| 引用本文: |
杨兰, 王贺勇, 周靖颖, 蒋廷, 何倩.益肾清浊汤联用艾灸与前列地尔对慢性肾衰竭的疗效及预后因素研究[J].湖南中医药大学学报,2026,46(6):1246-1253[点击复制] |
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| 益肾清浊汤联用艾灸与前列地尔对慢性肾衰竭的疗效及预后因素研究 |
| 杨兰,王贺勇,周靖颖,蒋廷,何倩 |
| (四川省中西医结合医院 肾病内科, 四川 成都 610000) |
| 摘要: |
| 目的 探讨益肾清浊汤联合艾灸及前列地尔注射液治疗慢性肾衰竭（CRF）的临床疗效，并分析影响患者生存预后的危险因素。方法 选取2022年1月至2024年9月四川省中西医结合医院肾内科收治的150例CRF患者为研究对象，随机分为对照组和观察组，每组75例。对照组予前列地尔常规治疗，观察组在对照组基础上加用益肾清浊汤及艾灸治疗。对比两组患者临床疗效、中医证候积分、肾功能及微炎症因子。随访1年，根据生存状态分为生存组（112例）与死亡组（38例），采用LASSO回归筛选变量，保留系数非零变量后行多因素Logistic回归分析筛选预后独立影响因素，并构建列线图预测模型。结果 观察组治疗总有效率（90.67%）高于对照组（77.33%）（P＜0.05）；治疗后，观察组中医证候积分各项维度及微炎症因子各项指标水平均低于对照组（P＜0.01）；观察组血尿素氮（BUN）、血肌酐（Scr）水平低于对照组，内生肌酐清除率（Ccr）、估算肾小球滤过率（eGFR）高于对照组（P＜0.01）。LASSO回归筛选后，多因素Logistic回归分析显示，心力衰竭、持续性血液透析时间、低白蛋白水平、脂蛋白（a）水平及单治疗方法均为CRF患者死亡的独立危险因素（P＜0.05）。基于上述因素构建的列线图模型，预测死亡风险的ROC曲线AUC为0.846（95% CI：0.785~0.908）；1 000次Bootstrap重抽样验证提示模型可靠；H-L检验提示校准曲线拟合良好（χ2=12.635，P=0.125）；决策曲线显示，风险阈值＞0.08时模型可获得稳定临床净收益。结论 益肾清浊汤联合艾灸及前列地尔治疗CRF疗效确切，可改善患者中医证候、肾功能指标及微炎症状态。心力衰竭、持续性血液透析时间过长、低白蛋白水平、高脂蛋白（a）血症及单治疗模式是CRF患者死亡的独立危险因素，基于这些因素构建的列线图模型可为临床预后评估及个体化治疗提供可靠依据。 |
| 关键词: 慢性肾衰竭 益肾清浊汤 艾灸 前列地尔 预后因素 |
| DOI：10.3969/j.issn.1674-070X.2026.06.022 |
| 投稿时间：2026-03-24 |
| 基金项目:四川省中医药管理局科学技术研究专项项目（2024MS567）。 |
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| Efficacy and prognostic factors of Yishen Qingzhuo Decoction combined with moxibustion and alprostadil in chronic renal failure |
| YANG Lan, WANG Heyong, ZHOU Jingying, JIANG Ting, HE Qian |
| (Department of Nephrology, Sichuan Integrative Medicine Hospital, Chengdu, Sichuan 610000, China) |
| Abstract: |
| Objective To explore the clinical efficacy of Yishen Qingzhuo Decoction (YSQZD) combined with moxibustion and alprostadil injection in the treatment of chronic renal failure (CRF) and analyze the risk factors affecting survival prognosis. Methods A total of 150 CRF patients admitted to the Department of Nephrology, Sichuan Integrative Medicine Hospital from January 2022 to September 2024 were enrolled as study subjects and randomly divided into control group and observation group, with 75 cases in each group. The control group received conventional treatment with alprostadil, while the observation group received additional YSQZD and moxibustion on the basis of the control group. Clinical efficacy, TCM pattern scores, renal function, and microinflammatory factors were compared between the two groups. All patients were followed up for 1 year, and were classified into survival group (n=112) and death group (n=38) based on their survival status. LASSO regression was used to screen variables, and variables with non-zero coefficients were retained for multivariate logistic regression analysis to identify independent prognostic factors. A nomogram prediction model was then constructed. Results The total effective rate in the observation group (90.67%) was higher than that in the control group (77.33%) (P<0.05). After treatment, all dimensions of TCM pattern scores and levels of micro-inflammatory factors in the observation group were lower than those in the control group (P<0.05). The levels of blood urea nitrogen (BUN) and serum creatinine (Scr) in the observation group were lower than those in the control group, while endogenous creatinine clearance rate (Ccr) and estimated glomerular filtration rate (eGFR) were higher (P<0.05). After LASSO regression screening, multivariate Logistic regression analysis showed that heart failure, duration of maintenance hemodialysis, low albumin level, high lipoprotein(a) level, and monotherapy were independent risk factors for death in CRF patients (P<0.05). The nomogram model constructed based on these factors had an AUC of 0.846 (95% CI: 0.785-0.908) for predicting death risk. Bootstrap resampling with 1,000 iterations verified the model's reliability. The Hosmer-Lemeshow (H-L) test indicated good calibration (χ2=12.635, P=0.125), and the decision curve showed that the model provided a stable net clinical benefit when the risk threshold exceeded 0.08. Conclusion YSQZD combined with moxibustion and alprostadil shows definite efficacy in treating CRF, improving TCM patterns, renal function indicators, and micro inflammatory status. Heart failure, prolonged continusus hemodialfsis, hypoalbuminemia, elevated lipoprotein(a) level, and single-modality treatment are independent risk factors for death in CRF patients. The nomogram model constructed based on these factors can provide a reliable basis for clinical prognostic assessment and individualized treatment. |
| Key words: chronic renal failure Yishen Qingzhuo Decoction moxibustion alprostadil prognostic factor |
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