Background Environmental pollutant exposure has been associated with chronic kidney disease (CKD), yet specific chemicals related to renal function variation remain incompletely characterized. Methods We analyzed the plasma exposome using liquid chromatography-mass spectrometry (LC-MS) in 734 biopsy-confirmed CKD patients (452 IgA nephropathy [IgAN] and 282 membranous nephropathy [MN]), quantifying 62 chemical exposure species. Associations between exposures and estimated glomerular filtration rate (eGFR) were assessed using regression models and were further evaluated in an independent external cohort (Shanghai Brain Aging Study, SBAS) of 464 older adults. In addition, clinical remission status was assessed after a median follow-up of one year, and its associations with specific chemicals were subsequently evaluated. Proteomic data were integrated to explore protein features related to the exposure-eGFR association in the MN subgroup. Results In the discovery CKD cohort, two PAHs, biphenyl and 2,6-dimethylnaphthalene, were associated with lower eGFR after multivariable adjustment, a finding also observed in the external SBAS cohort. Moreover, in the MN subgroup, these two PAHs were also associated with remission status. Proteomic profiling in MN patients identified six proteins (CDH1, CALR, PTGDS, DAG1, PEBP4, and YIPF3) with statistically significant interaction terms for the biphenyl-eGFR association. Conclusions Combining exposome and proteome analysis, this study identified exploratory associations between PAHs and renal function in CKD patients, and these effects may be related to certain key proteins.

Background Chronic kidney disease(CKD)is a worldwide public health problem,stage 4 CKD is a critical stage during the course of CKD,marking the significant decline of kidney function and the obvious appearance of symptoms.Although fermented cordyceps sinensis powder has been used in the treatment of chronic kidney disease for a long time,its prognostic effect on CKD,especially the curative effect of stage 4 CKD,lacks evidence-based medical evidence.Objective To explore the long-term prognosis of stage 4 CKD patients treated with fermented cordyceps sinensis powder and the potential related factors affecting the prognosis.Methods A total of 631 patients diagnosed with stage 4 CKD in the nephrology Department of Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from 2013 to 2022 were collected.Based on standardized integrated Chinese and Western medicine treatment,patients were divided into cordyceps treatment group(339 cases)and integrated Chinese and Western medicine treatment group(252 cases)according to whether fermented cordyceps sinensis powder was used.Data such as patients'basic information,whether they were accompanied by diabetes,the occurrence and time of endpoint events,the time of diagnosis of stage 4 CKD,and relevant laboratory indicators at diagnosis were collected.After eliminating baseline differences between groups with propensity score matching,COX regression analysis was conducted to analyze potential prognostic factors.Survival curve was drawn by Kaplan-Meier method,and the difference of survival between groups was compared by Log-rank test.Results A total of 378 patients were included after matching at a ratio of 1:1.Multivariate Cox proportional hazard regression analysis showed that the using of fermented cordyceps sinensis powder(HR=0.79,95%CI=0.64-0.98,P=0.030),the increased level of estimated glomerular filtration(HR=0.97,95%CI=0.94-1.00,P=0.025)and serum albumin(HR=0.97,95%CI=0.96-0.99,P=0.002)prolonged the survival time of stage 4 CKD patients;male(HR=1.37,95%CI=1.09-1.71,P=0.006),the increased level of brain natriuretic peptide(HR=1.00,95%CI=1.00-1.00,P=0.003),blood phosphorus(HR=2.44,95%CI=1.63-3.67,P<0.001)and 24 h urinary protein(HR=1.00,95%CI=1.00-1.00,P<0.001)shortened the survival time of patients with stage 4 CKD.The results of survival curve analysis showed that cumulative survival rate of cordyceps treatment group was higher than that of integrated Chinese and Western medicine treatment group(HR=0.70,95%CI=0.57-0.86,P<0.001).The cumulative survival rate in the low protein level subgroup was higher in the cordyceps treatment patients than in the integrated Chinese and western medicine treatment patients(HR=0.67,95%CI=0.52-0.85,P<0.001).In the high urinary protein level subgroup,there was no significant difference in cumulative survival between the two treatment groups(P=0.518).Conclusion Long-term use of fermented cordyceps sinensis powder can prolong the progression of renal function in patients with stage 4 CKD,and can play a better clinical effect under the premise of active control of urinary protein.Relatively low levels of brain natriuretic peptide and serum phosphorus,and relatively high levels of serum albumin are also potential factors for good prognosis in patients with stage 4 CKD.

背景  慢性肾脏病（CKD）是世界性公共卫生问题，CKD 4 期是CKD病程中一个关键的阶段，标志着肾功能的显著下降和症状的明显出现。发酵虫草菌粉虽然长期应用于CKD的治疗之中，但其对CKD的预后影响尤其是 CKD 4 期的疗效缺乏循证医学证据。目的  探索发酵虫草菌粉治疗 CKD 4 期患者的长期预后情况及影响预后的潜在相关因素。方法  选取2013—2022年于上海中医药大学附属龙华医院肾病科住院诊断为CKD 4期的患者631例为研究对象。在中西医结合治疗的基础上，根据是否使用发酵虫草菌粉分为虫草治疗组（339 例）和中西医结合治疗组（252例）。收集患者基本信息、是否伴随糖尿病、发生终点事件情况及进入终点事件时间、确诊 CKD 4 期时间及确诊时相关实验室指标等资料。采用倾向性得分匹配消除组间基线差异后，通过 Cox 比例风险回归分析影响CKD 4期患者预后的潜在相关因素；采用 Kaplan-Meier 法绘制CKD 4期患者预后的生存曲线，采用Log-rank检验比较组间生存情况差异。结果  按 1∶1比例匹配后最终共纳入378例患者。多因素Cox比例风险回归分析结果显示，使用发酵虫草菌粉（HR=0.79，95%CI=0.64~0.98，P=0.030），估算肾小球滤过滤（HR=0.97，95%CI=0.94~1.00，P=0.025）、血清白蛋白（HR=0.97，95%CI=0.96~0.99，P=0.002） 水 平 升 高 可 延 长 CKD 4 期 患 者 的 生 存 时 间； 男 性（HR=1.37，95%CI=1.09~1.71，P=0.006）、脑利钠肽（HR=1.00，95%CI=1.00~1.00，P=0.003）、血磷（HR=2.44，95%CI=1.63~3.67，P<0.001）和 24h 尿蛋白（HR=1.00，95%CI=1.00~1.00，P<0.001）水平升高可缩短 CKD 4 期患者的生存时间。生存曲线分析结果显示，虫草治疗组累积生存率高于中西医结合治疗组（HR=0.70，95%CI=0.57~0.86，P<0.001）；低尿蛋白水平亚组中，虫草治疗组累积生存率高于中西医结合治疗组（HR=0.67，95%CI=0.52~0.85，P=0.001）；高尿蛋白水平亚组中，两治疗组累积生存率比较，差异无统计学意义（P=0.518）。结论  长期使用发酵虫草菌粉能够延长CKD 4期患者肾功能进展，在积极控制尿蛋白的前提下可发挥更好的临床疗效。相对低水平的脑利钠肽和血磷、相对高水平的血清白蛋白也是CKD 4期患者良好预后的潜在因素。

目的 研究碳酸镧对维持性腹膜透析合并继发性甲状旁腺功能亢进患者动脉钙化的疗效.方法 将80例腹膜透析合并继发性甲状旁腺功能亢进患者作为研究对象,随机分为对照组和试验组,2组各40例.对照组给予常规治疗+骨化三醇口服治疗,试验组在对照组的基础上加用碳酸镧口服治疗.比较2组血清全段甲状旁腺激素(iPTH)、血清肌腱蛋白-C(TN-C)水平,甲状旁腺大小、冠状动脉钙化(CAC)积分,钙、磷和钙磷乘积水平,药物不良反应发生情况.结果 治疗后,对照组和试验组的血钙水平分别为(2.30±0.15)和(1.98±0.20)mmol·L-1;这2组的血磷水平分别为(1.75±0.23)和(1.67±0.20)mmol·L-1;这2组的钙磷乘积水平分别为(4.02±0.56)和(3.34±0.56)mmol·L-1;这2组的iPTH水平分别为(570.59±101.57)和(368.90±86.63)pg·mL-1;这2组的TN-C水平分别为(63.66±5.15)和(56.48±5.66)μg·L-1;这2组的甲状旁腺体积(长、宽、高)分别为(8.25±0.54),(4.63±0.49),(3.63±0.49)mm和(6.43±0.55),(3.75±5.43),(2.75±0.44)mm;这2组治疗6个月后CAC积分分别为(490.19±34.03)和(455.45±28.25)分.上述指标,试验组各项指标均优于对照组,差异均有统计学意义(均P<0.05).试验组和对照组的药物不良反应发生率分别为7.50％和15.00％,差异无统计学意义(P>0.05).结论 碳酸镧可下调腹膜透析合并继发性甲状旁腺功能亢进患者降低血清甲状旁腺激素、TN-C水平,缓解甲状旁腺功能亢进,减轻患者冠状动脉钙化.

目的 分析中医"健脾补肾、活血解毒"法治疗特发性膜性肾病(idiopathic membranons nephropath,IMN)的临床疗效及影响疗效的相关因素,探讨该治疗方案的有效性和安全性.方法 采用单中心回顾性研究方法,严格按照纳排标准搜集、整理分析2014年1月—2019年1月于上海中医药大学附属龙华医院肾病科病房和门诊就诊的IMN患者临床病例资料.结果 该研究纳入244例IMN患者,中医辨证分型本虚证属脾肾气虚证,标实证以血瘀证(28.69％,70/244)、热毒证(26.23％,64/244)为主;中药组缓解率81.63％(80/98),中西结合组缓解率71.25％(57/80),西药无效组缓解率66.67％(44/66),整体缓解率74.18％(181/244)、复发率2.87％(7/244);性别、高血压病、疗程、蛋白尿、血清白蛋白是各治疗组预后的影响因素,合并用药是单纯中药组预后的影响因素,血肌酐水平是西药无效组预后的影响因素.多因素Logistic回归分析提示蛋白尿、血清白蛋白、高血压病可能是该方案治疗IMN疗效的独立影响因素.结论 中医"健脾补肾、活血解毒"法治疗IMN疗效确切,复发率低,且治疗时间越长、疗效越好、缓解率越高;蛋白尿、高血压病、血清白蛋白是影响"健脾补肾,活血解毒"方案治疗IMN的相关因素.

目的:探讨早期特发性膜性肾病伴贫血的发病率、临床特征及其影响因素.方法:在2015年11月—2019年10月间,对上海中医药大学附属龙华医院肾内科初诊的、经临床及病理明确诊断、且病史资料完整的早期膜性肾病(估算的肾小球滤过率≥60 ml·min-1·1.73 m-2)患者208例进行回顾性分析.调查贫血的发病率,并通过单因素及多因素分析了解发病的危险因素.结果:贫血的总发生率为51.0％.伴有贫血的早期膜性肾病患者的病理分级重(P<0.001),血白蛋白低(P<0.001),血清肌酐、血尿素高(P<0.05),肾小球滤过率低(P<0.05).血红蛋白与血白蛋白、肾小球滤过率呈正相关(P<0.05).难治型膜性肾病患者的贫血发生率为58.8％,明显高于普通型患者的44.1％(P<0.05).免疫抑制药物的使用对于膜性肾病患者贫血发病具有显著影响(P<0.05).多因素回归分析提示,低蛋白血症(OR=0.895,95％CI 0.854,0.938)、高病理分级(OR=1.552,95％CI 0.732,3.289;OR=10.302,95％CI 2.903,36.560;OR=12.379,95％CI 0.839,182.618)以及曾使用免疫抑制药物(OR=1.964,95％CI 1.056,3.654)是贫血发生的独立危险因素.结论:特发性膜性肾病患者贫血发生早、发病率高,血白蛋白、病理分级以及使用免疫抑制药物史与伴发贫血独立相关.

BACKGROUND:Idiopathic membranous nephropathy (IMN) is one of the most common causes of nephrotic syndrome in adults involving multiple targets and factors. The effect of conservative nonimmunosuppressive or immunosuppressive therapies is unsatisfactory and with many side effects. Traditional Chinese medicine (TCM) can regulate immune function and improve kidney function.PURPOSE:To evaluate the total effective rate, curative rate, recurrence rate and adverse events of TCM alone or TCM as an adjunctive therapy for IMN.METHODS:Randomized controlled trials (RCT) comparing either TCM alone or the combination of TCM to western medicine (WM) therapies for patients with IMN were retrieved by searching English and Chinese database. Risk of bias summary was used to assess the methodological quality of eligible studies. Dichotomous data were presented using odds ratios (OR). The primary outcome measure was the total effective rate. Secondary outcomes included curative rate, recurrence rate and adverse events.RESULTS:29 RCTs involving 1883 participants met the inclusion criteria. There was no statistically significant difference between the therapy of TCM alone and WM on the total effective rates (OR: 2.00; 95% CI: 0.80-4.98; P = 0.14) and curative rate (OR: 1.66; 95%CI: 0.66-4.22; p = 0.28). However, compared to basic treatment or immunosuppressive therapies alone, results showed that TCM as an adjunctive therapy had beneficial effects on the total effective rate (OR: 2.59; 95% CI: 1.38-4.86; P = 0.003 and OR: 3.01; 95% CI: 2.25-4.04; P < 0.00001) and curative rate (OR: 3.01; 95%CI: 1.24-7.28; p = 0.01 and OR: 1.73; 95%CI: 1.10-2.71; p = 0.02). In addition, the combination of TCM treatment could reduce the recurrence rate (OR: 0.28; 95% CI: 0.12-0.68; P = 0.004) and adverse reactions (OR: 0.38; 95% CI: 0.27-0.54; p < 0.00001).CONCLUSION:The results indicate that TCM is well-tolerated for the treatment of IMN. However, there remains a need for large-scale and high-quality trials.

目的 探讨合并2型糖尿病患者的开展腹膜透析的结局和危险因素. 方法 选取2015年5月至2020年5月间在上海中医药大学附属龙华医院肾内科开展腹膜透析时已确诊2型糖尿病的患者,收集病例资料和结局信息,分析筛选出现终点事件即退出腹膜透析的危险因素. 结果 最终共筛选纳入研究对象113例,其中男性70例(61.95％),女性43例(38.05％),中位年龄60 (54,68)岁,中位透析随访时长27(15,48)月.共47例(41.59％)发生了定义的终点事件,其中死亡17例(15.04％),转血液透析30例(26.55％).经单因素筛选和多因素COX分析显示,肥胖(HR=2.131,95％ CI:1.123～4.045,P=0.021)是影响PD病人生存的独立危险因素.113例患者中位腹膜透析时间为50(25,123)月;肥胖患者中位透析时间42 (20,71)月,相较于非肥胖病例的中位透析时间85(34,123)月显著减少(x2=5.750,P=0.016);晚透析患者中位透析时间73(33,120)月,相较于非晚透析患者中位透析时间41 (20,58)月,差异有统计学意义(Z=4.501,P=0.034).结论 肥胖的合并2型糖尿病患者开展腹膜透析的退出风险相对较高.

IgA nephropathy (IgAN) is a leading cause of chronic kidney disease (CKD), which are commonly accompanied by dyslipidemia. Obesity is also associated with dyslipidemia and risk of CKD, but the relation of the dyslipidemia patterns with obesity and disease progression in IgAN patients remains unknown. Traditional Chinese medicine (TCM) and the combined treatment with corticosteroids and TCM have been shown to be of benefit for IgAN patients, but predictive markers for guiding these treatments are lacking. Here, we quantified 545 lipid species in the plasma from 196 participants, including 140 IgAN patients and 56 healthy volunteers, and revealed an altered plasma lipidome in IgAN patients as compared to healthy participants. Association analysis showed that a subgroup of glycerides, particularly triacylglycerols (TGs) containing docosahexaenoic acid, were positively associated with high body mass index (BMI) in under- or normal-weight IgAN patients, while several free fatty acids and sphingomyelins were positively associated with high BMI in overweight or obese IgAN patients. Further, our study suggested that elevated levels of eight lipids, mainly TG species containing linolenic acid, were independent risk factors for IgAN progression and also reported the prospective association of circulating lipids with treatment outcomes in IgAN. Taken together, our findings may not only help to achieve precision medicine but also provide a knowledge base for dietary intervention in the treatment of IgAN.

目的:探讨健脾补肾通络方对3期～5期慢性肾脏疾病(CKD)患者血管钙化和微炎症状态的影响.方法:前瞻性选取上海中医药大学附属龙华医院2017年10月～2019年3月CKD非透析患者120例,随机分为中药组、西药组、联合组,每组各40例.在常规治疗的基础上,中药组辅以健脾补肾通络方,西药组辅以骨化三醇,联合组辅以健脾补肾通络方和骨化三醇.连续治疗24w,比较三组患者的临床疗效,治疗12 w和24w中医证候总积分、血钙、血磷、血清全段甲状腺激素(iPTH)、Klotho蛋白、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、血清肌酐(SCr)、β2-微球蛋白(β2-MG)、尿素氮(BUN)水平以及颈动脉和心脏超声血管钙化结果.结果:联合组患者显效率(67.5％)和临床总有效率(97.5％)均明显高于中药组和西药组;并且与中药组和西药组相比,联合组可有效降低中医证候总积分、血清iPTH、hs-CRP、IL-6、TNF-α、SCr、β2-MG、BUN水平以及血管钙化的总发生率,同时提高血清Klotho水平.另外,治疗12 w和24w时,中药组和联合组患者血磷和钙磷乘积明显低于西药组;中药组患者血钙水平明显低于西药组和联合组.结论:健脾补肾通络方在改善CKD患者肾功能的基础上,可有效抑制微炎症内环境,调节钙磷代谢,以达到缓解临床症状和降低血管钙化发生率的目的;联合组对中晚期CKD患者预防血管钙化发生的临床获益更明显,值得临床推广.

目的:探讨肾脏病理类型分布及临床、病理类型特点并分析其相互关系.方法:收集2015年04月～2019年02月上海中医药大学附属龙华医院肾病科451例≥14岁肾活检患者资料,根据患者性别、年龄、地域,分析肾脏各病理类型的变化及分布.结果:(1)原发性肾小球疾病(PGD) 376例(83.37％),继发性肾小球疾病(SGD)66例(14.63％),肾小管间质性疾病6例(1.33％),遗传性肾病2例(0.44％)急性肾衰竭1例(0.22％).(2)原发性肾小球疾病最常见病理类型为IgA肾病(208例,55.32％),其次为膜性肾病(80例,21.28％),局灶节段性肾小球硬化症(40例,10.64％);继发性肾小球疾病最常见的病理类型为糖尿病肾病(32例,48.48％),其次是紫癜性肾炎(11例,16.67％),乙肝相关性肾炎(9例,13.64％);(3)PGD的临床表现以肾炎综合征(184例,48.94％)为主;其次是无症状尿检异常(74例,19.68％)和肾病综合征(63例,16.76％).结论:本院IgA肾病是原发性肾小球疾病最常见的肾小球疾病,其次是膜性肾病,继发性肾脏疾病中糖尿病肾病占第一位.肾脏病理类型与患者年龄、性别、临床表现有有一定相关性,但未构成明确的规律对应关系,故对于肾脏疾病,肾活检仍是明确诊断,指导治疗的最佳手段.

膜性肾病(membranous nephropathy,MN)是临床上常见的成人肾病综合征病理类型之一,其病理特征为肾小球基底膜(glomerular basement membrane,GBM)上皮下免疫复合物的沉积,分为特发性膜性肾病(Idiopathic membranous nephropathy,IMN)和继发性膜性肾病(secondary membranounephropathy,SMN). IMN是我国目前发病率高,增长最快的原发性肾小球疾病,在台湾,2014年～2016年间,1 445例肾活检结果显示IMN是原发性肾小球病肾病综合征最常见的病理类型,比例为28.8％[1].山东省2005年～2015年间6 841例肾穿刺病例,IMN占原发性肾小球比例为26.25％,于2012年后一直居于原发性肾小球肾炎病理类型首位[2].北京大学第一医院对2003年～2012年间的6 049例肾活检患者的回顾性分析发现IMN在原发性肾小球肾炎的比例由16.8％上升到29.35％[3]. 然而IMN的发病机制尚不完全清楚,并且缺乏公认有效的治疗方案.因此良好的IMN动物模型对疾病的研究具有重要意义.下面将近年来IMN动物模型综述如下.

原发性肾病综合征( primary nephrotic syndrome,PNS)是临床一类以高度水肿、大量蛋白尿、低蛋白血症为主要表现的原发性肾脏疾病的总称. 现代医学大多采取激素和(或)免疫药物开展治疗. 难治性肾病综合征( refractory nephritic syndrome, RNS)可理解为是一类对于治疗反应性不佳的肾病综合征. 目前,国内外对于RNS的诊断尚缺乏统一的认识. 现存大多数研究对其诊断主要是依据个体(主要是儿童病患)对于激素治疗的反应来定义,多指对糖皮质激素抵抗、依赖和(或)频繁复发. 然而就目前临床所见,成人肾病综合征的发病率更高、治疗缓解率更低. 其次,PNS包含有许多不同病理类型的肾脏疾病,它们对于激素治疗的敏感性存在明显的差异. 例如,作为PNS中最常见的两种病理类型,膜性肾病、微小病变[1]. 微小病变经激素治疗后病情缓解且无明显复发者可达 50％以上[2] ,而膜性肾病则不推荐单纯使用激素,常需联合免疫药物共同治疗[3]. 因而,RNS的定义不应局限于儿童,还应根据不同病理表现进行区分对待. 若在接受正规免疫抑制治疗时出现不能耐受的情况者,同样应归属于RNS的范畴中.

Effective evaluation or prediction of therapy response could be helpful for treatment of chronic kidney disease (CKD), which may rely on accurate biomarkers. Acylcarnitines are involved with lipid metabolism and mitochondrial function. The relation of acylcarnitines with treatment response in patients with CKD is unknown. The purpose of this study is to investigate the association of plasma acylcarnitines with renal function and its alteration by intervention in patients with IgA nephropathy (IgAN). A retrospective study was performed in 81 IgAN patients with treatment by traditional Chinese medicine (TCM). Multivariate linear regression analyses were performed to identify the association of acylcarnitines with baseline estimated glomerular filtration rate (eGFR) and eGFR changes after treatment. Twenty-seven acylcarnitines were measured at baseline and after 1-year TCM intervention. Certain short-chain and median-chain acylcarnitines were independently associated with baseline eGFR and eGFR alterations after 1 year treatment. Particularly, patients with high C5:1(β = − 0.42), C8:1(β = − 0.49), C3DC(β = − 0.5), C10:1(β = − 0.36) and C5DC(β = − 0.64)at baseline would have worse prognosis and treatment response. Moreover, certain acylcarnitines could be changed along with the eGFR alteration after 1-year TCM treatment. The findings indicate a significant association between plasma acylcarnitines with prognosis and treatment responses in patients with IgAN, which suggest its role as a potential penal of biomarker for IgAN.

特发性膜性肾病是最常见的慢性肾小球肾炎之一,致力于筛选IMN生物标记物是近年来国内外肾脏病学者研究的热点.自2009年Beck团队发现抗PLA2R抗体是IMN重要的自身抗体,MN的诊断、鉴别诊断、治疗及预后发生了变革性改变.目前越来越多的肾脏病学者致力于MN患者血清、组织、尿液标本的生物标记物研究,极大地推进了IMN的实验研究进展、提高了临床诊疗技术.

局灶节段硬化性肾小球肾炎( focalsegmental glomerular sclerosis,FSGS)是一组病理诊断学名词,其病理表现为局灶性( <50％的肾小球受累)、节段性(非累及整个肾小球)肾小球硬化性病变,常伴不同程度的小管间质损害. 免疫荧光显示IgM及C3 呈团块样沉积在肾小球病变区,电镜可见足突广泛融合. 根据其硬化部位及细胞增殖特点的不同,可分为非特殊型、门周型、顶端型、塌陷型、细胞型5个亚型. 临床上以非特殊型最多见,约占半数以上[1].

介绍邓跃毅教授从肝论治肾脏病的临床经验.认为肾脏病不仅责于肺脾肾,肝失疏泄亦为发病的重要因素;临证可从肝治肾,以清肝、平肝、疏肝为基本大法,肝经湿热证治以清肝泻热,阴虚阳亢证治以平肝柔肝,肝郁气滞证施以疏肝理气,疏肝法贯穿治疗始终.并举验案3则.

目的:观察健脾益肾活血方外用穴位敷贴对维持性腹膜透析患者残肾功能的保护作用.方法:选择在我院腹透中心行维持性腹膜透析患者共80例,按照随机数字表法随机分为试验组和对照组,每组各40例.其中试验组采用健脾益肾活血方外用穴位敷贴联合基础治疗(包括维持性腹膜透析,降压降糖治疗,补铁、促红素治疗,纠正钙磷代谢紊乱及甲旁亢等治疗);对照组采用口服健脾益肾活血方联合基础治疗(同前).统计两组患者治疗前后残肾功能、尿量、中医证候积分、计算尿素清除指数(Kt/V),腹膜透析肌酐清除率(creatinine clearance rate,Ccr),血白蛋白、前白蛋白、血红蛋白、钙磷乘积、甲状旁腺激素、体重指标、三酰甘油、胆固醇等指标进行比较.结果:两组治疗前后残肾功能、尿量均有所下降,但差异无统计学意义(P>0.05),且两组RRF的差值差异亦无统计学意义(P>0.05);试验组中医证候有效率为37.5％,对照组为30％,两组无明显组间差异(P>0.05).治疗后,试验组患者在营养指标(血浆白蛋白、前白蛋白、血红蛋白、体重指数、三酰甘油、胆固醇)方面均无明显变化(P>0.05).对照组相较于基线,在血红蛋白、前白蛋白上有所下降(P<0.05),体重指数有所升高(P<0.05),其余各指标在治疗前后差异无统计学意义(P>0.05).两组营养指标方面在治疗后组间差异均无统计学意义(P>0.05).试验组与对照组在透析充分性指标(Kt/V、腹膜透析CCr)方面,组内、组间差异均无统计学意义(P>0.05).结论:健脾益肾活血外用中药穴位敷贴对腹透患者残肾功能有一定的保护作用,与口服中药汤剂比较疗效相当,且对改善患者营养状态方面有一定优势.

流行病学资料显示,我国慢性肾脏病的患病比例约为10.8％,人口数约为1.12亿[1].随着医疗水平的提高和人均寿命的延长,再加上人口干预政策之后,我国目前正在加速进入老龄化社会,老年人占慢性肾脏病患者比例也逐年增多.在老年肾脏病患者中,有较大的比例伴有肾功能的减退,这部分肾功能减退的病人相较于肾功能正常者,病情更重,进展到终末期肾病的比例更高,临床预后较差.老年慢性肾衰竭患者多同时合并有高血压、糖尿病等慢性疾病,肾穿刺意愿和比例低、风险高,发现肾衰竭时,病情多已经相对滞后,可能的病因复杂多样,且多无法追溯和确认.

流行病学资料显示,我国慢性肾脏病的患病率呈逐年升高的趋势,其患病率已达10.8％,估计我国约有1.2亿人患有慢性肾脏病,其中30％左右会进展至慢性肾功能衰竭.慢性肾衰竭(CRF)临床多表现为少尿或无尿、皮肤瘙痒、恶心呕吐、神昏、谵语等.现代医学对CRF没有特异性的治疗办法,多采用饮食调整;积极控制血压、血糖;纠正贫血;纠正钙磷代谢以及调节水、电解质、酸碱平衡紊乱等一体化治疗,晚期多在一体化治疗的基础上加用肾脏替代治疗.对患者而言,不仅医疗费用昂贵,而且生存质量降低,患者接受度低.中医学在长期的发展中,总结出治疗CRF具有独特优势的中医内治法及外治法,不仅可以延缓肾功能损害的进程,提高肾脏存活率,还可以推迟使用肾脏替代治疗的时间,提高患者的生存质量.