自拟补肾活血清热方联合雷公藤多苷片治疗早期糖尿病肾病的疗效及对糖脂代谢及血清TIMP-1、TGF-β1的影响

Curative effect of self-made Bushen Huoxue Qingre prescription combined with tripterysium glycosides tablets on early diabetic nephropathy and its influences on glucose-lipid metabolism,serum TIMP-1 and TGF-β1

目的:探讨自拟补肾活血清热方联合雷公藤多苷片治疗早期糖尿病肾病(DN)的疗效及对糖脂代谢及血清组织型金属蛋白酶抑制剂-1(TIMP-1)、转化生长因子β1(TGF-β1)的影响。方法:选取本院2017年8月~2019年11月92例早期DN患者,按随机数字表法分为观察组与对照组,每组各46例患者,对照组给予雷公藤多苷片治疗,观察组在对照组的基础上给予自拟补肾活血清热方,比较两组疗效、临床症状、糖脂代谢、肾功能及肾纤维化指标、不良反应发生情况。结果:观察组治疗有效率97.83%高于对照组82.61%;观察组治疗后神疲乏力,腰膝酸软,夜尿频多,畏寒肢冷、口干咽燥,口唇色暗,面足浮肿,肢体麻木或刺痛、舌脉象评分均低于对照组;观察组治疗后糖化血红蛋白(HbAlC)、血空腹血糖(FPG)、胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平低于对照组,高密度脂蛋白胆固醇(HDL-C)水平高于对照组;观察组治疗后血清胱抑素(Cys-C)、尿白蛋白排泄率(UAER)、尿β2微球蛋白(β2-MG)、尿微量白蛋白(ALB)水平低于对照组;观察组治疗后血TGF-β、基质金属蛋白酶-9(MMP-9)水平低于对照组,TIMP-1水平高于对照组;两组不良反应发生率比较。结论:自拟补肾活血清热方联合雷公藤多苷片有利于改善DN患者临床症状,有效调节患者糖脂代谢,调控TGF-β1、MMP-9、TIMP-1水平,延缓肾间质纤维化,进而改善患者肾功能,效果显著,安全性高。

Objective To explore the curative effect of self-made Bushen Huoxue Qingre prescription combined with tripterysium glycosides tablets on early diabetic nephropathy(DN)and its influences on glucose-lipid metabolism,serum tissue inhibitor of metalloproteinase-1(TIMP-1)and transforming growth factorβ1(TGF-β1).Methods Ninety-two patients with early DN in the hospital from August 2017 to November 2019 were enrolled and divided into observation group and control group according to random number table method,46 cases in each group.The control group was treated with tripterysium glycosides tablets,while observation group was given self-made Bushen Huoxue Qingre prescription on basis of control group.The curative effect,clinical symptoms,glucose-lipid metabolism,renal function and renal fibrosis indexes,and the occurrence of adverse reactions between the two groups were compared.Results The response rate of treatment in observation group was higher than that in control group(97.83%vs 82.61%).After treatment,scores of fatigue,soreness and weakness of waist and knees,frequent nocturia,extreme chilliness,dry mouth and throat,dark lips,facial and foot edema,numbness or tingling of limbs,tongue and pulse in observation group were lower than those in control group,levels of glycosylated hemoglobin(HbAlC),fasting blood glucose(FPG),insulin resistance index(HOMA-IR),triglyceride(TG),total cholesterol(TC)and low-density lipoprotein cholesterol(LDL-C)were lower than those in control group,and level of high-density lipoprotein cholesterol(HDL-C)was higher than that in control group.After treatment,levels of serum cystatin C(Cys-C),urinary albumin excretion rate(UAER),urinaryβ2 microglobulin(β2-MG)and urinary microalbumin(ALB)in observation group were lower than those in control group,levels of serum TGF-βand matrix metalloproteinase-9(MMP-9)were lower than those in control group,and TIMP-1 level was higher than that in control group.The difference in the incidence of adverse reactions between the two groups was not statistically significant.Conclusion The self-made Bushen Huoxue Qingre prescription combined with tripterysium glycosides tablets is beneficial to improve clinical symptoms of DN patients,effectively regulate glucose-lipid metabolism,levels of TGF-β1,MMP-9 and TIMP-1,and delay renal interstitial fibrosis,thus improving renal function,with significant effect and high safety.