专题:中医临床研究的范式与应用

中医药对慢性肾脏病3—5期患者肾功能进展的保护作用

  • 朱佩琦 ,
  • 何佳怡 ,
  • 谢佳东 ,
  • 赵静 ,
  • 唐睿婕 ,
  • 孙伟 ,
  • 何伟明
展开
  • 1. 南京中医药大学附属医院, 南京 210029;
    2. 南京中医药大学人工智能与信息技术学院, 南京 210023
朱佩琦,博士研究生,研究方向为中医药防治慢性肾脏病,电子信箱:Zhupeiqi0708@163.com;孙伟(通信作者),主任中医师,教授,研究方向为中医药防治慢性肾脏病,电子信箱:jssunwei@163.com;何伟明(共同通信作者),主任中医师,研究方向为中医药防治慢性肾脏病,电子信箱:yfy0019@njucm.edu.cn

收稿日期: 2024-05-24

  修回日期: 2024-08-05

  网络出版日期: 2024-12-14

基金资助

国家重点研发计划项目(2023YFC3502900);江苏省中医药科技发展专项(k2020j14)

Protective effect of Chinese medicine on progression of renal function in patients with chronic kidney disease stages 3-5

  • ZHU Peiqi ,
  • HE Jiayi ,
  • XIE Jiadong ,
  • ZHAO Jing ,
  • TANG Ruijie ,
  • SUN Wei ,
  • HE Weiming
Expand
  • 1. Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China;
    2. School of Artificial Intelligence and Information Technology, Nanjing University of Chinese Medicine, Nanjing 210023, China

Received date: 2024-05-24

  Revised date: 2024-08-05

  Online published: 2024-12-14

摘要

基于江苏省中医院“临床-科研-慢病管理一体化平台”,探讨慢性肾脏病(chronic kid-ney disease,CKD)3—5期患者病情进展的危险因素及中医药的保护作用。收集了2020年3月1日至2023年10月30日,在江苏省中医院就诊的CKD 3—5期患者186例,根据患者肾功能进展情况分组,通过logistic回归,评估患者肾功能进展的危险因素,以及中药对肾功能的影响。结果表明,186例CKD 3—5期患者中,肾功能进展组平均估算的肾小球滤过率(eG-FR)降低率约为15.22%,平均eGFR斜率为-3.44 mL·(min·1.73 m2-1,肾功能平稳组平均eG-FR降低率约1.02%,平均eGFR斜率为1.33 mL·(min·1.73 m2-1。以肾功能是否进展为因变量,临床指标为自变量,logistic回归分析显示,合并高血压、尿酸>420 μmol·L-1、白蛋白<34g·L-1是CKD患者肾功能进展的危险因素,年龄>65岁、服用中药是保护因素。以服用中药时长进行分组,生存分析显示,间断及连续服用中药组比未服用中药组患者肾功能平稳率更高、eGFR更高。研究结果证明CKD患者并发高血压,且尿酸水平越高、白蛋白越低,肾功能进展的风险越高,服用中药治疗、年龄在65岁以上且越大的患者,肾功能趋于平稳。连续及长期间断服用中药能延缓CKD患者肾功能进展,延迟进入肾脏替代治疗。

本文引用格式

朱佩琦 , 何佳怡 , 谢佳东 , 赵静 , 唐睿婕 , 孙伟 , 何伟明 . 中医药对慢性肾脏病3—5期患者肾功能进展的保护作用[J]. 科技导报, 2024 , 42(21) : 47 -54 . DOI: 10.3981/j.issn.1000-7857.2024.05.00463

Abstract

Based on the Clinical-Research-Disease Management Integration Platform of Jiangsu Hospital of Traditional Chinese Medicine, this article investigates the risk factors for the progression of patients with chronic kidney disease (CKD) stages 3-5 and the protective effects of traditional Chinese medicine (TCM).A total of 186 patients with CKD stages 3-5 attending the hospital from Mar 1, 2020 to Oct 30, 2023 were collected and grouped according to progression of their renal function, and the risk factors for the progression of the patients' renal function, as well as the effects of traditional Chinese medicine on their renal function, were assessed by logistic regression.Among 186 patients the average estimated glomerular filtration rate (eGFR) reduction rate was about 15.22% and the average eGFR slope was -3.44 mL·(min·1.73 m2-1 in the group with progressive renal function, and the average eGFR reduction rate was about 1.02% and the average eGFR slope was 1.33 mL·(min·1.73 m2-1 in the group with stable renal function.Logistic regression analysis using whether renal function progressed as the dependent variable and clinical indicators as independent variables showed that combined hypertension, uric acid >420 μmol·L-1, and albumin <34 g·L-1 were the risk factors for renal function progression in CKD patients, and age >65 years and taking TCM were the protective factors.Patients were grouped based on the duration of TCM usage.Survival analysis indicated that both the intermittent and continuous TCM usage groups had a higher rate of stable kidney function and higher eGFR compared to the group that did not use TCM.The results demonstrate that in CKD patients with concurrent hypertension, the higher uric acid levels and the lower albumin levels, the higher the risk of kidney function progression.TCM treatment and patients aged 65 and above tend to stabilize kidney function.Continuous and long-term intermittent use of TCM can delay the progression of kidney function deterioration in CKD patients and postpone the need for renal replacement therapy.

参考文献

[1] Jager K J, Kovesdy C, Langham R, et al. A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases[J]. Nephrology, Dialysis, Transplantation, 2019, 34(11): 1803-1805.
[2] Wang L M, Xu X, Zhang M, et al. Prevalence of chronic kidney disease in China: Results from the sixth China chronic disease and risk factor surveillance[J]. JAMA Internal Medicine, 2023, 183(4): 298-310.
[3] Ruilope L M, Ortiz A, Lucia A, et al. Prevention of cardiorenal damage: Importance of albuminuria[J]. European Heart Journal, 2023, 44(13): 1112-1123.
[4] Zhu P, Liu Y, Han L, et al. Serum uric acid is associated with incident chronic kidney disease in middle-aged populations: A meta-analysis of 15 cohort studies[J]. PLoS One, 2014, 9(6): e100801.
[5] Mitrofanova A, Merscher S, Fornoni A. Kidney lipid dysmetabolism and lipid droplet accumulation in chronic kid-ney disease[J]. Nature Reviews Nephrology, 2023, 19(10): 629-645.
[6] 陈继红, 盛梅笑, 许陵冬, 等. 基于真实世界原理评价益肾清利泄浊方治疗慢性肾脏病3 期患者临床疗效的研究[J]. 世界科学技术-中医药现代化, 2019, 21(6): 1055- 1061.
[7] 赵静, 孙伟. 基于大数据平台的“益肾清利、和络泄浊方”治疗慢性肾脏病3-5期肾功能进展的疗效分析[J]. 世界 科学 技术 -中医 药现 代化, 2021, 23(10): 3468- 3473.
[8] 孙斯凡, 赵静, 俞璐嘉, 等. 基于大数据平台探讨“益肾清利活血方”治疗慢性肾脏病1-2期蛋白尿的临床疗效分析[J]. 世界科学技术-中医药现代化, 2021, 23(10): 3447-3453.
[9] 美国改善全球肾脏病预后组织, 王海燕. KDIGO慢性肾脏病评价及管理临床实践指南: 2012版[M]. 北京: 人民卫生出版社, 2014.
[10] Lu J L, Molnar M Z, Naseer A, et al. Association of age and BMI with kidney function and mortality: A cohort study[J]. The Lancet Diabetes & Endocrinology, 2015, 3(9): 704-714.
[11] Inker L A, Heerspink H J L, Tighiouart H, et al. GFR slope as a surrogate end point for kidney disease progression in clinical trials: A meta-analysis of treatment effects of randomized controlled trials[J]. Journal of the American Society of Nephrology, 2019, 30(9): 1735-1745.
[12] Inker L A, Collier W, Greene T, et al. A meta-analysis of GFR slope as a surrogate endpoint for kidney failure[J]. Nature Medicine, 2023, 29(7): 1867-1876.
[13] 杨琦, 潘锦婷, 刘妍, 等. 基于肾小球滤过率轨迹的2型糖尿病患者肾功能降低快速进展危险因素分析及与胰岛素抵抗的相关性[J]. 中国糖尿病杂志, 2023, 31(8): 571-575.
[14] 王琳娜, 阎磊, 尹忠, 等. 高尿酸血症与老年特发性膜性肾病患者预后的关系[J]. 中华实用诊断与治疗杂志, 2024, 38(2): 135-140.
[15] Srivastava A, Kaze A D, McMullan C J, et al. Uric acid and the risks of kidney failure and death in individuals with CKD[J]. American Journal of Kidney Diseases, 2018, 71(3): 362-370.
[16] Oh T R, Choi H S, Kim C S, et al. Hyperuricemia has increased the risk of progression of chronic kidney disease: Propensity score matching analysis from the KNOW-CKD study[J]. Scientific Reports, 2019, 9(1): 6681.
[17] 韩婧, 张勉之, 孙岚云. 血清RBP4、NGAL、CysC、IL-2、 白蛋白球蛋白比值在老年慢性肾脏病中的变化特点及意义[J]. 中国老年学杂志, 2023, 43(7): 1606-1609.
[18] 翁俊影, 曹王芳, 黎海英. 慢性肾脏病4~5期患者血清白蛋白和超敏C反应蛋白水平分析[J]. 临床合理用药杂志, 2022, 15(32): 71-74.
[19] 袁丹, 陈海平. 老年慢性肾脏病与非慢性肾脏病患者肾小球滤过率随增龄变化的差异[J]. 中国老年学杂志, 2019, 39(9): 2183-2186.
[20] 曹聃, 张伟光, 张银平, 等. 不同年龄健康人肾脏滤过功能评价指标的生理范围及影响因素[J]. 中国中西医结合肾病杂志, 2017, 18(5): 409-412.
[21] Pina P M R, Arcon L C, Zatz R, et al. Older patients are less prone to fast decline of renal function: A propensity-matched study[J]. International Urology and Nephrology, 2023, 55(12): 3245-3252.
[22] 朱佩琦, 何伟明. 基于“去宛陈莝”探讨通法在肾系病中的应用[J]. 实用中医内科杂志, 2023, 37(5): 71-74.
[23] 陈澍, 马钰, 张赛, 等. 基于补肾活血法对治疗慢性肾脏病的临床有效性及安全性的Meta分析[J]. 天津中医药, 2023, 40(12): 1558-1566.
[24] 周红伶, 郑艳辉. 基于数据挖掘、网络药理学方法和分子对接技术探讨中医药治疗慢性肾脏病的核心中药及作 用机 制[J]. 山西 中医 药大 学学 报, 2023, 24(11): 1257-1263.
[25] 邹燕勤, 王钢, 朱俊, 等. 邹氏肾科对孟河医派核心学术思想“和缓学说”的传承与发展[J]. 江苏中医药, 2023, 55(6): 1-6.
[26] 沈佳丽, 杨晓宇, 张颖煜, 等. 国医大师邹燕勤从虚、 热、湿、瘀论治糖尿病肾病[J]. 湖南中医药大学学报, 2022, 42(4): 528-531.
[27] 尹聪, 陈阳, 胡超娜, 等. 国医大师邹燕勤运用补脾泻火升阳法治疗慢性肾脏病[J]. 时珍国医国药, 2023, 34(5): 1246-1248.
[28] 易岚, 周恩超, 高坤, 等. 国医大师邹燕勤教授运用“和法缓治”学术思想治疗慢性肾脏病经验[J]. 南京中医药大学学报, 2020, 36(4): 552-556.
[29] 张荣东, 林莺, 刘利华. 国医大师邹燕勤从肾虚湿瘀论治慢性肾脏病经验[J]. 中国中医药信息杂志, 2021, 28(6): 109-111.
[30] 周雪忠, 王世华, 张迪, 等. 构建中医药特色真实世界临床研究新模式的实践与思考[J]. 科技导报, 2023, 41(14): 22-31.
[31] 张迪, 雒琳, 文天才, 等. 中医辨证论治疗效评价研究进展[J]. 科技导报, 2023, 41(14): 32-41.
文章导航

/