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目的:观察化瘀益肾方联合腹膜透析对3~4期慢性肾脏病(CKD)合并颈动脉钙化(CAC)患者实验室临床指标及血管内皮损伤ICAM-1、VCAM-1水平的影响。方法:将80例3~4期CKD合并CAC患者随机分为对照组和观察组,每组40例。对照组给予基础治疗,并予以腹膜透析治疗,观察组在对照组治疗基础上,加用化瘀益肾方保留灌肠治疗。分别于治疗前后检测血清ICAM-1、VCAM-1、NF-κB、TNF-α水平、相关实验室指标水平及颈总动脉内中膜厚度(CIMT),比较两组治疗前后主要症状积分改善情况。结果:治疗后,观察组较对照组血清ICAM-1、VCAM-1、NF-κB、TNF-α水平及BUN、Scr、UA水平明显均降低(P<0.05);治疗后,观察组CIMT较治疗前无显著变化(P>0.05),而对照组CIMT较治疗前明显增厚(P<0.05);治疗后,观察组疲倦乏力、纳呆食少、面肢水肿等症状评分明显低于对照组(P<0.05)。结论:化瘀益肾方联合腹膜透析治疗3~4期CKD合并CAC,可通过降低血清ICAM-1、VCAM-1、NF-κB、TNF-α水平而减轻患者炎症症状,减慢动脉钙化加重,改善患者肾功能及临床症状,从而延缓病情进展。
Objective: To observe the laboratory clinical indexes and the levels of ICAM-1 and VCAM-1 in vascular endothelial cells of 3 ~ 4 chronic kidney disease (CKD) patients with carotid artery calcification (CAC). Methods: Eighty patients with stage 3 ~ 4 CKD complicated with CAC were randomly divided into control group and observation group, 40 cases in each group. Control group given basic treatment, and peritoneal dialysis treatment, the observation group in the control group based on the treatment, plus retention Huayu Prescription enema treatment. Serum levels of ICAM-1, VCAM-1, NF-κB and TNF-α were measured before and after treatment, and the related laboratory parameters and the common carotid artery intima-media thickness (CIMT) . Results: The levels of serum ICAM-1, VCAM-1, NF-κB, TNF-α and the levels of BUN, Scr and UA in the observation group were significantly lower than those in the control group after treatment (P <0.05) There was no significant change before treatment (P> 0.05), while the CIMT in the control group was significantly thicker than that before treatment (P <0.05). After treatment, the symptom scores in the observation group were weaker than those in the control group Group (P <0.05). Conclusion: Huayu Yishen decoction combined with peritoneal dialysis for stage 3 ~ 4 CKD combined with CAC can reduce the inflammatory symptoms and decrease the arterial calcification in the patients by decreasing the levels of serum ICAM-1, VCAM-1, NF-κB and TNF-α , Improve renal function and clinical symptoms, thereby slowing the progression of the disease.