【摘要】：目的:本課題通過觀察非透析慢性腎臟病(CKD)腎性骨病(ROD)濕熱證患者腰椎骨密度、血清骨形成蛋白-7(BMP-7)水平的變化及大黃泄?jié)犷w粒劑保留灌腸的干預作用,旨在探討大黃泄?jié)犷w粒對ROD的治療作用及其可能機制。方法:選擇64例符合納入標準的非透析CKD3~5期濕熱證患者,隨機分為治療組和對照組各32例,治療過程中失訪4例,其中治療組和對照組各2例,最終實際完成60例。并設正常組20例。兩組患者均予相應的降壓、利尿、糾正腎性貧血、調(diào)節(jié)鈣磷水平、抑制甲旁亢等對癥治療;治療組加用大黃泄?jié)犷w粒保留灌腸治療,每天一次。兩組療程均為8周。觀察兩組患者濕熱證證候、腎功能等指標變化及不良反應情況;并檢測兩組患者治療前后血清鈣(Ca)、磷(P)、堿性磷酸酶(ALP)、甲狀旁腺激素(i PTH)、BMP-7水平、腰椎2~4椎體骨密度(L2~4BMD)及Z值的變化情況,同時檢測正常組血清BMP-7、L2~4 BMD和Z值,根據(jù)實驗結果進行療效判定和統(tǒng)計學處理。結果:治療組臨床疾病療效、濕熱證證候及各主要臨床癥狀療效均顯著優(yōu)于對照組,差異具有統(tǒng)計學意義(P0.05或0.01)。治療后兩組患者的濕熱證證候積分值隨療程的增加,下降愈顯著(P0.05或0.01);同療程比較,治療組下降幅度均明顯優(yōu)于對照組(P0.01)。治療組治療后腎功能(Scr、BUN)及e GFR均較治療前改善顯著(P0.01),對照組除BUN改善明顯(P0.05)外,其余改善均不明顯(P0.05);治療組治療后上述諸項指標均較對照組改善顯著(P0.01)。兩組患者治療前L2~4 BMD、Z值及BMP-7水平均明顯低于正常組(P0.01),而兩組患者之間比較均無明顯差異(P0.05);治療后兩組患者L2~4 BMD、Z值及BMP-7水平較治療前均明顯升高(P0.05或P0.01),而治療組均較對照組改善顯著(P0.01)。采用Pearson法分析:兩組患者治療前的L2~4 BMD及BMP-7水平與e GFR、血Ca成正相關性,與血清BUN、Scr、P、i PTH呈顯著負相關,均具有統(tǒng)計學意義(P0.01)。結論:非透析CKD腎性骨病濕熱證患者L2~4 BMD、Z值及BMP-7水平均低于健康人群;大黃泄?jié)犷w粒劑保留灌腸可通過改善非透析CKD合并ROD濕熱證患者的臨床癥狀及腎功能,升高血Ca、降低血P、i PTH、ALP水平,明顯提高L2~4 BMD、Z值,從而達到有效防治ROD,改善CKD患者預后的目的,其機制可能與血清BMP-7含量升高密切相關。
[Abstract]:Objective: to observe the changes of bone mineral density (BMD) and serum bone morphogenetic protein-7 (BMP-7) level of lumbar vertebrae and bone morphogenetic protein (BMP-7) in patients with renal osteopathy (ROD) of non-dialysis chronic kidney disease (CKD) and the intervention effect of rhubarb Xiezhuo granule retention enema. To explore the therapeutic effect and possible mechanism of Rhubarb Xiezhuo granule on ROD. Methods: Sixty-four patients with non-dialysis CKD _ 3N _ 5 damp-heat syndrome were randomly divided into treatment group (n = 32) and control group (n = 32). 4 cases were lost in the course of treatment, including 2 cases in the treatment group and 2 cases in the control group, and 60 cases were actually completed. There were 20 cases in normal group. The two groups were given corresponding antihypertensive, diuretic, renal anemia correction, regulation of calcium and phosphorus levels, inhibition of hyperthyroidism and other symptomatic treatment; treatment group with rhubarb Xiezhuo granule retention enema treatment, once a day. The course of treatment was 8 weeks in both groups. Serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), parathyroid hormone (I PTH) and BMP-7 were measured before and after treatment. The changes of bone mineral density (L2BMD) and Z value of lumbar vertebrae were measured. The BMD and Z value of serum BMP-7 and L2C4BMD in normal group were determined and statistically analyzed according to the experimental results. Results: the curative effect of clinical disease, syndrome of dampness and heat and main clinical symptoms in the treatment group were significantly better than those in the control group, the difference was statistically significant (P0.05 or 0.01). After treatment, the score of dampness and heat syndrome in the two groups decreased significantly with the increase of the course of treatment (P0.05 or 0.01); compared with the course of treatment, the decrease of the treatment group was significantly better than that of the control group (P0.01). After treatment, the renal function (Scrn bun) and eGFR in the treatment group were significantly improved compared with those before treatment (P0.01), except bun in the control group, the other improvements were not significant (P0.05), and the above indexes in the treatment group were significantly improved compared with the control group (P0.01). Before treatment, the level of BMDZ and BMP-7 in the two groups were significantly lower than those in the normal group (P0.01), but there was no significant difference between the two groups (P0.05), and after treatment, the values of L24-BMD-Z and BMP-7 in the two groups were significantly higher than those before treatment (P0.05 or P0.01), while the level of BMP-7 in the treatment group was significantly higher than that before treatment (P0.05 or P0.01). Compared with the control group, the improvement was significant (P0.01). Pearson method was used to analyze: the levels of L2O4BMD and BMP-7 were positively correlated with eGFRand serum Ca, and negatively correlated with serum BUNG ScrP Pi PTH before treatment in both groups (P0.01). Conclusion: the values of L2O4BMD-Z and BMP-7 in non-dialysis CKD renal osteopathy with damp-heat syndrome are lower than those in healthy people, the retention enema of Rhubarb Xiezhuo granule can improve the clinical symptoms and renal function of non-dialysis CKD patients with ROD dampness and heat syndrome. Raising blood Ca, decreasing the level of serum Phi-PTHHfen ALP and increasing the value of L2O4BMDZ can effectively prevent and cure ROD and improve the prognosis of patients with CKD. The mechanism may be closely related to the increase of serum BMP-7 content.
【學位授予單位】：安徽中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R692;R681

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