中药保留灌肠法对CKD3-4期合并高尿酸血症患者肠道菌群失调的影响
Effect of Retention Enema with Traditional Chinese Medicine on Intestinal Flora Imbalance in Patients with CKD Stage 3-4 and Hyperuricemia

目的：探讨中药保留灌肠法对慢性肾脏病(Chronic kidney disease, CKD)3-4期合并高尿酸血症(Hyperuricemia, HUA)患者肠道菌群失调的影响。方法：选取40例CKD3-4期合并高尿酸血症患者，按照随机数字表法分为对照组和治疗组，每组各20例。对照组给予常规西医对症治疗，治疗组在对照组基础上加用中药保留灌肠治疗，治疗4周后，观察比较2组治疗前后生化指标(血清内毒素、CRP、BUN、SCR及UA)及肠道菌群(大肠杆菌、肠球菌、双歧杆菌、乳酸杆菌)变化。结果：治疗后，2组在降低血清内毒素、CRP、BUN、SCR及UA上与治疗前相比均具有统计学意义(P < 0.05)，且治疗组在降低血清内毒素、SCR及UA的效果上明显优于对照组(P < 0.05)。治疗后，2组在降低大肠杆菌、肠球菌，升高乳酸杆菌、双歧杆菌均具有统计学意义(P < 0.05)，且治疗组在降低大肠杆菌及升高乳酸杆菌上明显优于对照组(P < 0.05)。结论：中药保留灌肠法治疗CKD3-4期合并高尿酸血症能明显降低尿酸水平，提高肠道屏障功能并积极调节肠道菌群变化，在CKD合并高尿酸血症的治疗上具有一定的优势。
Objective: To investigate the effect of retention enema with traditional Chinese medicine on intestinal flora imbalance in patients with Chronic kidney disease (CKD) and Hyperuricemia (HUA). Methods: 40 patients with CKD stage 3-4 and Hyperuricemia were randomly divided into treatment group and control group. Patients in the control group were treated with conventional Western medicine, while patients in the treatment group were treated with retention enema with traditional Chinese medicine on the basis of the control group, the changes of serum endotoxin, CRP, BUN, SCR and UA as well as intestinal microflora (E. coli, Enterococcus, Bifidobacterium and Lactobacillus) were observed before and after treatment. Results: After treatment, the levels of serum endotoxin, CRP, BUN, SCR and UA in both groups were significantly lower than those before treatment (P < 0.05), the treatment group was superior to the control group in reducing serum endotoxin, SCR and UA (P < 0.05). After treatment, the levels of E. coli, Enterococcus, Lactobacillus and Bifidobacterium were significantly decreased in both groups (P < 0.05), in addition, the treatment group was superior to the control group in decreasing E. coli and increasing Lactobacillus (P < 0.05). Conclusion: Retention enema with traditional Chinese medicine can significantly reduce the level of uric acid, improve the intestinal barrier function and positively regulate the changes of intestinal flora in patients with CKD 3-4 stage complicated with Hyperuricemia, it has some advantages in the treatment of CKD with Hyperuricemia.