摘要
目的观察三黄益肾颗粒治疗糖尿病肾脏疾病慢性肾脏病(CKD)2~3期气阴两虚兼血瘀证患者的疗效,并探讨其可能作用机制。方法选择2022年10月-2023年4月在北京中医药大学房山医院肾病科门诊治疗的60例糖尿病肾脏疾病CKD 2~3期气阴两虚兼血瘀证患者,按照随机数字表法分为2组各30例。治疗组给予西医常规治疗及三黄益肾颗粒口服,对照组给予西医常规治疗及渴络欣胶囊口服,2组疗程均为8周。比较2组治疗前后肾功能相关指标[24 h尿蛋白定量、血肌酐、血尿素氮、估算肾小球滤过率(eGFR)]、肾脏纤维化相关指标[血清转化生长因子-β_(1)(TGF-β_(1))、环磷酸腺苷(cAMP)、蛋白激酶A(PKA)水平]、血脂指标[血清三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平]及中医证候积分,统计2组不良反应发生情况。结果治疗组27例、对照组25例完成研究。治疗后治疗组血肌酐水平明显低于治疗前及对照组(P均<0.05),eGFR明显高于治疗前及对照组(P<0.05),对照组血肌酐、eGFR与治疗前比较差异均无统计学意义(P均>0.05),2组治疗前后24 h尿蛋白定量、血尿素氮及血脂指标比较差异均无统计学意义(P均>0.05);治疗后2组血清TGF-β_(1)水平均明显低于治疗前(P均<0.05),血清cAPM、PKA水平均明显高于治疗前(P均<0.05),但2组各指标比较差异均无统计学意义(P均>0.05);治疗后治疗组倦怠乏力、口干、头晕、面浮肢肿、腰膝酸软、排便不畅评分均明显低于治疗前(P均<0.05),且除面浮肢肿外其余各项评分均明显低于对照组(P均<0.05)。2组治疗前后肝功能、血常规、心电图等未见明显变化。结论三黄益肾颗粒可改善糖尿病肾脏疾病CKD 2~3期气阴两虚兼血瘀证患者肾功能和临床症状,机制可能与调控TGF-β_(1)、cAMP、PKA表达,抑制肾脏纤维化有关。
Objective It is to observe the efficacy of Sanhuang Yishen granules in the treatment of patients with stage 2-3 chronic kidney disease(CKD)of diabetic kidney disease(DKD)with syndrome of Qi-Yin deficiency and blood stasis,and to explore its potential mechanisms of action.Methods Sixty patients with stage 2-3 CKD of DKD with syndrome of Qi-Yin deficiency and blood stasis treated at the outpatient clinic of Nephrology Department of Fangshan Hospital of Beijing University of Chinese Medicine from October 2022 to April 2023 were randomly divided into two groups by a random number table,with 30 cases in each group.The treatment group was treated with conventional western medical therapy plus oral administration of Sanhuang Yishen granules,while the control group was treated with conventional western medical therapy plus oral administration of Keloxin capsule,both groups were treated for 8 weeks.The renal function-related indicators[24-hour urine protein quantification,serum creatinine,blood urea nitrogen,estimated glomerular filtration rate(eGFR)]and renal fibrosis-related indicators[serum transforming growth factor-β_(1)(TGF-β_(1)),cyclic adenosine monophosphate(cAMP),protein kinase A(PKA)],blood lipid indicators[triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)]and scores of traditional Chinese medical syndrome were compared between the two groups before and after treatment,the occurrences of dverse reactions in the two groups were statistically analyzed.Results Twenty-seven patients in the treatment group and 25 ones in the control group completed the study.The level of serum creatinine in the treatment group was significantly lower,while eGFR was significantly higher than those before treatment and in the control group(all P<0.05),there were no significant differences in the level of serum creatinine and eGFR between before and after treatment in the control group(both P>0.05),there were no significant differences in 24-hour urine protein quantification,blood urea nitrogen,and blood lipid indicators between the two groups before and after treatment(all P>0.05).The serum levels of TGF-β_(1) in both groups were significantly lower(both P<0.05),while the serum levels of cAPM and PKA were significantly higher than those before treatment(all P<0.05),however,there were no statistically significant differences in these indicators between the two groups(all P>0.05).The scores of fatigue,dry mouth,dizziness,facial and limb edema,lower back and knee weakness,and constipation were significantly lower after treatment than those before treatment in the treatment group(all P<0.05),and the scores of these symptoms except for facial and limb edema were significantly lower than those in the control group(all P<0.05).No significant changes were observed in liver function,complete blood count,or electrocardiogram after treatment in either group.Conclusion Sanhuang Yishen granules can improve renal function and clinical symptoms of patients with stage 2-3 CKD of DKD with syndrome of Qi-Yin deficiency and blood stasis,the mechanism may be related to regulation of expressions of TGF-β_(1),cAMP,and PKA and inhibition of renal fibrosis.
作者
王艳云
孔令新
张晓苗
王然
王晶
WANG Yanyun;KONG Lingxin;ZHANG Xiaomiao;WANG Ran;WANG Jing(Fangshan Hospital of Beijing University of Chinese Medicine,Beijing 102400,China)
出处
《现代中西医结合杂志》
2025年第21期2962-2967,共6页
Modern Journal of Integrated Traditional Chinese and Western Medicine
基金
北京中医药大学校级课题(2022-BUCMXJKY-022)。
关键词
三黄益肾颗粒
糖尿病肾脏疾病
渴络欣胶囊
中焦
脾胃论治
Sanhuang Yishen granules
diabetic kidney disease
Keloxin capsules
San-Jiao
treatment determination based on spleen-stomach
