摘要
【目的】研究滋膵益肾汤对老年糖尿病肾病疗效及外周血NOD样受体蛋白3(NLRP3)炎性小体和血管内皮生长因子(VEGF)水平的影响。【方法】将112例老年糖尿病肾病气阴两虚兼血瘀证患者随机分为研究组和对照组,每组各56例。2组患者均给予降压、调脂、降糖、纠正电解质紊乱、应用肾素-血管紧张素-醛固酮系统(RAAS)抑制剂和补充优质蛋白质等基础治疗,在此基础上,研究组给予口服滋膵益肾汤治疗,疗程为3个月。观察2组患者治疗前后糖代谢指标、肾功能指标、血液流变学指标及血清NLRP3、VEGF水平的变化情况,评价2组患者的中医证候疗效及安全性。【结果】(1)中医证候疗效方面:治疗3个月后,研究组的总有效率为89.3%(50/56),对照组为75.0%(42/56),组间比较,研究组的中医证候疗效明显优于对照组(P<0.05)。(2)糖代谢指标方面:治疗后,2组患者的空腹血糖(FBG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)水平均较治疗前降低(P<0.05),且研究组的降低作用均明显优于对照组(P<0.05)。(3)肾功能指标方面:治疗后,2组患者的肌酐、尿素氮、24 h尿蛋白量均较治疗前明显改善(P<0.05),且研究组的改善作用均明显优于对照组(P<0.05)。(4)血液流变学指标方面:治疗后,2组患者的全血高切黏度、全血低切黏度、血浆黏度均较治疗前明显改善(P<0.05),且研究组的改善作用均明显优于对照组(P<0.05)。(5)血清NLRP3、VEGF水平方面:治疗后,2组患者血清NLRP3、VEGF水平均较治疗前明显下降(P<0.05),且研究组的下降作用均明显优于对照组(P<0.05)。(6)安全性方面:治疗期间,2组患者均未发生严重不良反应,也均无严重胃肠道不适及过敏反应等情况发生。【结论】滋膵益肾汤治疗老年糖尿病肾病气阴两虚兼血瘀证患者疗效确切,能够有效降低患者FBG、2h PG、HbA1c水平,改善肾功能,减少24 h尿蛋白量,降低血黏度和体内NLRP3、VEGF水平。
Objective To investigate the clinical efficacy of Zicui Yishen Decoction for the treatment of senile diabetic nephropathy and to observe its effect on the peripheral blood level of NOD-like receptor protein 3(NLRP3)inflammasome and vascular endothelial growth factor(VEGF). Methods A total of 112 cases of senile diabetic nephropathy differentiated as the syndrome of deficiency of both qi and yin complicated with blood stasis were randomly divided into the study group and the control group,56 cases in each group. Both groups of patients were given fundamental treatment such as lowering blood pressure, regulating blood lipid, lowering glucose,correcting electrolyte disorder,applying renin-angiotensin-aldosterone system(RAAS)inhibitor and supplementing high-quality protein. And additionally,the study group was given oral use of Zicui Yishen Decoction,a herbal compound prescription mainly with the actions of activating spleen and nourishing kidney. The course of treatment lasted 3 months. The changes of glucose metabolism indexes,renal function indexes,hemorheology indexes,and serum NLRP3 and VEGF levels in the two groups were observed before and after treatment,and the efficacy for traditional Chinese medicine(TCM)syndrome and the clinical safety in the two groups were also evaluated.Results(1)The efficacy for TCM syndromes:after 3 months of treatment,the total effective rate of the study group was 89.3%(50/56),and that of the control group was 75.0%(42/56). The intergroup comparison showed that the efficacy for TCM syndromes in the study group was significantly superior to that in the control group(P<0.05).(2)Glucose metabolism indexes: after treatment, the levels of fasting blood glucose(FBG), 2-hour postprandial blood glucose(2 hPG)and glycosylated hemoglobin(HbA1 c)in the two groups were lower than those before treatment(P<0.05),and the lowering effects in the study group were significantly superior to those in the control group(P<0.05).(3)Renal function indexes:after treatment,the serum creatinine,blood urea nitrogen and 24-hour urinary protein levels in the two groups were significantly improved compared with those before treatment(P<0.05),and the improvement in the study group was significantly superior to that in the control group(P<0.05).(4)Hemorheological indicators:after treatment,whole blood high-shear viscosity,whole blood lowshear viscosity and plasma viscosity in the two groups were significantly improved compared with those before treatment(P<0.05),and the improvement in the study group was significantly superior to that in the control group(P<0.05).(5)Serum NLRP3 and VEGF levels: after treatment, serum NLRP3 and VEGF levels in the two groups were significantly decreased compared with those before treatment(P<0.05),and the lowering effect in the study group was significantly superior to that in the control group(P<0.05).(6)Clinical safety:during the treatment,no severe adverse reactions occurred in the patients of the two groups,neither severe gastrointestinal discomforts or allergy occurred in the patients of the two groups. Conclusion Zicui Yishen Decoction has certain effect in treating senile diabetic nephropathy with the syndrome of deficiency of both qi and yin complicated with blood stasis. It can effectively reduce the levels of FBG,2 hPG and HbA1 c,improve renal function,reduce 24-hour urinary protein volume,and decrease blood viscosity and NLRP3 and VEGF levels.
作者
张文吉
赵瑛瑛
张宛哲
刘丁
ZHANG Wen-Ji;ZHAO Ying-Ying;ZHANG Wan-Zhe;LIU Ding(The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014 Henan,China)
出处
《广州中医药大学学报》
CAS
2021年第11期2329-2335,共7页
Journal of Guangzhou University of Traditional Chinese Medicine
基金
国家自然科学基金项目(编号:81473268)。
关键词
滋膵益肾汤
老年糖尿病肾病
气阴两虚兼血瘀证
NOD样受体蛋白3(NLRP3)
血管内皮生长因子(VEGF)
Zicui Yishen Decoction
senile diabetic nephropathy
syndrome of deficiency of both qi and yin complicated with blood stasis
NOD-like receptor protein 3(NLRP3)
vascular endothelial growth factor(VEGF)
