摘要
目的:观察补阳还五汤合三仁汤加减治疗早期糖尿病肾病(DN)脾肾亏虚兼湿热瘀血证的临床疗效及对糖脂代谢、氧化应激、炎症因子的影响,并探讨其作用机制。方法:将72例患者按随机数字表法分为对照组与治疗组,各36例。在常规治疗基础上,对照组口服氯沙坦钾片,50 mg/次,1次/d。治疗组在对照组治疗的基础上给予补阳还五汤合三仁汤加减内服,1剂/d。两组疗程均为连续治疗3个月。观察两组患者临床疗效,比较两组患者治疗前后24 h尿微量白蛋白排泄率(UAER),血肌酐(SCr),血清胱抑素C(Cys C),尿素氮(BUN),空腹血糖(FBG),餐后2 h血糖(2 h PG),糖化血红蛋白(Hb A1c),总胆固醇(TC),甘油三酯(TG),低密度脂蛋白胆固醇(LDL-C),高密度脂蛋白胆固醇(HDL-C),丙二醛(MDA),超氧化物歧化酶(SOD),谷胱甘肽过氧化物酶(GSH-Px),白细胞介素-2(IL-2),白细胞介素-4(IL-4),白细胞介素-8(IL-8),白细胞介素^-10(IL^-10),肿瘤坏死因子-α(TNF-α)水平和安全性指标。结果:治疗组临床总有效率为88.9%,对照组61.1%,治疗组优于对照组(P<0.05)。两组治疗后UAER,SCr,Cys C,BUN水平较本组治疗前均降低(P<0.05);且治疗组均明显低于对照组(P<0.05)。两组治疗后FBG,2 h PG和Hb A1c水平较本组治疗前均降低(P<0.05);治疗后与对照组比较,两组FBG,2 h PG和Hb A1c水平比较差异无统计学意义。两组治疗后HDL-C水平较本组治疗前均升高(P<0.05);且治疗组明显高于对照组(P<0.05)。两组治疗后TC,TG和LDL-C,MDA水平较本组治疗前均降低(P<0.05);且治疗组均明显低于对照组(P<0.05)。两组治疗后MDA水平较本组治疗前均降低(P<0.05);且治疗组明显低于对照组(P<0.05)。两组治疗后血清IL-2,IL-8和TNF-α水平较本组治疗前均降低(P<0.05);且治疗组均明显低于对照组(P<0.05)。两组治疗后血清IL-4和IL^-10水平较本组治疗前均升高(P<0.05);且治疗组均明显高于对照组(P<0.05)。结论:补阳还五汤合三仁汤加减治疗早期DN脾肾亏虚兼湿热瘀血证的临床疗效显著且安全性好,能够进一步改善早期DN患者的肾功能、脂质代谢,抑制氧化应激反应及调节炎症因子分泌平衡。
Objective:To observe the clinical efficacy of modified Buyang Huanwu Tang combined with Sanrentang in treating early diabetic nephropathy(DN)with deficiency of spleen and kidney,damp-heat and blood stasis syndrome and its effect on glucose and lipid metabolism,oxidative stress and inflammatory factors,in order to explore its mechanism.Method:A total of 72 early DN atients were randomly divided into control group and treatment group,with 36 cases in each group.The control group was orally treated with losartan potassium tablets(50 mg every time,once/day),while the treatment group was treated with modified Buyang Huanwu Tang combined with Sanrentang orally in addition to the therapy of the control group(1 dose/day).Both groups were treated for 3 months.The changes in clinical efficacy and safety indicators were observed for both groups.The 24 h urine albumin excretion rate(UAER),serum creatinine(SCr),serum cystatin C(Cys C),urea nitrogen(BUN),fasting blood glucose(FBG),2 h postprandial blood glucose(2 h PG),glycosylated hemoglobin(HbA1c),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),highdensity lipoprotein cholesterol(HDL-C),malondialdehyde(MDA),superoxide dismutase(SOD),glutathione Peroxidase(GSH-Px),interleukin-2(IL-2),interleukin-4(IL-4),interleukin-8(IL-8),interleukin^-10(IL^-10),tumor necrosis factor-α(TNF-α)of patients in two groups were observed before and after treatment.Result:The total clinical effective rate was 88.9%in therapy group,which was higher than 61.1%in control group(P<0.05).After treatment,levels of UAER,SCr,Cys C and BUN were lower in both groups(P<0.05),and the levels in treatment group were all lower than those in control group(P<0.05).Levels of FBG,2 hPG and HbA1c were lower in both groups(P<0.05).There was no significant difference in FBG,2 h PG and HbA1c levels between two groups after treatment.The levels of HDL-C were higher in both groups(P<0.05),and the levels in treatment group were higher than that in control group(P<0.05).The levels of TC,TG and LDL-C were lower in both groups(P<0.05),and the levels in treatment group were all lower than those in control group(P<0.05).The level of MDA was lower in both groups(P<0.05),and the level in the treatment group was lower than that in control group(P<0.05).The levels of SOD and GSH-Px were higher in both groups(P<0.05),and the levels in the treatment group were all higher than those in the control group(P<0.05).Serum levels of IL-2,IL-8 and TNF-αwere lower in both groups(P<0.05),and the levels in the treatment group were lower than those in control group(P<0.05).Serum levels of IL-4 and IL^-10 were higher in both groups(P<0.05),and the levels in the treatment group was higher than those in control group(P<0.05).Conclusion:Modified Buyang Huanwu Tang combined with Sanrentang is effective and safe in the treatment of early DN with spleen and kidney deficiency,damp-heat and blood stasis syndrome.They can further improve renal function and lipid metabolism,inhibit oxidative stress reaction and regulate the secretion balance of inflammatory factors in early DN patients.
作者
黄雅兰
黄国东
蔡林坤
甘佳丽
薛涵予
黄琼荷
HUANG Ya-lan;HUANG Guo-dong;CAI Lin-kun;GAN Jia-li;XUE Han-yu;HUANG Qiong-he(Guangxi University of Chinese Medicine,Nanning 530001,China;International Zhuang Medical Hospital Affiliated to Guangxi University of Chinese Medicine,Nanning 530201,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2020年第5期60-68,共9页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家自然科学基金项目(81560808,81160434)
广西中医药大学硕士研究生教育创新计划项目(YCSW20190041).
关键词
补阳还五汤
三仁汤
早期糖尿病肾病
糖脂代谢
氧化应激
炎症因子
Buyang Huanwu Tang
Sanrentang
early diabetic nephropathy
glucose and lipid metabolism
oxidative stress
inflammatory factors
作者简介
第一作者:黄雅兰,在读硕士,从事中西医结合防治肾脏病研究,E-mail:1352880962@qq.com;通信作者:黄国东,博士,教授,主任医师,从事中西医结合防治肾脏病研究,E-mail:644781538@qq.com
