糖肾方对糖尿病肾病患者同型半胱氨酸代谢的影响

Effects of Tangshen Recipe on the Homocysteine Metabolism of Patients with Diabetic Nephropathy

目的观察中药糖肾方对糖尿病肾病(DN)患者同型半胱氨酸(Hcy)代谢循环的影响。方法 64例DN患者随机分为西医治疗组和糖肾方组,每组32例,西医治疗组接受胰岛素治疗及口服降糖药物,糖肾方组接受胰岛素治疗加服中药糖肾方(由黄芪、生地、三七、鬼箭羽、大黄、枳壳和山茱萸等组成,4g/袋)。均6个月为1个疗程。另设48名健康志愿者为对照组。在给药前、给药3个月及6个月后对患者血浆中8种Hcy中间代谢物的含量进行定量测定,分析给药后各化合物在体内的变化。结果两治疗组治疗前体内硫醇氨基酸含量与健康对照组比较,半胱氨酸(Cys)、Hcy、腺苷甲硫氨酸(SAM)、腺苷同型半胱氨酸(SAH)显著升高,甲硫氨酸(Met)、谷胱甘肽(GSH)和半胱氨基甘氨酸(Cys-gly)显著降低,差异有统计学意义(P<0.05);上述指标治疗3个月及6个月后与本组给药前比较,患者体内Cys、Hcy、SAM、SAH含量显著降低,Met、GSH以及Cys-gly显著升高,差异均有统计学意义(P<0.05)。两组SAH、SAM及GSH含量在治疗6个月后与健康对照组比较差异无统计学意义(P>0.05)。两组患者均未出现不良反应。结论胰岛素联合糖肾方治疗DN与西医治疗具有同样良好的效果,可以改善体内低甲基化以及氧化应激水平。

Objective To observe the effects of Tangshen Recipe （TR） on the homocysteine （Hcy） metabolism of patients with diabetic nephropathy.Methods 64 patients with diabetic nephropathy were randomly assigned to two groups,32 in each.Those in the Western medicine treatment group （Group A） received insulin and orally took anti-diabetic drugs,while those in the TR group （Group B） received insulin and orally took TR （consisting of astragalus,raw rehmannia root,sanchi root,euonymus branchlet,rhubarb,bitter orange,and dogwood fruit,etc.4 g/package）.Six months was taken as one therapeutic course.Another 48 healthy volunteers were recruited as the control group.Eight intermediate metabolites of the homocysteine metabolism in plasma were quantitated before treatment,three months and six months after treatment.The in vivo changes of each metabolite after treatment were analyzed.Results Compared with the healthy control group,contents of cysteine （Cys）,Hcy,s-adenosylmethionine （SAM）,and SAH significantly increased in Group A and B before treatment.Contents of methionine （Met）,glutathione （GSH）,and Cys-gly decreased significantly,showing statistical difference （P0.05）.Patients＇ in vivo contents of Cys,Hcy,SAM,and SAH significantly decreased,while contents of Met,GSH,and Cys-gly significantly increased after three and six months of treatment when compared with before treatment in the same group （all P0.05）.No statistical difference existed in contents of SAH,SAM,and GSH of Group A and B after six months of treatment when compared with the healthy control group （P0.05）.No adverse reaction occurred in Group A and B.Conclusions Treatment of insulin and TR showed similar favorable effect to Western medicine in treatment of diabetic nephropathy.It could improve in vivo hypomethylation and oxidative stress.