补肾活血祛风法治疗Ⅳ、Ⅴ期糖尿病肾病的疗效及其对MCP-1的影响

Clinical Effects of Kidney-invigorating,Blood-promoting and Wind-dispelling Therapy on Diabetic Nephropathy in Ⅳ and Ⅴ Stages and Its Influence on MCP-1

目的:观察补肾活血祛风法对脾肾气虚兼痰瘀型Ⅳ、Ⅴ期糖尿病肾病患者的疗效,并探讨其可能具有的抗炎机制。方法:将45例患者随机分为治疗组24例和对照组21例。在常规治疗的基础上,对照组口服缬沙坦,治疗组口服缬沙坦联合中药补肾活血祛风方,疗程均为12周。观察并监测两组患者的相关指标,比较两组患者24 h尿蛋白定量的变化及其Scr、尿MCP-1水平的变化。结果:治疗后,治疗组患者的24 h尿蛋白定量情况较治疗前明显改善(P<0.05),且治疗组患者的24 h尿蛋白定量情况较对照组亦明显改善(P<0.05);治疗组患者的Scr、尿MCP-1水平较治疗前均明显降低(P<0.01),且治疗组患者的Scr、尿MCP-1水平较对照组亦明显降低(P<0.01)。结论:补肾活血祛风方与ARB类药物联用能够降低糖尿病肾病患者的尿蛋白,改善其肾功能,其作用机制可能与抑制肾脏组织细胞产生MCP-1、减轻炎症反应有关。

Objective： To observe the effects of kidney-invigorating,blood-promoting and wind-dispelling therapy on diabetic nephropathy（DN） of qi-deficiency of spleen and kidney combined with phlegm and blood stasis syndrome in the stages of Ⅳ and Ⅴ,and further explore the anti-inflammatory mechanism of this therapy.Methods： Forty-five patients with DN of qi-deficiency of spleen and kidney combined with phlegm and blood stasis syndrome were randomly divided into treatment group（24 cases） and control group（21 cases）.All of the cases were given normal treatment;the control group was given valsartan,and the treatment group was given valsartan combined with kidney-invigorating,blood-promoting and wind-dispelling recipe.The therapeutic courses of two groups were both 12 weeks.The correlative indexes were observed,and the change of 24 h urine protein and the levels of serum creatinine（SCr） and urine monocyte chemoattractant protein-1（MCP-1） were compared.Results： After treatment,the 24 h urine protein of treatment group was obviously improved compared with before treatment and control group（P0.05）;the levels of SCr and urine MCP-1 of treatment group were significantly decreased compared with before treatment and control group（P0.01）.Conclusion： Kidney-invigorating,blood-promoting and wind-dispelling recipe combined with angiotensin receptor blocks（ARB） can decrease the urine protein of patients with DN,and improve their renal function.Its mechanisms may have relationship with inhibiting the expression of MCP-1 and reducing the inflammatory reaction in kidney.