艾灸疗法治疗尿毒症胃肠功能障碍患者的效果观察

王一峰; 杨美霞; 蔡红珠; 刘琨; 余春丽; 费秀丽; 姚卫国

doi:10.16766/j.cnki.issn.1674-4152.003338

艾灸疗法治疗尿毒症胃肠功能障碍患者的效果观察

doi: 10.16766/j.cnki.issn.1674-4152.003338

1.
上海市金山区张堰镇社区卫生服务中心全科医学科，上海 201514
2.
上海中医药大学附属普陀医院肾内科，上海 200062
3.
上海健康医学院附属金山区中心医院肾病科, 上海 201599

基金项目:

上海市卫生健康委员会科研资助项目 202040217

上海市名老中医学术经验研究工作室建设项目 SHGZS-202237

上海市金山区第七周期医学重点专科建设项目 JSZK2023H04

上海市“十四五”中医特色专科建设项目 ZYTSZK2-13

详细信息

通讯作者:
姚卫国，E-mail：saynever2004@163.com

中图分类号: R692.5 R245.81
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- 被引次数: 0
出版历程
- 收稿日期: 2023-03-18
- 网络出版日期: 2024-03-09

Effect of moxibustion therapy on gastrointestinal dysfunction in patients with uremia

1.
Department of General Practice, Zhangyan Town Community Health Service Center, Jinshan District, Shanghai 201514, China

摘要

摘要: 目的观察艾灸疗法对尿毒症腹膜透析胃肠功能障碍患者的炎症因子水平、中医症候积分的影响及临床疗效。方法选取2021年5月—2022年1月在上海中医药大学附属普陀医院及上海市第六人民医院金山分院肾内科治疗的尿毒症胃肠功能障碍患者72例，采用随机数字表法将患者分为艾灸组(36例)与对照组(36例)，对照组接受基础治疗(持续规律腹膜透析, 降血压，控制血糖，营养摄入及抑酸护胃、促胃肠动力等对症处理)，艾灸组在对照组基础上辅以艾灸足三里、三阴交穴。收集治疗前后1周患者的安全性指标、血清炎症因子(CRP、TNF-α、IL-6)及中医症候疗效结果。结果观察期间脱落3例(2例转血液透析治疗，1例退出)，实际完成69例(对照组35例，艾灸组34例)。艾灸组治疗尿毒症胃肠功能障碍总有效率明显高于对照组(P＜0.05)。艾灸组和对照组患者血清CRP、TNF-α、IL-6水平均较治疗前降低，且艾灸组均低于对照组(P＜0.01)。艾灸组中医症候治疗总有效率为88.24%(30/34)，明显高于对照组的65.71%(23/35，χ²=4.911，P=0.027)。结论艾灸疗法能显著降低尿毒症腹膜透析胃肠功能障碍患者炎症因子IL-6、TNF-α、CRP水平，提高临床治疗有效率，安全性良好。
- 艾灸疗法 /
- 尿毒症 /
- 腹膜透析 /
- 胃肠功能障碍 /
- C-反应蛋白 /
- 肿瘤坏死因子-α /
- 白介素-6
Abstract: Objective To observe the effect of moxibustion therapy on the level of inflammatory factors and the traditional Chinese medicine (TCM) syndrome scores and clinical efficacy on gastrointestinal dysfunction in patients with uremia. Methods Selected 72 cases of gastrointestinal dysfunction in patients with uremia in Putuo Hospital of Shanghai University of Traditional Chinese Medicine and Jinshan District Central Hospital Affiliated to Shanghai University of Medicine & Health Sciences from May 2021 to January 2022. The patients were divided into a moxibustion group (n=36) and a control group (n=36) by randomized numerical table method. The control group received basic treatment(continuous peritoneal dialysis, antihypertensive therapy, control of blood glucose, support nutritional intake, inhibition of the secretion of stomach acid, improvement of gastrointestinal motility, and other symptomatic treatment). The moxibustion group was supplemented by moxibustion at Zusanli and Sanyin jiao acupoint on the based on the control group. Safety indicators, serum tests for inflammatory factors (CRP, TNF-α, IL-6), and TCM symptomatic efficacy results were collected from patients before and after 1 week of treatment. Results Three cases were dislodged during the observation period (2 cases were transferred to hemodialysis treatment and 1 case withdrew), and 69 cases were completed (35 cases in the control group and 34 cases in the moxibustion group). The effective rate of treating gastrointestinal dysfunction in uremia was significantly higher than that of the control group (P < 0.05). The serum CRP, TNF-α, and IL-6 in the moxibustion group and the control group were lower than those before treatment, and the moxibustion group were lower than the cotrol group (P < 0.01). The total effective rate of the treatment of the TCM syndrome in the moxibustion group was (88.24%, 30/34), which was significantly higher than that in the control group (65.71%, 23/35, χ²=4.911, P=0.027). Conclusion Moxibustion therapy can significantly reduce the levels of inflammatory factors IL-6, TNF-α, and CRP on gastrointestinal dysfunction in patients with uremia, improves the efficiency of clinical treatment, and has a favorable safety profile.
- Moxibustion therapy /
- Uremia /
- Peritoneal dialysis /
- Gastrointestinal dysfunction /
- C-reactive protein /
- Tumor necrosis factor alpha /
- Interleukin-6

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表 1 2组尿毒症腹膜透析伴胃肠功能障碍患者一般资料比较

Table 1. Comparison of general data between the two groups of uremic peritoneal dialysis patients with gastrointestinal dysfunction

项目	艾灸组(n=34)	对照组(n=35)	统计量	P值
年龄(x±s, 岁)	61.47±8.83	59.09±12.68	0.902^a	0.370
性别[例(%)]			0.354^b	0.552
男性	17(50.0)	20(57.3)
女性	17(50.0)	15(42.7)
原发病诊断[例(%)]
慢性肾炎	15(44.1)	18(51.4)	0.369^b	0.543
糖尿病肾病	9(26.5)	10(28.6)	0.038^b	0.845
高血压肾病	7(20.6)	5(14.3)	0.477^b	0.490
其他	3(8.8)	2(5.7)	0.001^b	0.974
透析时间(x±s, 月)	66.89±20.23	61.50±19.74	1.120^a	0.267
尿素氮(x±s, mmol/L)	17.65±4.67	19.08±5.05	1.220^a	0.227
肌酐(x±s, μmol/L)	1 001.60±288.24	1 063.70±298.03	0.879^a	0.382
血清β2微球蛋白(x±s, mg/L)	42.18±9.90	43.15±7.60	0.457^a	0.649
血红蛋白(x±s, g/L)	112.85±13.09	116.49±12.13	1.199^a	0.235
血白蛋白(x±s, g/L)	33.80±4.63	33.95±5.61	0.121^a	0.904
谷丙转氨酶(x±s, U/L)	10.97±3.77	9.66±5.12	1.207^a	0.232
谷草转氨酶(x±s, U/L)	11.71±4.68	10.93±4.06	0.740^a	0.462
血清钙(x±s, mmol/L)	2.29±0.24	2.28±0.22	0.181^a	0.857
血清磷(x±s, mmol/L)	2.00±0.70	1.83±0.69	1.016^a	0.313
甲状旁腺素(x±s, pg/mL)	262.15±54.81	272.02±58.79	0.721^a	0.474
血钾(x±s, mmol/L)	5.01±0.89	4.74±0.75	1.364^a	0.177
血钠(x±s, mmol/L)	138.18±3.05	137.91±3.38	0.348^a	0.729
透析充分性(x±s, Kt/V)	1.77±0.12	1.73±0.19	1.042^a	0.301
注：^a为t值，^b为χ²值。

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表 2 2组尿毒症腹膜透析伴胃肠功能障碍患者胃肠道症状疗效比较[例(%)]

Table 2. Comparison of the gastrointestinal symptoms efficacy in two groups of uremic peritoneal dialysis patients with gastrointestinal dysfunction[cases (%)]

组别	例数	显效	有效	无效	总有效
艾灸组	34	11(32.35)	18(52.94)	5(14.71)	29(85.29)
对照组	35	6(17.14)	16(45.72)	13(37.14)	22(62.86)
注：2组疗效比较，Z=2.183，P=0.029。

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表 3 2组尿毒症腹膜透析伴胃肠功能障碍患者中医症候总有效率比较[例(%)]

Table 3. Evaluation of Traditional Chinese Medicine Symptom efficacy between the two groups of uremic peritonealdialysis patients with gastrointestinal dysfunction[cases (%)]

组别	例数	痊愈	显效	有效	无效	总有效
艾灸组	34	4(11.76)	11(32.35)	15(44.12)	4(11.76)	30(88.24)
对照组	35	0	7(20.00)	16(45.71)	12(34.29)	23(65.71)
注：2组总有效率比较，χ²=4.911，P=0.027。

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表 4 2组尿毒症腹膜透析伴胃肠功能障碍患者血清CRP、TNF-α、IL-6水平比较[M(P₂₅, P₇₅)]

Table 4. Comparison of Serum CRP, TNF-α and IL-6 levels between the two groups of uremic peritoneal dialysis patients with gastrointestinal dysfunction[M(P₂₅, P₇₅)]

组别	例数	CRP(mg/L)		TNF-α(pg/mL)		IL-6(mg/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
艾灸组	34	23.79(19.75, 46.92)	2.98(1.80, 8.75)^a	10.14(9.82, 20.78)	2.63(1.76, 6.37)^a	22.34(16.79, 46.28)	7.56(6.72, 10.37)^a
对照组	35	23.94(16.97, 42.34)	12.40(9.17, 20.03)^a	10.51(8.76, 28.43)	4.97(2.94, 10.78)^a	26.34(14.76, 41.92)	19.50(13.74, 28.96)^a
Z值		0.072	12.352	0.240	5.184	1.820	15.331
P值		0.943	＜0.001	0.811	＜0.001	0.073	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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