厄贝沙坦联合小柴胡颗粒在慢性肾功能不全患者中治疗对尿蛋白水平影响

李兆华?钟巧诗?陈婉嫦?谢兵?张永强?李伟

[摘要] 目的 探讨厄贝沙坦联合小柴胡颗粒在慢性肾功能不全患者中治疗效果及对尿蛋白水平影响。 方法 选取2015年4月～2016年5月我社区中心诊治的慢性肾功能不全患者80例为研究对象，采用信封分组法将患者随机分为联合组和常规组。两组患者给予饮食控制、补液、纠正水电解质等常规治疗，常规组给予厄贝沙坦治疗，联合组在常规组基础上给予小柴胡颗粒治疗，比较两组患者疗效，治疗前后24h尿蛋白、血肌酐（Scr）、尿素氮（BUN）水平及药物不良反应发生率。 结果 联合组治疗总有效率显著高于常规组（95.00% vs.75.00%，P<0.05）。治疗前两组患者24h尿蛋白、Scr、BUN水平比较差异无统计学意义（P>0.05）；治疗后联合组患者24h尿蛋白、Scr、BUN水平均低于常规组[（0.34±0.08）g vs.（0.79±0.12）g，（82.6±16.8）μmol/L vs.（106.4±20.5）μmol/L，（6.5±1.1）mmol/L vs.（9.1±1.6）mmol/L，P<0.05]。两组患者治疗期间眩晕、恶心呕吐、血钾升高、腹泻、口干药物不良反应发生率比较差异无统计学意义（P>0.05）。 结论 厄贝沙坦联合小柴胡颗粒在慢性肾功能不全患者中治疗能有效改善患者肾功能，降低尿蛋白水平，具有显著临床疗效和较高用药安全性。

[关键词] 慢性肾功能不全；厄贝沙坦；小柴胡颗粒；尿蛋白

[中图分类号] R692.5 [文献标识码] A [文章编号] 2095-0616（2017）05-48-04

[Abstract] Objective To discuss the clinical efficacy of irbesartan combined with Xiaochaihu granules for chronic renal insufficiency and the effect on urinary protein. Methods Selected 80 patients with chronic renal insufficiency in our community center from April 2015 to May 2016 were randomly divide into combination group and conventional group by envelope grouping. All cases were treated with routine treatment of diet control， fluid replacement， correct water and electrolyte. The conventiona group was treated with irbesartan， and the combination group was treated with irbesartan combined with Xiaochaihu granules. The clinical efficacy， the levels of 24-hour urinary protein， Serum creatinine （Scr）， blood urea nitrogen （BUN） and the adverse drug reaction rate of two groups were compared. Results The total effective rate of combination group was significantly higher than that of the conventional group （95.00% vs 75.00%， P<0.05）. The levels of 24 h urinary protein， Scr and BUN in the two groups before treatment showed no significantl difference （P>0.05）. The levels of 24 h urine protein， Scr and BUN in the combination group after treatment were lower than those in the conventional group[（0.34±0.08）g vs.（0.79±0.12）g，（82.6±16.8）μmol/L

vs.（106.4±20.5）μmol/L，（6.5±1.1）mmol/L vs.（9.1±1.6）mmol/L，P<0.05]. The incidence of vertigo， nausea， vomiting， hyperkalemia， diarrhea and dry mouth of two groups showed no significant difference （P>0.05）. Conclusion Irbesartan combined with Xiaochaihu granules for chronic renal insufficiency can effectively improve renal function， reduce urinary protein levels， with significant clinical efficacy and higher drug safety.

[Key words] Chronic renal insufficiency； Irbesartan； Xiaochaihu particles； Urinary protein

慢性腎功能不全为各种原因引起慢性进行性肾实质损伤，不能维持肾脏基本代谢、分泌等生理功能，导致水钠潴留、水电解质及酸碱代谢失衡，严重影响患者健康和生活质量[1]。慢性肾功不全患者

由于肾脏滤过和重吸收功能损伤，蛋白物质可经肾脏屏障流失出体外，形成尿蛋白，尿蛋白同时能加重患者肾功能损伤，形成恶性循环[2]。厄贝沙坦为血管紧张素拮抗剂，同时能抑制肾组织纤维化，保护肾脏功能。近年来，中药辨证在慢性肾功能不全中整体治疗具有显著临床疗效，为探讨厄贝沙坦联合小柴胡颗粒在慢性肾功能不全患者中治疗效果及对尿蛋白水平影响，现报道如下。……