摘要
目的:基于网络药理学预测降尿酸方治疗尿酸性肾病的机制,同时采用临床试验进行验证,证实降尿酸方对尿酸性肾病患者的临床疗效及脂质代谢的影响。方法:采用网络信息学分析技术,筛选出降尿酸方发挥疗效的核心靶点及通路,通过临床随机双盲法,将符合纳入标准的84例尿酸性肾病痰浊瘀阻证患者随机分为对照组和观察组,对照组予非布司他40 mg+降尿酸方安慰剂,试验组予非布司他40 mg+降尿酸方颗粒,治疗周期12 w,观察患者治疗前后血脂(总胆固醇、甘油三酯、低密度脂蛋白)、血尿酸、肌酐、肾小球滤过率及证候评分结果。结果:网络药理学分析显示,脂质与动脉粥样硬化为降尿酸方治疗尿酸性肾病的最富集通路,临床试验结果表明,经治疗后试验组有效率为95%,与对照组的80%相比疗效明显(P<0.05)。与治疗前相比,治疗后试验组血脂相关指标(总胆固醇、甘油三酯、低密度脂蛋白胆固醇)明显改善(P<0.05),对照组仅甘油三酯明显降低(P<0.05),两组血尿酸、胱抑素C、血肌酐含量降低、肾小球滤过率升高(P<0.05),试验组在降低血尿酸、胱抑素C、血肌酐、升高肾小球滤过率明显优于对照组(P<0.05);试验组的倦怠乏力、肢体困重、关节疼痛、肌肤甲错、水肿、舌苔、脉象积分明显降低(P<0.05),对照组的关节疼痛、肌肤甲错、水肿积分明显降低(P<0.05)。结论:降尿酸方能够有效改善尿酸性肾病患者肾损伤,降低血尿酸水平,其机制之一与纠正脂质代谢紊乱有关,这与网络药理学结果Lipid and atherosclerosis为降尿酸方治疗尿酸性肾病的最富集通路相契合。
Objective:To predict the mechanism of Jiangniaosuan Prescription in the treatment of uric acid nephropathy based on network pharmacology and to validate its clinical efficacy and effects on lipid metabolism in patients with uric acid nephropathy through clinical trials.Methods:The core targets and pathways for the efficacy of Jiangniaosuan Prescription were screened by network informatics analysis.A total of 84 patients with uric acid nephropathy with Tanzhuoyuzu(痰浊瘀阻)syndrome who met the inclusion criteria were randomly divided into a control group and an observation group using a double-blind clinical randomized method.The control group received febuxostat(40 mg)plus a placebo for the Jiangniaosuan Prescription,while the observation group received febuxostat(40 mg)plus Jiangniaosuan Granules for a treatment period of 12 weeks.Blood lipids(total cholesterol,triglycerides,low-density lipoprotein),blood uric acid,creatinine,glomerular filtration rate,and syndrome scores were assessed before and after treatment.Results:Network pharmacological analysis indicated that lipid and atherosclerosis were the most enriched pathways for Jiangniaosuan Prescription in treating uric acid nephropathy.Clinical trial results showed that after treatment,the effective rate in the observation group was 95%,significantly higher than the 80%in the control group(P<0.05).In the observation group,total cholesterol,triglycerides,and low-density lipoprotein cholesterol showed significant improvement compared to baseline(P<0.05),while the control group only demonstrated statistical significance in triglycerides(P<0.05).The observation group also showed significantly better results than the control group in reducing blood lipids after treatment(P<0.05).Serum uric acid,cystatin C,serum creatinine,and glomerular filtration rate in both groups all showed significant differences compared to baseline(P<0.05),with the observation group exhibiting greater reductions in these parameters than the control group(P<0.05).Scores for fatigue,body heaviness,joint pain,scaly skin,edema,tongue coating,and pulse significantly decreased in the observation group compared to baseline(P<0.05).In the control group,scores for joint pain,scaly skin,and edema also significantly decreased compared to baseline(P<0.05),but after treatment,the observation group had significantly lower scores for fatigue,joint pain,scaly skin,edema,and pulse compared to the control group(P<0.05).Conclusion:Jiangniaosuan Prescription effectively improves kidney injury and reduces blood uric acid levels in patients with uric acid nephropathy.One of the mechanisms is related to correcting lipid metabolism disorders,consistent with network pharmacological findings that lipid and atherosclerosis are the most enriched pathways for Jiangniaosuan Prescription in treating uric acid nephropathy.
作者
辛家东
高建东
XIN Jiadong;GAO Jiandong(Department of Nephrology,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine/TCM Institute of Kidney Disease,Shanghai University of Traditional Chinese Medicine/Key Laboratory of Liver and Kidney Diseases,Ministry of Education/Shanghai Key Laboratory of Traditional Chinese Clinical Medicine(20DZ2272200),Shanghai 201203;Integrated Chinese and Western Medicine Department of Yantai Yuhuangding Hospital,Yantai 264099)
出处
《中药药理与临床》
北大核心
2025年第10期62-67,共6页
Pharmacology and Clinics of Chinese Materia Medica
基金
上海市科委项目(编号:20Y21901800)
国家自然科学基金(编号:82274415)。
