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[针灸治疗慢性移植肾肾病:一项随机对照试验]

[Acupuncture-moxibustion for chronic allograft nephropathy: a randomized controlled trial].

作者信息

Nie Feng, Yang Qianyun, Deng Kaiwen, Sun Xuyong, Dong Jianhui, Li Zhuangjiang

出版信息

Zhongguo Zhen Jiu. 2015 Nov;35(11):1110-4.

Abstract

OBJECTIVE

To observe the effects of acupuncture-moxibustion on chronic allograft nephropathy (CAN) and explore the methods of acupoint selection along meridian for transplanted-kidney-related diseases.

METHODS

A total of 180 patients of CAN were randomized into a syndrome differentiation group, a spleen-meridian group, a kidney-meridian group and a control group, 45 cases in each one. A total of 33 cases dropped out before the end of the study, including 8 cases in the syndrome differentiation group, 12 cases in the spleen-meridian group, 13 cases in the kidney-meridian group and no case in the control group. Patients in the control group were treated with conventional western medicine; based on this, patients in other three groups were treated with acupuncture-moxibustion. In the syndrome differentiation group, Qihai (CV 6), Hegu (LI 4), Guanyuan (CV 4), Feishu (BL 13), Shenshu (BL 23), etc. were selected for qi deficiency of lung and kidney; Qihai (CV 6), Zusanli (ST 36), Sanyinjiao (SP 6), Taixi (KI 3), Yinlingquan (SP 9), etc. were selected for deficiency of qi and yin; Ganshu (BL 18), Shenshu (BL 23), Sanyinjiao (SP 6), Taixi (KI 3), Yinlingquan (SP 9), Ququan (LR 8), etc. were selected for yin deficiency of liver and kidney; Zhongji (CV 3), Guanyuan (CV 4), Mingmen (GV 4), Guanyuanshu (BL 26), etc. were selected for yang deficiency of spleen and kidney. In addition, Sanyinjiao (SP 6), Diji (SP 8), Yinlingquan (SP 9), Xuehai (SP 10), etc. were added in the spleen-meridian group; Taixi (KI 3), Zhaohai (KI 6), Fuliu (KI 7), Ciliao (BL 32), etc: were added in the kidney-meridian group. Serum creatinine (Scr), creatinine clearance (Ccr) and 24-hour urinary protein before and after the treatment were com- pared among the four groups.

RESULTS

After treatment, 24-hour urinary protein in the acupuncture-moxibustion groups and control group were all reduced (all P < 0.05); compared before treatment, the Scr in the spleen-meridian group was significantly reduced (P < 0.05); the difference of Ccr before and after treatment was insignificant in all the groups (all P > 0.05). Compared with the control group, 24-hour urinary protein in spleen-meridian group could relieve or recover the damage of transplant kidney induced by CAN. A new interlink may be established between the transplanted kidneys and the spleen meridians, indicating that transplanted kidney-related diseases can be treated by selecting acupoints of spleen meridian.

摘要

目的

观察针灸对慢性移植肾肾病(CAN)的影响,探索与移植肾相关疾病的经络选穴方法。

方法

将180例CAN患者随机分为辨证组、脾经组、肾经组和对照组,每组45例。研究结束前共有33例患者退出,其中辨证组8例,脾经组12例,肾经组13例,对照组无退出病例。对照组采用常规西药治疗;在此基础上,其他三组患者采用针灸治疗。辨证组中,肺肾气虚者选取气海(CV 6)、合谷(LI 4)、关元(CV 4)、肺俞(BL 13)、肾俞(BL 23)等穴位;气阴两虚者选取气海(CV 6)、足三里(ST 36)、三阴交(SP 6)、太溪(KI 3)、阴陵泉(SP 9)等穴位;肝肾阴虚者选取肝俞(BL 18)、肾俞(BL 23)、三阴交(SP 6)、太溪(KI 3)、阴陵泉(SP 9)、曲泉(LR 8)等穴位;脾肾阳虚者选取中极(CV 3)、关元(CV 4)、命门(GV 4)、关元俞(BL 26)等穴位。此外,脾经组加用三阴交(SP 6)、地机(SP 8)、阴陵泉(SP 9)、血海(SP 10)等穴位;肾经组加用太溪(KI 3)、照海(KI 6)、复溜(KI 7)、次髎(BL 32)等穴位。比较四组治疗前后的血清肌酐(Scr)、肌酐清除率(Ccr)及24小时尿蛋白。

结果

治疗后,针灸组和对照组的24小时尿蛋白均降低(均P < 0.05);与治疗前比较,脾经组Scr显著降低(P < 0.05);各组治疗前后Ccr差异无统计学意义(均P > 0.05)。与对照组比较,脾经组24小时尿蛋白可缓解或恢复CAN所致移植肾损伤。移植肾与脾经之间可能建立了新的联系,提示选取脾经穴位可治疗与移植肾相关的疾病。

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