刘鹏 桂壮 邵治国

〔摘要〕 目的 探讨不同剂量大黄附子细辛汤对慢性肾衰竭脾肾阳虚证患者炎症因子及临床疗效的观察。方法 120例确诊的慢性肾功能衰竭脾肾阳虚证患者随机分为治疗组和对照组各60例，两组在常规治疗基础之上，对照组给予小剂量大黄附子细辛汤，治疗组给予大剂量大黄附子细辛汤，观察两组患者治疗前后尿素氮（BUN）、血肌酐（Scr）、血清胱抑素C（CysC）、C反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-a（TNF-a）水平、药物不良反应及临床疗效。结果 两组患者血清BUN、Scr、CysC、IL-6、TNF-a较治疗前均明显降低， 治疗组下降幅度更为显著（P<0.05），治疗组治疗后中医证候积分及综合疗效均优于对照组（P<0.05），治疗后2组安全性比较无显著差异（P>0.05）。结论 大剂量大黄附子细辛汤对慢性肾功能衰竭脾肾阳虚证患者中有助于改善肾功能，降低炎症因子水平，可能与降低血清炎性因子IL-6、TNF-a值，发挥抗炎及促进肾代谢作用有关。

〔关键词〕 慢性肾功能衰竭;脾肾阳虚证;大黄附子细辛汤;炎症因子;临床疗效

〔中图分类号〕R256.5       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2019.05.018

〔Abstract〕 Objective To explore the effects of different doses of Dahuang Fuzi Xixin Decoction on inflammatory factors and clinical efficacy in patients with chronic renal failure with syndrome of spleen and kidney Yang deficiency. Methods A total of 120 patients with chronic renal failure diagnosed with spleen and kidney Yang deficiency syndrome were randomly divided into a treatment group and a control group， with 60 cases in each group. The 2 groups were given conventional treatment. The control group was given a small dose of Dahuang Fuzi Xixin Decoction， and the treatment group was given large dose. The levels of urea nitrogen （BUN）， serum creatinine （Scr）， serum cystatin C （CysC）， C-reactive protein （CRP）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α） were observed before and after treatment， and the adverse drug reactions and clinical effects were also observed before and after treatment. Results The serum levels of BUN， Scr， CysC， IL-6 and TNF-α in the 2 groups were significantly lower than those before treatment， and the decrease in the treatment group was more significant （P<0.05）. The TCM syndromes scores and comprehensive efficacy in the treatment group were better than those in the control group after treatment in the treatment group （P<0.05）， and there was no significant difference in the safety between the 2 groups （P>0.05）. Conclusion Large-dose of Dahuang Fuzi Xixin Decoction can improve renal function and reduce inflammatory factors in patients with chronic renal failure and spleen and kidney Yang deficiency syndrome， which may be related with reducing serum inflammatory factors IL-6 and TNF-α， exerting anti-inflammatory effects， and promoting kidney metabolism.

〔Keywords〕 chronic renal failure; spleen and kidney Yang deficiency syndrome; Dahuang Fuzi Xixin Decoction; inflammatory factor; clinical effect

慢性腎功能衰竭（chronicrenalfailure， CRF）是由于各种原因引起的慢性、进行性肾实质损害，导致肾脏发生不同程度功能减退，难以维持机体基本需要，临床表现为代谢产物潴留，水、电解质及酸碱平衡失调。国内学者研究表明[1]：慢性肾功能衰竭发病机制常见诱因包括：各种原发性、继发性肾小球肾炎、泌尿系统畸形、遗传因素及高血压等，不同诱因之间能相互作用、相互影响，进一步加剧疾病的发生、发展。近年来，随着中医的不断发展而在慢性肾功能衰竭患者中得到应用，通过整体辨证、四诊合参及内外兼治的方法能实现多途径、多靶点治疗，最大限度弥补现代医学的不足[2]。……