| Objective:To observe the incidence of PEW in dialysis patients,and to analyze the risk factors of PEW in dialysis patients.To observe the curative effect of Baoshen Tablet in treating PEW in maintenance dialysis patients,and also explore Pathogenesis and Treatment of PEW in TCM.Methods:① 291 patients of maintenance dialysis(hemodialysis or peritoneal dialysis)were collected from January 2014 to December 2016 in Nephrology of Jiangsu Provincal Hospital of TCM,Which included 153 patients with PEW.Study the incidence and risk factors of PEW in dialysis patients.② 113 maintenance dialysis patients who meets the diagnosis of PEW were collected from March 2015 to June 2016.On the basis of Western medicine treatments and dialysis treatment,according to whether taking Baoshen tablets or not,patients naturally divided into treatment group(52 cases)and control group(61 cases).Observe the changes of two groups in surface measurement(TSF,MAC,BMI,etc.),Nutritional indicators(Hb,Alb,P-Alb,TC,T,etc.),MQSGA,hs-CRP,Kt/V,other laboratory indicators(BUN,Scr,PTH,etc.),and Echocardiographic(LVEF,E/A,LVDd,etc.)after 6 months.Results:① The incidence rate of PEW was 52.40%in dialysis patients,53.51%in HD patients and 50.47%in PD patients.There was no significant difference between the two dialysis methods(P>0.05).② Risk factors of PEW:Kt/V,Hb,TRF and LVEF,whose P<0.05,b<0,OR<l,were protective factors of PEW;BUN,LVDd,IVS and LVPW,whose P<0.05,b>0,OR>1,were dangerous factors of PEW.③ The overall efficacy:in the treatment group of 52 patients,24(32.69%)markedly effective,21(40.39%)effective and 7(13.46%)failed,the total clinical effective rate was 86.54%;in the control group of 61 patients,6(9.83%)markedly effective,20(32.79%)effective and 35(57.38%)failed,the total clinical effective rate was 42.63%.The difference between the two groups had statistically significant(P<0.01).④Surface measurement:The body weight,BMI,TSF,MAC and MAMC in the treatment group were significantly higher than before(P<0.01).The TSF of the control group was statistically significant lower than before(P<0.01).The body weight,TSF,MAC and MAMC of the treatment group were higher than those of the control group after 6 months(P<0.01).⑤Nutritional indicators:The levels of Hb,Alb,PA,TQ TRF and SF in the treatment group were significantly higher than those 6 months ago(P<0.01).There was no significant difference in control groups(P>0.05).Hb,Alb,PA and TRF in the treatment group were higher than those in the control group(P<0.05).MQSGA scores in both treatment group and control group decreased after 6 months(P<0.01);The scores of MQSGA in the treatment group were significantly lower than those in the control group(P<0.01).After 6 months,the treatment group had good nutrition in 1 case(1.92%),mild to moderate malnutrition in 49 cases(94.23%),severe malnutrition in 2 cases(3.85%);the control group had good nutrition in 0 cases,51 cases(83.61%)with mild to moderate malnutrition,and 10 cases(16.39%)with severe malnutrition.the difference between the two groups was statistically significant(p<0.05).⑥ hs-CRP:hs-CRP decreased in the treatment group and increased in the control group(P<0.01).The difference between two groups was statistically significant(P<0.01).⑦ Kt/V:Kt/V of both groups increased after treating(P<0.01).The Kt/V of the treatment group was significantly higher than that of the control group(P<0.01).⑧ Other laboratory indicators:The treatment group BUN,Scr,p3+decreased after 6 months(P<0.05).The control group Scr increased(P<0.05).The BUN and Scr of the control group was significantly higher than those of the treatment group(P<0.05).⑨Echocardio graphic:LVEF and E/A increased and LVDd decreased in treatment group(P<0.01),LVEF,LVDd and I VS decreased in the control group(P<0.05).LVEF and E/A in the treatment group were higher and the LVDd was lower than those in the control group(P<0.05).Conclusions:① In our survery,the incidence of PEW was 52.40%in dialysis patients,53.51%in HD patients and 50.47%in PD patients.② The occurrence of PEW was closely related to Hb,TRF,Kt/V,BUN,LVEF,LVDd,IVS,LVPW.Suggesting that promoting uptake of iron,improving anemia,increasing of dialysis adequacy and left ventricular ejection fraction can reduce the occurrence of PEW,high levels of uremic toxin,ventricular hypertrophy are risk factors of PEW.③ On the basic of basic treatment and dialysis treatment,Baoshen tablets can improve the PEW in dialysis patients and using changes of MAMC to do efficacy evaluation,the total effective rate is 86.54%.④ Baoshen tablets can improve the nutritional status of patients,at the same time,patients with cardiac ejection fraction,ventricular hypertrophy and inflammation indicators have been improved,patients got better tolerance of dialysis.⑤ Effect mechanism of Baoshen Tablet on PEW jnclude improving the dialysis tolerance and dialysis adequacy by benefiting qi,preventing microinflammatory state and cardiovascular function by living blood and soaking turbidity.,and invigorating the spleen to help regulate gastrointestinal function to increase appetite. |
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