摘要：目的 探討肾安方联合西药常规治疗早中期慢性肾功能不全（CRF）的临床疗效。方法 采用随机数字表法将60例CRF患者分为2组。对照组予西医常规治疗（抗感染、纠正酸中毒、降压、纠正电解质紊乱），治疗组在对照组治疗基础上予肾安方，每日1剂，分早晚口服。2组均14 d为1个疗程，连续治疗2个疗程。于治疗前后检测血肌酐（SCr）、血尿素氮（BUN）、胱抑素C（Cys-C）、尿κ轻链、尿λ轻链、β2-微球蛋白（β2-MG）、甲状旁腺激素（PTH）、24 h尿总蛋白定量、24 h尿白蛋白定量、尿微量总蛋白、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、脂蛋白（A）[Lp（A）]、血红蛋白（Hb），比较2组临床疗效及中医疗效。结果 治疗组临床疗效、中医疗效均显著优于对照组（P<0.05）。与本组治疗前比较，治疗组治疗后24 h尿总蛋白定量、24 h尿白蛋白定量、尿微量总蛋白、PTH、β2-MG、SCr、BUN、Cys-C、尿κ轻链及尿λ轻链水平明显降低（P<0.05）;2组治疗后比较，治疗组上述指标均低于对照组（P<0.05）。与本组治疗前比较，治疗组治疗后Lp（A）水平明显降低，Hb显著升高（P<0.05）;2组治疗后比较，治疗组Lp（A）水平明显低于对照组（P<0.05）。与本组治疗前比较，2组治疗后中医症状积分显著降低（P<0.05）;2组治疗后比较，治疗组中医症状积分明显低于对照组，积分减少率明显高于对照组（P<0.05）。结论 肾安方联合西医常规治疗早中期CRF可有效改善患者肾功能，降低蛋白尿，显著抑制CRF病情进展，疗效显著。
关键词：慢性肾功能不全;肾安方;肾功能;中医证候
中图分类号：R277.522.5 文献标识码：A 文章编号：1005-5304（2019）02-0020-06
DOI：10.3969/j.issn.1005-5304.2019.02.005
开放科学（资源服务）标识码（OSID）：
Abstract： Objective To investigate the clinical efficacy of Shen"an Prescription combined with Western medicine in the treatment of chronic renal insufficiency （CRF）. Methods Totally 60 CRF patients were randomly divided into two groups. The control group was given routine Western medicine， including anti-infective treatment， correcting acidosis， anti-hypertension and correcting electrolyte imbalance， while the treatment group was treated with Shen’an Prescription on the basis of the control group， one dosage per day， orally taken in the morning and evening. 14 d were set as one treatment course for both groups. The treatment for both groups lasted for two treatment courses. Serum creatinine （SCr）， blood urea nitrogen （BUN）， cystatin C （Cys-C）， urinary κ light chain， urinary λ light chain， β2-microglobulin （β2-MG）， parathyroid hormone （PTH）， 24-hour total urinary protein quantitation， 24-hour urinary albumin quantification， total urinary microprotein， total cholesterol （TC）， triglyceride （TG）， low-density lipoprotein cholesterol （LDL-C）， high density lipoprotein cholesterol （HDL-C）， lipoprotein （A） [Lp （A）] and hemoglobin （Hb） before and after treatment were detected. Clinical efficacy and TCM efficacy of both groups were compared. Results The clinical efficacy and TCM efficacy of the treatment group were significantly better than the control group （P<0.05）. Compared with before treatment， the 24 h total urinary protein quantification， 24 h urinary albumin quantitation， urinary total protein， PTH， β2-MG， SCr， BUN， Cys-C， urinary κ light chain and urinary λ light chain in the treatment group decreased significantly （P<0.05）. After treatment， the above indexes in the treatment group were lower than those in the treatment group （P<0.05）. Compared with before treatment， the Lp（A） level significantly decreased and the Hb significantly increased in the control group （P<0.05）. The level of Lp（A） in the treatment group was significantly lower than that in the control group （P<0.05）. Compared with before treatment， the scores of TCM symptoms in the two groups were significantly lower （P<0.05）. After treatment， the scores of TCM symptoms in the treatment group were significantly lower than those in the control group， and the reduction rate of the score was significantly higher than that in the control group （P<0.05）. Conclusion Shen"an Prescription combined with routine Western medicine can effectively improve renal function and reduce proteinuria in patients with CRF， and can significantly inhibit the progress of CRF， with obvious efficacy.