摘要
目的:观察肾功能正常的慢性肾炎血瘀证患者的血、尿Ⅳ型胶原(Col-Ⅳ)及层粘蛋白(LN)含量的变化与中医本虚证、血瘀证症状积分的关系及临床应用价值;观察复方丹参注射液治疗前后的血、尿Col-Ⅳ及LN含量的变化,探讨复方丹参注射液治疗肾脏纤维化的疗效及可能机制。方法:采用双抗体夹心酶联免疫吸附(ELISA)法测定67例肾功能正常的慢性肾炎血瘀症患者和20例健康人的血、尿Col-Ⅳ与LN含量,观察以上指标与中医本虚证及血瘀证症状积分的关系;67例慢性肾炎患者随机分为35例复方丹参治疗组和32例对照组,对照组给以潘生丁、雷公藤多苷等常规处理,伴肾病综合征者加用激素,血压高者加用降压药,治疗组给予以上对照组治疗+复方丹参注射液50mL静脉滴注。比较治疗前后两组的血、尿Col-Ⅳ及LN含量的变化。结果:与健康人相比,慢性肾炎组患者血、尿Col-Ⅳ及LN水平均明显增高(P<0.05);各本虚证型血、尿Col-Ⅳ及尿LN较健康者均明显增高(P<0.01),气阴两虚与健康者相比,血LN明显增高(P<0.01),气阴两虚与肺肾气虚比较,血Col-Ⅳ及血、尿LN均明显增高(P<0.05),脾肾阳虚与肝肾阴虚比较,尿Col-Ⅳ明显下降(P<0.01);各血瘀证组与健康人组比较,血、尿Col-Ⅳ及LN均明显增高(P<0.05,P<0.01),而各血瘀证组间两两比较,各指标均无显著差异,Spearm an相关分析结果显示,血、尿Col-Ⅳ与LN水平与血瘀证积分均无线性相关关系;治疗组治疗前后血Col-Ⅳ、LN及尿Col-Ⅳ、LN均明显下降(P<0.05)。治疗组与对照组治疗前后血Col-Ⅳ、LN及尿Col-Ⅳ、LN差值比较有显著差异(P<0.05)。Spearm an相关分析:治疗前后血Col-Ⅳ与血LN二者水平的改变呈显著正相关(P<0.01)。结论:肾脏纤维化可能是慢性肾炎血瘀证的内在物质基础,肾脏纤维化是肾脏局部的血瘀状态,即所谓的微型癥积。外在的血瘀证症状积分难于体现肾脏局部的瘀血严重程度。复方丹参注射液对于减轻慢性肾炎的纤维化程度,延缓纤维化进展可能有一定的益处,其抗肾脏纤维化作用可能是通过多个途径而实现的。对延缓肾脏纤维化的治疗提供了又一药物选择。
Objetive： To study the relationship between the content change of serum , urinary Collagen Ⅳ （ Col - Ⅳ ）, Laminin （LN） and the deficiency,the score blood stasis syndrome of TCM of glomerulonephritis patients with the normal renal function and its application value in clinic. To study the content change of serum ,urinary Col -Ⅳ,LN on blood stasis syndrome of TCM of chronic glomerulonephritis patients with the normal renal function before and after therapy with Compound Danshen Injection, to explore the clinical effect about kidney fibrosis with therapy of Compound Danshen Injection and its mechanism. Methods： The serum , urinary Col - Ⅳ and serum , urinary LN in 67 cases chronic glomerulonephritis blood stasis syndrome patients with the normal renal function and 20 cases healthy controls were measured respectively by two - layer antibody sandwich enzyme - linked immunoad sorbent assay（ELISA） method. All 67 cases chronic glomerulonephritis blood stasis syndrome patients with the normal renal function were chosen and divided randomly into therapy with Compound Danshen Injection group and control group. The control group was treated with Persatin and Triptergium wilfordii Hook. f. , Nephritic Syndrome added corticosteroids, hypertension added blood pressure reduction agents, therapy group was treated with the treatment of control group ＋ Compound Danshen Injection 50ml ivgtt. The contents of serum ,urinary Col- Ⅳ,LN of both groups were compared the before and after therapy. Results： Compared with healthy controls , chronic glomerulonephritis patients contents of Serum ,Urinary Collagen Ⅳ （Col - Ⅳ ） ,Laminin（LN） increased significantly （ P 〈 0.05） ; Compared with healthy controls, contents of serum , urinary Col -Ⅳ and urinary LN in all the groups of deficiency of TCM increased sigthificantly（ P 〈0.01 ） ; Compared with healthy controls, contents of serum LN in qi - yin asthenia group increased significantly （ P 〈0.01 ） ; Compared with qi -yin asthenia group, contents of Serum, Urinary Col - Ⅳ ,LN in lung and kidney qi deficiency group increased significantly （ P 〈 0.01 ） ; Compared with spleen yang and kidney yang deficiency group, contents of serum ,urinary Col- Ⅳ and LN in liver and kidney yin deficiency group urinary Col - Ⅳ decreased significantly （ P 〈 0.01 ）. Spearman correction analysis indicated, there was no linear dependence between serum , urinary Col - Ⅳ ,LN and the score of blood stasis syndrome. In therapy group, contents of serum, urinary Col - Ⅳ and LN decreased after therapy （ P 〈 0.05 ）. There is remarkably difference in contents of serum , urinary Collage Ⅳ and LN between therapy group and controls （ P 〈 0.05 ）. Spearman： There was postive correlation between the before therapy and after therapy in serum Col - Ⅳ and serum LN （ P 〈 0.01 ）, remarkably dependence. Conclusion： Renal fibrosis may be the basement of chronic glomerulonephritis blood stasis syndrome; renal fibrosis is blood stasis of itself, which is tiny ZhengJi. The score of blood stasis syndrome of TCM can not reflect degree of blood stasis in kidney. Compound Danshen Injection can helpful to lessen degree of chronic glomerulonephritis fibrosis and halt fibrosis progression. Its anti -fibrosis can attend through many ways. It gives another treatment to halt the renal fibrosis progression.
出处
《中医药学刊》
2006年第8期1462-1466,共5页
Study Journal of Traditional Chinese Medicine
基金
福建省教育厅科研项目(JB01057)
关键词
慢性肾炎
中医药疗法
血瘀证
细胞外基质
血清Ⅳ型胶原
尿Ⅳ型胶原
血清层粘蛋白
尿层粘蛋白
纤雏化
复方丹参注射液
glomerulonephritis
TCM therapeutics
Blood Stasis Syndrome
Extracellular matrix （ECM）
Serum collagen Ⅳ（Col- Ⅳ）
urinary Col -Ⅳ
Serum Laminiin （LN）
urinary LN
Fibrosis
Compound Danshen Injection
