小柴胡汤合五苓散对维持性腹膜透析患者残余肾功能的保护及对腹膜纤维化、微炎症状态的影响

钟锦; 钟凌云

doi:10.13422/j.cnki.syfjx.20182425

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小柴胡汤合五苓散对维持性腹膜透析患者残余肾功能的保护及对腹膜纤维化、微炎症状态的影响

临床 | 更新时间：2021-02-09

- 小柴胡汤合五苓散对维持性腹膜透析患者残余肾功能的保护及对腹膜纤维化、微炎症状态的影响
- Effect of Xiao Chaihutang and Wulingsan on Protection of Residual Renal Function in Patients with Maintenance Peritoneal Dialysis and Effect on Peritoneal Fibrosis and Micro-inflammation
- 中国实验方剂学杂志 2019年25卷第3期页码：114-119
- 作者机构：
  
  重庆市中医院，重庆　 400021
- 作者简介：
  
  钟锦，副主任医师，从事慢性肾脏病的诊断与研究，E-mail: 120852723@qq.com
  *钟凌云，主管护师，从事慢性肾脏病及腹膜透析的研究，E-mail: liwei200885@163.com
- 基金信息：
  
  重庆市科研院所绩效激励引导专项(cstc2017jxj1130038)
- DOI：10.13422/j.cnki.syfjx.20182425
  中图分类号： R22;R242;R2-031;R287
- 收稿日期：2018-06-21，
  
  网络出版日期：2018-09-28，
  
  纸质出版日期：2019-02-05
- 稿件说明：
移动端阅览
钟锦, 钟凌云. 小柴胡汤合五苓散对维持性腹膜透析患者残余肾功能的保护及对腹膜纤维化、微炎症状态的影响[J]. 中国实验方剂学杂志, 2019,25(3):114-119.

Jin ZHONG, Ling-yun ZHONG. Effect of Xiao Chaihutang and Wulingsan on Protection of Residual Renal Function in Patients with Maintenance Peritoneal Dialysis and Effect on Peritoneal Fibrosis and Micro-inflammation[J]. Chinese journal of experimental traditional medical formulae, 2019, 25(3): 114-119.
钟锦, 钟凌云. 小柴胡汤合五苓散对维持性腹膜透析患者残余肾功能的保护及对腹膜纤维化、微炎症状态的影响[J]. 中国实验方剂学杂志, 2019,25(3):114-119. DOI： 10.13422/j.cnki.syfjx.20182425.

Jin ZHONG, Ling-yun ZHONG. Effect of Xiao Chaihutang and Wulingsan on Protection of Residual Renal Function in Patients with Maintenance Peritoneal Dialysis and Effect on Peritoneal Fibrosis and Micro-inflammation[J]. Chinese journal of experimental traditional medical formulae, 2019, 25(3): 114-119. DOI： 10.13422/j.cnki.syfjx.20182425.

摘要

目的:

观察小柴胡汤合五苓散对维持性腹膜透析(PD)患者残余肾功能的保护及对腹膜纤维化、微炎症状态的影响。

方法:

选取重庆市中医院自2016年6月至2017年6月收治的65例PD患者作为观察对象，按照随机数字表法分为对照组32例，研究组33例。对照组给予常规治疗，研究组给予常规治疗+小柴胡汤合五苓散治疗，治疗前、治疗3个月采空腹静脉血，测定血肌酐(SCr)，尿素氮(BUN)水平。采集尿液，记录24 h尿量，使用比色法检测24 h尿蛋白定量水平(24 h UP)，计算肾小球滤过率(eGFR)，残余肾功能(RRF)，其中RRF采用残余肾肌酐清除率表示。使用化学发光法检测炎症因子，包括白细胞介素-6(IL-6)，白细胞介素-8(IL-8)和肿瘤坏死因子-

(TNF-

)水平。采用酶联免疫吸附试验(ELISA)测定血清Janus激酶(Janus Kinase

JAK)2，信号传导及转录激活因子(STAT)3水平。采用蛋白免疫印迹法检测E-钙黏蛋白(E-cadherin)，

-肌动蛋白(

-SMA)水平。

结果:

治疗前两组RRF比较差异均无统计学意义，治疗后研究组RRF明显优于对照组(

0.05)。治疗后研究组24 h UP低于对照组，日均尿量高于对照组(

0.05)。治疗后研究组IL-6，IL-8，TNF-

水平均明显低于对照组(

0.05)，研究组JAK2，STAT3水平均低于对照组(

0.01)。对照组腹透液中的上皮细胞E-cadherin蛋白表达量较本组治疗前显著降低(

0.01)，

-SMA蛋白表达量较本组治疗前显著升高(

0.01)，研究组治疗前后E-cadherin

-SMA蛋白表达量无明显变化。

结论:

小柴胡汤合五苓散能够保护PD患者的残余肾功能，其机制可能与其改善腹膜纤维化进程，减轻机体的微炎症状态有关，具有较高的应用价值。

Abstract

Objective:

To observe the protective effect of Xiao Chaihutang and Wulingsan on residual renal function in patients with maintenance peritoneal dialysis (PD) and investigate its effect on peritoneal fibrosis and microinflammation.

Method:

The 65 patients with PD who were admitted to our hospital from June 2016 to June 2017 were enrolled in the study

and divided into control group (32 cases) and study group (33 cases) according to the random number table. The control group received routine treatment. The study group received routine treatment+ Xiao Chaihutang and Wulingsan. The fasting venous blood was taken before treatment and 3 months after treatment to measure serum creatinine (SCr) and urea nitrogen (BUN). Urine was collected; 24 hour urine volume was recorded; 24 h urine protein (24 h UP) was measured by colorimetry; glomerular filtration rate (eGFR) was calculated; residual renal function (RRF) was expressed with residual renal creatinine clearance. Inflammatory factors were detected by using chemiluminescence

including interleukin-6 (IL-6)

interleukin-8 (IL-8)

and tumor necrosis factor-

(TNF-

) levels. Serum Janus Kinase (JAK) 2 as well as signal transducer and activator of transcription (STAT) 3 levels were determined by double antibody sandwich enzyme-linked immunosorbent assay (ELISA). E-cadherin and

-smooth muscle actin (

-SMA) levels were determined by Western blot.

Result:

Before treatment

there was no significant difference in the residual renal function between two groups. After treatment

the residual renal function of the study group was significantly better than that of control group (

0.05). After treatment

24 h UP of study group was lower than that of control group

and the daily average urine volume was higher than that of control group (

0.05). After treatment

the levels of IL-6

IL-8 and TNF-

in study group were lower than those in control group (

0.05); the levels of JAK2 and STAT3 in study group were significantly lower than those in control group (

0.01). The expression of E-cadherin protein in the dialysate of control group was significantly decreased after treatment (

0.01)

and the expression level of

-SMA protein was significantly increased after treatment (

0.01); however

study group had no significant changes in the expression of E-cadherin and

-SMA protein after treatment.

Conclusion:

Xiao Chaihutang and Wulingsan can protect the residual renal function of PD patients

and the mechanism may be related to the improvement of peritoneal fibrosis and the reduction of micro-inflammation of the body

showing a high application value.

关键词

Keywords

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