1、黑龙江医学2023年2月25日第47卷第4期HEILONGJIANG MEDICAL JOURNALFeb.25,2023Vol.47No.4 临床研究 暖肾健脾汤联合艾灸治疗脾肾阳虚型慢性肾衰竭患者的临床观察*刘佳齐齐哈尔市中医医院，黑龙江齐齐哈尔161005摘要目的：探究暖肾健脾汤联合艾灸治疗脾肾阳虚型慢性肾衰竭（CRF）患者的临床疗效。方法：选取2018年1月2020年12月齐齐哈尔市中医医院肾内科门诊及住院治疗的72例脾肾阳虚型CRF患者作为研究对象，按照随机数表法分为对照组和治疗组，每组各36例。对照组严格控制血压、血糖及血脂，饮食方面主要以优质低蛋白配合必需氨基酸为主，依据实际情况
2、调节水电解质平衡，纠正代谢性酸中毒、贫血等对症治疗；治疗组在对照组的基础上加服暖肾健脾汤，并联合艾灸，疗程3周。观察两组患者治疗后西医症状疗效总有效率、中医症状疗效评分、实验室指标及不良反应发生情况。结果：治疗组西医临床疗效总有效率显著高于对照组，差异有统计学意义（2=4.069，P0.05）。治疗组各中医症状疗效均优于对照组，差异有统计学意义（t=4.609、5.612、4.648、2.099、2.330，P0.05）。治疗后，治疗组血肌酐（Scr）、尿素氮（BUN）水平均低于对照组，差异有统计学意义（t=2.904、2.310，P0.05）。两组患者表皮生长因子受体（eGFR）水平比较，差
3、异无统计学意义（t=1.678，P0.05）。治疗组血红蛋白（Hb）水平明显高于对照组，差异有统计学意义（t=5.383，P0.05）。两组患者不良反应总发生率比较，差异无统计学意义（2=0.458，P0.05）。结论：暖肾健脾汤联合艾灸可显著提升脾肾阳虚型CRF患者的临床总有效率，并降低临床症状评分，改善血清肾功能及血红蛋白指标，安全有效。关键词慢性肾衰竭；脾肾阳虚；暖肾健脾汤；艾灸；疗效观察doi10.3969/j.issn.1004-5775.2023.04.007学科分类代码320.2435中图分类号R692.5文献标识码BClinical Observation of Warming
4、 Kidney and Spleen Decoction Combined with Moxibustion in the Treatment ofChronic Renal Failure Patients with Spleen and Kidney Yang Deficiency/LIU Jia/Qiqihar Hospital of Traditional Chinese Medicine,Qiqihar,Heilongjiang,161005,ChinaAbstract Objective:To investigate the clinical efficacy of warming
5、 the kidney and strengthening the spleen decoction combined with moxibustion in the treatment of patients with chronic renal failure(CRF)with spleen and kidney yang deficiency.Methods:72 patients with CRF with spleen-kidney yang deficiency treated in the outpatient and inpatient departments of the n
6、ephrology department of the hospital from January 2018 to December 2020 were selected as study subjects and divided into controlgroup and treatment group according to the random number table method,with 36 cases in each group.In the control group,bloodpressure,blood glucose and lipids were strictly
7、controlled,and the diet was mainly based on high quality and low protein with essential amino acids,and the water-electrolyte balance was adjusted according to the actual situation,and the symptomatic treatment such as metabolic acidosis and anemia was corrected.In the treatment group,warming kidney
8、 and spleen decoction was added tothe control group and combined with moxibustion for 3 weeks.The total efficacy rate of Western medicine symptoms,the efficacyscore of Chinese medicine symptoms,laboratory indexes and the occurrence of adverse reactions were observed in the twogroups after treatment.
9、Results:The total clinical efficacy of Western medicine in the treatment group was significantly higher thanthat in the control group,and the difference was statistically significant(2=4.069,P0.05).The efficacy of each TCM symptom inthe treatment group was better than that in the control group,with
10、statistically significant differences(t=4.609,5.612,4.648,2.099,2.330,P0.05).After treatment,Scr and BUN levels were lower in the treatment group than in the control group,with statisticallysignificant differences(t=2.904,2.310,P0.05).There was no statistically significant difference in the eGFR lev
11、els between thetwo groups(t=1.678,P0.05).The Hb level in the treatment group was significantly higher than that in the control group,and thedifference was statistically significant(t=5.383,P0.05).There was no statistically significant difference in the total incidence ofadverse reactions between the
12、 two groups(2=0.458,P0.05).Conclusion:Warming kidney and spleen decoction combined withmoxibustion can significantly improve the total clinical efficiency and reduce clinical symptom scores,improve serum kidney functionand hemoglobin index in patients with CRF with spleen and kidney yang deficiency
13、in a safe and effective manner.Keywords Chronic renal failure;Yang deficiency of spleen and kidney;Warming kidney and spleen Decoction;Moxibustion;Curative effect observation*基金项目：齐齐哈尔市科技计划创新激励项目（CSFGG-2021225）。411黑龙江医学2023年2月25日第47卷第4期HEILONGJIANG MEDICAL JOURNALFeb.25,2023Vol.47No.4慢性肾衰竭（CRF）归属于祖国
14、医学中“关格”“癃闭”等范畴，主要是由多种因素引发的慢性、进行性肾实质损害，进而呈现代谢产物潴留，水电解质、酸碱平衡失调以及全身各系统受累的一系列临床综合征。流行病学统计1-2显示，每年 CRF 发生的占比为 1/10 000，而截至2017年，全球CRF的患病率已高达14.3%。有研究3显示，对CRF患者尽早、准确地予以中医辨证施治，能够较好地改善CRF患者的临床症状及指标，进而调控CRF的发生与发展。本研究探究暖肾健脾汤联合艾灸治疗脾肾阳虚型CRF患者的临床疗效，现报告如下。1资料与方法1.1一般资料选取2018年1月2020年12月齐齐哈尔市中医医院肾内科门诊及住院治疗的72例脾肾阳虚型
15、CRF患者作为研究对象，按照随机数表法分为对照组和治疗组，每组各36例。对照组：男20例，女16例；年龄3266岁，平均年龄（51.425.76）岁；病程510年，平均病程（6.61.4）年。治疗组：男23例，女13例；年龄3468岁，平均年龄（52.075.69）岁；病程510年，平均病程（5.82.1）年。两组患者一般资料具有可比性（P0.05）。本研究经医院医学伦理委员会批准通过。纳入标准：（1）符合中华人民共和国国家标准中医临床诊疗术语疾病部分4诊断标准，并辨证为脾肾阳虚型。（2）符合国际肾脏病组织发布的 KDIGO-CKD 指南5中 CRF 诊断标准，并属于CRF 3、4期者。（3）
16、患者知情同意。排除标准：（1）1个月前或正在参加相关试验研究。（2）对本研究中药物过敏。（3）肝、肾、心等主要脏器存在严重疾病或功能障碍。（4）患有其他器官功能疾病以及精神病。1.2治疗方法对照组严格控制血压、血糖及血脂，饮食方面主要以优质低蛋白配合必需氨基酸为主，依据实际情况调节水电解质平衡（如水、钠调节，高钾血症的处理，钙、磷调节等），纠正代谢性酸中毒、贫血等对症治疗，治疗组在对照组的基础上加服暖肾健脾汤（包括熟附子10 g、生白术15 g、茯苓20 g、党参20 g、干姜10 g、仙灵脾20 g、山萸肉20 g、熟地20 g、山药15 g、菟丝子15 g、巴戟天10 g，并随症加减），每日分早晚温服。此外，选取气海穴、关元穴、神阙穴、足三里穴等穴位对患者进行艾灸，每次约2030 min，每日1次，疗程3周。1.3疗效评定指标参照中药新药临床研究指导原则6对CRF中、西医症状疗效判定标准、实验室指标及不良反应进行疗效判定。（1）西医症状疗效判定标准。显效：临床症状积分减少60，内生肌酐清除率增加20或血肌酐降低20；有效：临床症状积分减少30，内生肌酐清除率增加10或血肌酐降低10
