject group and there were statistical difference between the 2 groups.
The clinical study showed that the powder consists of QIGUISHEGNJIANGSAN could not only improve the clinical symptom, but also better improve anemia, delay the development of CRF in the early and middle stages, regulate the disorder of blood lipid of CRF patients. We inferred that the effect of regulating disorder of blood lipid was one of the probable mechanism in protecting the renal function.
本论文主要包括文献综述和临床研究两部分。
文献综述分两篇。第一篇“慢性肾功能衰竭及其脂质代谢紊乱现代研究进展”主要介绍了现代医学对慢性肾功能衰竭的有关认识，尤其是对慢性肾功能衰竭脂质代谢紊乱的认识和慢性肾功能衰竭非透析治疗的临床现状。第二篇“中医药治疗慢性肾功能衰竭及其脂质代谢紊乱概述”主要介绍了中医对慢性肾衰的认识、中医临床治疗慢性肾衰现状和有关中药作用机理研究的进展。
临床观察研究中，纳入63例慢性肾衰早、中期患者，采用随机对照研究方法，将病例分为芪归升降散治疗组和洛汀新对照组，其中治疗组共32例，对照组31例。两组患者均给予基础治疗(包括饮食及对症治疗)。治疗组在此基础上给予芪归升降散颗粒剂口服，对照组予ACEI制剂-洛汀新口服，疗程为12周，观测血红蛋白、肾功能和血脂变化情况。结果显示：治疗组病例，血红蛋白水平和肌酐清除率显著提高(p＜0.01)，血肌酐和血尿素水平显著降低(p＜0.01)；对照组病例，血红蛋白水平显著下降(p＜0.01)，血尿素水平显著降低(p＜0.01)；治疗组病例，TC、TG和LDL水平显著降低(p＜0.01)，HDL水平显著升高(p＜0.05)，载脂蛋白A1和载脂蛋白B水平无显著变化；对照组病例治疗后各项血脂指标均无显著变化；在改善患者临床症状、体征方面，两组在治疗后症状积分都明显降低(p＜0.01)，但治疗组较对照组作用更为显著(p＜0.01)。
研究结果说明：中药芪归升降散能够显著改善慢性肾衰早、中期患者临床症状和体征，纠正贫血，并具有调整慢性肾衰患者脂质代谢紊乱的作用，显著延缓病程进展。其调整脂质代谢紊乱的作用可能是其保护肾功能的重要机制之一。
Chronic renal failure (CRF) is a kind of common questioned disease as the end stage of many renal pathological changes. To study on a synthetic therapy including Chinese medicine and without hemodialysis to delay the development of CRF is of great importance.
The thesis includes two parts, review and clinical research.
The review part includes 2 papers. The first one reviewed the modern study on CRF. It introduced pathogenesis of CRF, especially which of the disorder of blood lipid metabolism during the development of CRF, and the non-hemodialysis therapy. The second one was about the modern Chinese medicine study on CRF, including general knowledge of CRF in Chinese medicine, the current awareness on treating CRF with Chinese medicine and the mechanism of the action of Chinese herb.
In clinical study part, we selected 63 patients who were all in the early or middle stages of CRF, and divided them into 2 groups randomly and comparably, 32 cases were in subject group, 31 in control group. The subject group patients were treated by basic treatment (including diet control and presCRFbing medicine according to the symptom) and the powder consists of QIGUISHENGJIANGSAN, the control group patients were given basic treatment and Lotensin. To observe the change of HGB, renal function, blood lipid and scores of Chinese medicine symptom, evaluate the curative effect after 12 weeks. Results: In SUBJECT GROUP group, HGB, Ccr and HDL were raised while Scr , BUN, TC,TG and LDL were lowered significantly, in control group, HGB and BUN were lowered significantly, while no remarkable change in blood lipid indexes. In both groups, there were significant improvement in symptom scores, but the effect was better in subject group and there were statistical difference between the 2 groups.
The clinical study showed that the powder consists of QIGUISHEGNJIANGSAN could not only improve the clinical symptom, but also better improve anemia, delay the development of CRF in the early and middle stages, regulate the disorder of blood lipid of CRF patients. We inferred that the effect of regulating disorder of blood lipid was one of the probable mechanism in protecting the renal function.
引文
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2. Brenner BM, Meyer TW, Hostetter TH. Dietary protein and the progressive nature of kidney disease: The role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation ,and intrinsic renal disease. N Engl J Med, 1982,307 (11):652-659.
3. Schrier RW, Harris DCH, Chan L, et al. Tubular Hypermetabolism as a factor in the progression of chronic renal failure. Am J Kidney Dis, 1988, 12(3):243-249.
4. Diammond JR, Karnosky MJ. Exacerbation of chronic aminonucleoside nephrosis by dietary cholesterol supplementation. Kidney Int, 1987,32:671.
5. Grone HJ, Walli A, Grone E, et al. Induction of glomerulosclerosis by dietary lipids. Lab Invest, 1989,60 (3):433-446.
6．张道友，孙亚南．慢性肾功能衰竭患者血脂质变化．中国动脉硬化杂志，1998，6(3)：249-250．
7．邹洪斌，王国印，崔明姬，等．老年肾脏疾病血清脂质水平的研究．中国老年学杂志，1999，19(3)：158-159．
8．上海市肾脏病心血管并发症调查协作组，上海地区透析患者血脂改变的调查．中华肾脏病杂志，2001，17(2)：01-104．
9．王云增，庄一义，汪俊军，等．慢性肾衰透析患者胆固醇酯转运蛋白及血脂变化．上海医学检验杂志，2000，15(1)：39-41．
10．安惠霞，刘素雁，任野平．血液透析对慢性肾功能衰竭患者血清脂质代谢的影响．哈尔滨医科大学学报，2001，35(6)：438-439．
11．樊均明，许国章．终末期肾功能不全患者高血压与血脂、脂蛋白和载脂蛋白的关系．临床内科杂志，1996，13(3)：35-36．
12．黄效维，麦慈光，梁波．慢性肾脏病患者血载脂蛋白AI的变化．安徽医学，2002．23(5)：21-23．
13. De-Gomez-Dumm NT, Giammona AM, Touceda LA, et al. Lipid abnormalities in chronic renal failure patients undergoing hemodialysis. Medicina-(B-Aires), 2001, 61(2):142-6.
14．汤天清，毛利民，陈曼丽，等．老年Ⅱ型糖尿病性肾病脂蛋白(a)与肾功能不全的关系．中国心血管杂志，2001，6(4)：213-214．
15．宋乃国，岳沛明，梁化岐，等．实验性慢性肾功能衰竭早期脂质代谢的研究：主动脉脂质沉积动态变化．中华医学检验杂志，1996，19(6)：349-353．
16．汪伟，陈家林，付荣新．慢性肾功能衰竭和血液透析患者血清脂蛋白(α)的变化。临床医学，2000．20(9)：36-37．
17．宋乃国，魏明竟，蒲晓允．实验性慢性肾衰血浆及残肾脂质含量的动态观察．第三军医大学学报，1995，17(2)：143-146．
18. Szolkiewicz M, Nieweglowski T, Korczynska J, et al. Upregulation of fatty acid synthase gene expression in experimental chronic renal failure. Metabolism, 2002, 51(12):1605-1610.
19．汪俊军，庄一义，陆炜，等．肾脏病患者脂蛋白(a)异常的初步研究．肾脏病与透析肾移植杂志，1994，3(2)：104-107．
20．赵兴波，鲁涛，王杰英．慢性肾病患者血清脂蛋白α的水平及其临床意义．中国医学检验杂志，2002．3(4)：248-249．
21. Tsumura M, Kinouchi T, Ono S, et al. Serum lipid metabolism abnormalities and change in lipoprotein contents in patients with advanced-stage renal disease. Clin-Chim-Acta, 2001, 314(1-2):27-37.
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34. Bergesio F, Monzani G, Ciuti R, et al. Autoantibodies against oxidized LDL in chronic renal failure: role of renal function, diet, and lipids.Nephron, 2001, 87(2):127-133.
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2. Brenner BM, Meyer TW, Hostetter TH. Dietary protein and the progressive nature of kidney disease: The role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation ,and intrinsic renal disease. N Engl J Med, 1982,307 (11):652-659.
3. Schrier RW, Harris DCH, Chan L, et al. Tubular Hypermetabolism as a factor in the progression of chronic renal failure. Am J Kidney Dis, 1988, 12(3):243-249.
4. Diammond JR, Karnosky MJ. Exacerbation of chronic aminonucleoside nephrosis by dietary cholesterol supplementation. Kidney Int, 1987,32:671.
5. Grone HJ, Walli A, Grone E, et al. Induction of glomerulosclerosis by dietary lipids. Lab Invest, 1989,60 (3):433-446.
6．张道友，孙亚南．慢性肾功能衰竭患者血脂质变化．中国动脉硬化杂志，1998，6(3)：249-250．
7．邹洪斌，王国印，崔明姬，等．老年肾脏疾病血清脂质水平的研究．中国老年学杂志，1999，19(3)：158-159．
8．上海市肾脏病心血管并发症调查协作组，上海地区透析患者血脂改变的调查．中华肾脏病杂志，2001，17(2)：01-104．
9．王云增，庄一义，汪俊军，等．慢性肾衰透析患者胆固醇酯转运蛋白及血脂变化．上海医学检验杂志，2000，15(1)：39-41．
10．安惠霞，刘素雁，任野平．血液透析对慢性肾功能衰竭患者血清脂质代谢的影响．哈尔滨医科大学学报，2001，35(6)：438-439．
11．樊均明，许国章．终末期肾功能不全患者高血压与血脂、脂蛋白和载脂蛋白的关系．临床内科杂志，1996，13(3)：35-36．
12．黄效维，麦慈光，梁波．慢性肾脏病患者血载脂蛋白AI的变化．安徽医学，2002．23(5)：21-23．
13. De-Gomez-Dumm NT, Giammona AM, Touceda LA, et al. Lipid abnormalities in chronic renal failure patients undergoing hemodialysis. Medicina-(B-Aires), 2001, 61(2):142-6.
14．汤天清，毛利民，陈曼丽，等．老年Ⅱ型糖尿病性肾病脂蛋白(a)与肾功能不全的关系．中国心血管杂志，2001，6(4)：213-214．
15．宋乃国，岳沛明，梁化岐，等．实验性慢性肾功能衰竭早期脂质代谢的研究：主动脉脂质沉积动态变化．中华医学检验杂志，1996，19(6)：349-353．
16．汪伟，陈家林，付荣新．慢性肾功能衰竭和血液透析患者血清脂蛋白(α)的变化。临床医学，2000．20(9)：36-37．
17．宋乃国，魏明竟，蒲晓允．实验性慢性肾衰血浆及残肾脂质含量的动态观察．第三军医大学学报，1995，17(2)：143-146．
18. Szolkiewicz M, Nieweglowski T, Korczynska J, et al. Upregulation of fatty acid synthase gene expression in experimental chronic renal failure. Metabolism, 2002, 51(12):1605-1610.
19．汪俊军，庄一义，陆炜，等．肾脏病患者脂蛋白(a)异常的初步研究．肾脏病与透析肾移植杂志，1994，3(2)：104-107．
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