摘要
目的:探讨养生益肾汤对早期糖尿病肾病(DN)气阴两虚证病情延缓作用及对血清肿瘤坏死因子-α(TNF-α),转化生长因子-β(TGF-β),血小板源生长因子(PDGF)和血管内皮生长因子(VEGF)水平的影响。方法:170例患者区组随机化按数字表法分为西医组和中西医结合组各85例。西医组给予生活方式指导;控制血糖和降压,纠正脂质代谢紊乱;厄贝沙坦片,1片/d,内服。中西医结合组在西医组治疗的基础上加用养生益肾汤,1剂/d。两组疗程均为6个月,并进行18个月随访。记录24个月内由DNⅢ期发展为DNⅣ期和肌酐(SCr)升高1倍等终点事件的发生情况;检测尿白蛋白排泄率(UAER),血肌酐(SCr),空腹血糖(FBG),糖化血红蛋白(Hb Alc),血脂包括胆固醇(TC),甘油三酯(TG),高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)检测和尿微量白蛋白与肌酐的比值(ACR)等指标,进行气阴两虚证评分,检测治疗前后TNF-α,TGF-β,PDGF和VEGF水平。结果:经Ridit分析,中西医结合组患者的临床疗效优于西医组(P<0.05);中西医结合组终点事件的发生率为7.41%,低于西医组的19.51%(χ2=5.113,P<0.05);在治疗后3个月时,中西医结合组ACR较治疗前下降,并低于同期西医组水平(P<0.05);在治疗后6个月时,中西医结合组UAER,SCr,ACR,Hb Alc,LDL-C均低于同期西医组水平(P<0.05),HDL-C则高于同期西医组水平(P<0.05);中西医结合组在治疗后3个月和6个月时气阴两虚证评分均低于西医组(P<0.05);治疗后中西医结合组后TNF-α,TGF-β,PDGF和VEGF水平均低于西医组(P<0.01)。结论:采用养生益肾汤配合西医常规干预方法对早期DN进行防治,能保护患者的肾功能,对DN病情起到延缓作用,降低终点事件的发生率,其作用机制可能与下调TNF-α,TGF-β,PDGF和VEGF等细胞炎症因子水平有关。
Objective： To discuss the clinical efficacy of Yangsheng Yishen decoction on delaying the disease for early staged diabetic nephropathy（ DN） with deficiency of both Qi and Yin and observe its effects on levels of tumor necrosis factor-α（ TNF-α）,transforming growth factor-β（ TGF-β）,platelet derived growth factor（ PDGF） and vascular endothelial growth factor（ VEGF）. Method： One hundred and seventy patients were randomly divided into western medicine group（ 85 cases） and integrated Chinese and western medicine group（ 85cases） by random number table. Patients in western medicine group received lifestyle guidance; controlled their blood glucose and blood pressure,corrected lipid metabolism disorders; took Irbesartan tablets,1 tablet / day.Based on the treatment in western medicine group,patients in integrated Chinese and western medicine group added Yangsheng Yishen decoction,1 dose / day. The treatment course was 6 months for both groups,and the patients were followed up for 18 months. Outcome events during 24 months were recorded,such as development of DN stage Ⅲ into DN stage Ⅳ,and increase of creatinine（ SCr） by 1 fold. Levels of urinary albumin excretion rate（ UAER）,serum creatinine（ SCr）,fasting blood-glucose（ FBG）,glycosylated hemoglobin（ Hb Alc）,serum creatinine（ SCr）, fasting blood glucose（ FBG）, glycosylated hemoglobin（ Hb Alc）, blood lipids Include cholesterol（ TC）,triglyceride（ TG）,high density lipoprotein cholesterol（ HDL-C） and low density lipoprotein cholesterol（ LDL-C） and urinary albumin / creatinine ratio（ ACR） were detected. Scores of deficiency of both Qi and Yin were graded; the levels of TNF-α,TGF-β,PDGF and VEGF were detected. Result： Ridit analysis showed that the clinical efficacy in integrated Chinese and western medicine group was superior to that in western medicine group（ P〈0. 05）. Occurrence rate of outcome events in integrated Chinese and western medicine group was 7. 41%,lower than 19. 51% in western medicine group（ χ2= 5. 113,P〈0. 05）. At the 3thmonth after treatment,ACR in integrated Chinese and western medicine group was decreased and was lower than that in control group at the same period（ P〈0. 05）. At the 6thmonth after treatment,levels of UAER,SCr,ACR,Hb Alc and LDL-C in integrated Chinese and western medicine group were all lower than those in western medicine group（ P〈0. 05）,but the level of HDL-C was higher than that in western medicine group（ P〈0. 05）. Scores of deficiency of both Qi and Yin in integrated Chinese and western medicine group were lower than those in western medicine group at the 3thand 6thmonth after treatment（ P〈0. 05）. Levels of TNF-α,TGF-β,PDGF and VEGF were lower than those in western medicine group after treatment. Conclusion： Yangsheng Yishen decoction combined with conventional western medicine treatment can protect renal function and delay state of an illness,and reduce the incidence of outcome events in early staged DN,and its mechanism of action may be associated with reducing levels of TNF-α,TGF-β,PDGF and VEGF.
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2017年第2期169-174,共6页
Chinese Journal of Experimental Traditional Medical Formulae
基金
广西壮族自治区中医药管理局科技计划项目(WS201303)
关键词
早期糖尿病肾病
气阴两虚证
养生益肾汤
终点事件
肿瘤坏死因子-α
转化生长因子-Β
血小板源生长因子
血管内皮生长因子
early staged diabetic nephropathy
deficiency of both Qi and Yin
Yangsheng Yishen decoction
outcome event
tumor necrosis factor-α
transforming growth factor-β
platelet derived growth factor
vascular endothelial growth factor
作者简介
[通讯作者]白云，硕士，副主任医师，从事中西医结合治疗糖尿病临床工作，Tel：13978407367，E-mail：1834912015@qq．com
