摘要
目的:观察从"风"论治方对慢性肾脏病-矿物质与骨异常3-5期透析患者脾肾两虚兼毒瘀证的临床疗效、血清钙、磷、甲状旁腺激素、成纤维细胞生长因子-23、成纤维细胞生长因子受体及Klotho蛋白的影响。方法:将符合纳入标准的100例慢性肾脏病-矿物质与骨异常3-5期脾肾两虚兼毒瘀证患者随机分为治疗组和对照组各50例,最终实际完成93例,对照组45例,治疗组48例,另设正常组20例。两组患者均予优质低蛋白[0.6~0.8 g/(kg·d)]、低磷饮食、控制血脂及血糖等基础治疗,对照组按照指南推荐方案予口服骨化三醇或(和)碳酸钙,治疗组在对照组基础上加从"风"论治方,每日1剂,分2次温服,疗程均为4周。观察两组患者治疗各时段中医证候变化,检测血钙、磷、甲状旁腺激素、成纤维细胞生长因子-23、成纤维细胞生长因子受体及Klotho蛋白的变化。结果:治疗组治疗后临床疗效显著优于对照组(P<0.05);治疗组各时段中医证候积分别显著优于对照组(P<0.01);治疗组各时段血清钙、磷、甲状旁腺激素改善水平分别显著优于对照组(P<0.05或P<0.01);治疗前,两组血清成纤维细胞生长因子-23、成纤维细胞生长因子受体、Klotho蛋白水平与正常组比较,差异均有统计学意义(P<0.01);治疗后,治疗组血清成纤维细胞生长因子-23、成纤维细胞生长因子受体及Klotho蛋白水平均较治疗前显著改善(P<0.05),对照组血清成纤维细胞生长因子-23、成纤维细胞生长因子受体、Klotho蛋白水平与治疗前比较均无显著差异(P>0.05),治疗组优于对照组(P<0.05)。结论:从"风"论治方能有效改善慢性肾脏病-矿物质与骨异常3-5期脾肾两虚兼毒瘀证患者的临床症状,纠正钙磷代谢紊乱,改善继续甲状旁腺功能亢进,防治慢性肾脏病-矿物质与骨异常病情进展,其机制可能与调节慢性肾脏病-矿物质与骨异常患者肾脏与骨骼Klotho/成纤维细胞生长因子受体/成纤维细胞生长因子-23之间应答有关。
Objective:To observe the effect of wind-oriented treatment on clinical effect,serum levels of Ca,P,parathyroid hormone,fibroblast growth factor-23,fibroblast growth factor receptor and Klotho protein in chronic kidney disease-mineral and bone disorder 3~5 D patients with spleen kidney deficiency and toxin stasis syndrome.Methods:100 chronic kidney disease-mineral and bone disorder 3~5 D patients with spleen kidney deficiency and toxin stasis syndrome were randomly divided into the treatment group and the control group,50 cases in each group.All the patients in the two groups were given high-quality low protein diet[0.6~0.8 g/(kg·d)],low phosphorus diet,control of blood lipids and blood glucose and other basic treatment.The control group was treated with calcitriol or(and)calcium carbonate according to the guideline,and the patients in the treatment group received additional wind-oriented treatment(take 1 dose daily,twice a day).After the 2-week and/or 4-week treatments,the patients were examined for changes of TCM syndromes,serum levels of Ca,P,parathyroid hormone,fibroblast growth factor-23,fibroblast growth factor receptor and Klotho proteins were detected each period of treatment.These parameters were also examined in 20 healthy volunteers.Results:The clinical efficacy in the treatment group was significantly better than the control group(P<0.05).The improvement levels of serum Ca,P and parathyroid hormone in the treatment group were significantly better(P<0.05 or P<0.01).Before treatment,there were significant differences in serum fibroblast growth factor-23,fibroblast growth factor receptor and Klotho protein levels between the two groups and the normal group(P<0.01).After treatment,the levels of serum fibroblast growth factor-23,fibroblast growth factor receptor and Klotho protein in the treatment group were significantly improved compared with those before treatment(P<0.05).There was no significant difference in serum fibroblast growth factor-23,fibroblast growth factor receptor and Klotho protein levels in the control group before and after treatment(P>0.05),and those in the treatment group were better than the control group(P<0.05).Conclusion:Wind-oriented treatment can effectively improve the clinical symptoms of chronic kidney disease-mineral and bone disorder 3~5 D patients with spleen kidney deficiency and toxin stasis syndrome,and correct the disorder of calcium and phosphorus metabolism,then prevent the progression of chronic kidney disease-mineral and bone disorder,the mechanism may be related to the regulation of fibroblast growth factor-23/fibroblast growth factor receptor/Klotho protein response in chronic kidney disease-mineral and bone disorder patients.
出处
《中医临床研究》
2021年第20期74-78,共5页
Clinical Journal Of Chinese Medicine
基金
国家自然科学青年基金项目(No.81904012)
重庆市自然科学基金项目(No.cstc2018jcyjAX0818,No.cstc2018jxjl130074)。
