基于“肠肾轴”理论探讨通腑泄浊灌肠方治疗CKD 3~4期患者的临床疗效及对NLR的影响

Clinical Efficacy and Effect on NLR of Tongfu Xiezhuo Enema in Treating Patients with Stage 3-4 CKD Based on Theory of Gut-kidney Axis

摘要:

目的 观察通腑泄浊灌肠方治疗慢性肾脏病（CKD）3~4期的临床疗效及对炎症指标中性粒细胞与淋巴细胞比值（NLR）水平的影响。方法 收集2022年12月至2023年6月于黑龙江中医药大学附属第一医院肾病科门诊及病房就诊的诊断为CKD 3~4期的患者60例，按照随机对照的原则将60例患者以1∶1的比例分入观察组和对照组。对照组在基础治疗的基础上加用肾康栓治疗，观察组在基础治疗的基础上加用通腑泄浊灌肠方治疗，治疗8周后统计疗效。观察患者治疗前后中医证候积分、肾功能指标、炎症指标NLR等指标。结果 ①与本组治疗前比较，治疗后两组患者中医证候积分均显著降低（P<0.01）；与对照组治疗后比较，观察组中医证候积分降低更明显（P<0.05）。观察组中医证候疗效总有效率为79.31%（23/29），对照组总有效率为62.96%（17/27），观察组的有效率优于对照组（Z=0.604，P<0.05）。②与本组治疗前比较，治疗后观察组患者血肌酐（SCr）、血尿素氮（BUN）、血清胱抑素C（Cys C）水平显著降低，肾小球滤过率（GFR）显著升高（P<0.01）；对照组患者SCr明显降低，GFR明显升高（P<0.05）。与对照组治疗后比较，观察组患者SCr水平降低、GFR升高更明显（P<0.05）。观察组总有效率为79.31%（23/29），对照组总有效率为55.56%（15/27），观察组的有效率显著优于对照组（Z=1.127，P<0.01）。③与本组治疗前比较，观察组治疗后NLR水平明显降低（P<0.05）。与对照组治疗后比较，观察组NLR水平明显降低（P<0.05）。④两组治疗前后各安全性指标差异无统计学意义。结论 通腑泄浊灌肠方能有效改善CKD 3~4期患者的临床症状和肾功能指标，且安全可靠，其作用机制可能与降低炎症指标NLR水平，抑制炎性反应有关。

Abstract:

Objective To observe the clinical efficacy of Tongfu Xiezhuo enema in treating stage 3-4 chronic kidney disease （CKD） and the effect of the therapy on the neutrophil-to-lymphocyte ratio （NLR） as an inflammation marker.Method Sixty patients diagnosed with stage 3-4 CKD who visited the Nephrology Department of the First Affiliated Hospital of Heilongjiang University of Chinese Medicine from December 2022 to June 2023 were included and randomly assigned into observation and control groups in a ratio of 1∶1. The control group received conventional therapy plus Shenkang suppositories， while the observation group received conventional therapy plus Tongfu Xiezhuo enema. After 8 weeks of treatment， the clinical efficacy was assessed based on the changes in traditional Chinese medicine （TCM） symptom scores， renal function indicators， and NLR.Result ① Both groups showed decreases in TCM symptom scores after treatment （P<0.01）， and the decreases were more significant in the observation group than in the control group （P<0.05）. The total response rate of TCM symptoms in the observation group was 79.31% （23/29）， which was higher than that （62.96%， 17/27） in the control group （Z=0.604，P<0.05）. ② After treatment， the observation group showed declined serum levels of creatinine （SCr）， blood urea nitrogen （BUN）， and cystatin C （Cys C） and increased glomerular filtration rate （GFR） （P<0.01）， and the control group showed lowered SCr level and increased GFR （P<0.05）. The observation group had lower SCr level and higher GFR than the control group after treatment （P<0.05）. The total response rate of renal function in the observation group was 79.31% （23/29）， which was higher than that （55.56%， 15/27） in the control group （Z=1.127，P<0.01）. ③ The NLR in the observation group decreased after treatment （P<0.05）， and it was lower than that in the control group （P<0.05）. ④ There were no significant differences in safety indicators between the two groups before and after treatment.Conclusion Tongfu Xiezhuo enema ameliorated symptoms and improved renal function indicators in the patients with stage 3-4 CKD by reducing the NLR and inhibiting inflammation.