尿毒清对慢性肾脏病3~4期患者肠道微生态影响的临床研究

目的] 探讨尿毒清颗粒对慢性肾脏病（CKD）3~4期未透析患者肠道微生态的影响。方法] 选取就诊的慢性肾脏病3~4期未透析患者60例，随机分为CKD组30例和尿毒清组30例，尿毒清组在CKD组常规治疗的基础上加用尿毒清颗粒，另外征集健康志愿者10名作为对照组，分别于试验前及试验后3个月观察各组肠道菌群结构及多样性、血清尿毒素及炎症因子水平、肾功能指标的变化。结果] CKD组和尿毒清组分别有2例和3例失访，最终分别纳入28例和27例。试验前，与对照组相比，CKD组及尿毒清组肠道菌群均发生了显著变化，且血清尿毒素及炎症因子水平、肾功能指标均明显升高，具有统计学差异（P<0.05）；试验后3个月，与CKD组相比，尿毒清组有肠道菌群多样性增加的趋势，且菌群结构更加接近对照组的菌群分布。此外，尿毒清组的硫酸吲哚酚（IS）及部分肾功能指标血清肌酐（Scr）、尿白蛋白肌酐比值（ACR）显著下降，具有统计学差异（P<0.05）。结论] CKD患者的肠道菌群发生了显著变化，经尿毒清干预可在一定程度上调节肠道菌群失调，减轻机体炎症反应状态以延缓慢性肾脏病进展，而肠道菌群失调与肾功能改变之间的相关性尚需进一步研究。

Clinical study of Niaoduqing on intestinal microecology in patients with stage 3~4 chronic kidney disease

Objective] To explore the effect of Niaoduqing Granule on intestinal microflora in non-dialysis patients with chronic kidney disease (CKD) at stage 3~4. Methods] The 60 non-dialysis patients with chronic kidney disease (CKD) at stage 3~4 were employed and randomly divided into CKD group (30 cases) and Niaoduqing group (30 cases). The patients in Niaoduqing group were treated with Niaoduqing Granule on the basis of routine treatment in CKD group. In addition,10 healthy volunteers were employed as control group. The changes of intestinal flora diversity and composition,serum inflammatory factor and urinary toxin levels,and renal function were observed before and 3 months after the test. Results] The 2 cases and 3 cases were respectively lost to follow up in CKD group and Niaoduqing group,finally 28 cases and 27 cases were included respectively. Before the test,compared with the control group,the intestinal flora in CKD group and Niaoduqing group changed significantly,and the levels of serum urotoxin,inflammatory factors and renal function indexes were significantly higher (P<0.05). Three months after the test,compared with CKD group,the diversity of intestinal flora in Niaoduqing group increased,and the flora composition were closer to the flora distribution of the control group. In addition,the level of C-reactive protein (CRP) in Niaoduqing group had the tendency of downward,while the level of indoxyl sulfate (IS) and some renal function indexes such as serum creatinine (Scr) and albumin-to-creatinine ratio (ACR) decreased significantly (P<0.05). Conclusion] The intestinal flora of CKD patients changed significantly. The intervention of Niaoduqing could regulate the imbalance of intestinal flora at a certain extent,reduce the state of inflammatory reaction,and delay the progress of CKD. The correlation between the imbalance of intestinal flora and the change of renal function needs to be further studied.