益肾通络方对早期糖尿病肾病发生的影响

The effects of Yishen Tongluo Decotion on Elderly diabetic nephropathy

目的探讨益肾通络方（YTD）保护糖尿病肾病患者（DN）肾功能的作用及其可能的机制.方法：将糖尿病肾病微量白蛋白尿期患者148 例随机分为两组,两组均给予低蛋白糖尿病饮食,控制血糖、血压,治疗组74 例在此基础上给予益肾通络方,疗程为60 天,观察试验前后两组血糖、血压、TG、BUN、Scr、UP 24 h、尿微量白蛋白、C-反应蛋白及中医证候积分的变化以及TGF-β1 和 VEGF 的表达变化.结果：两组治疗后,治疗组尿微量白蛋白、C-反应蛋白下降优于对照组,有显著性差异（P〈0.05, P〈0.01）;与对照组比较,治疗组的TG、BUN、Scr 和UP 24 h 均显著降低（P 〈 0.05,P 〈 0.01）;治疗组中医证候积分较治疗前明显下降,有显著性差异（P〈0.05, P〈0.01）,优于对照组;治疗组总有效率高于对照组（P〈0.01）.另外,TGF-β1 和 VEGF 的表达,治疗组显著低于对照组（P 〈 0.01）.结论：益肾通络方剂能减少早期糖尿病肾病患者尿微量白蛋白、超敏C 反应蛋白,延缓疾病进程和下调TGF-β1 和VEGF 的表达来保护DN 患者.

ObjectiveTo explore the protective effect and possible mechanisms of Yishen Tongluo Decotion （YTD） on diabetic nephropathy （DN）.Methods：148 cases ofpatients were randomly divided into 2 groups.74 cases orally took Yishen Tongluo Decotion （YTD） per-night.74 cases were given anti-diabetic therapy as usual.After 60 days, levelsof blood glucose （BG）, blood pressure （BP）, triglyceride （TG）, blood urea nitrogen （BUN）, serum creatinine （Scr）, urine protein 24 h （UP 24 h）, 24 hour urinary albumin excretion rate（UAER）, C-reactive protein （CRP）, syndrome points （SP） of the two groups were tested and compared with each other.TGF-β1 and VEGF expression were detected by ELISA.Results：In YTD group,the expressions of UAER and CRP post-treatment were significantly reduced as compared to control group （P〈0.05, P〈0.01）.TG, BUN, Scr and UP 24 h weresignificantly decreased in YTD group compared with the control group （P 〈 0.05,P 〈 0.01）. The SP also reduced after treatment and the levels were significantly lower than those incontrol group.Moreover, the protein expression of TGF-β1and VEGF in YTD group were significantly lower than the control group （P 〈 0.01）. Conclusion：YTD may play a role inpreventing the development of DN through reducing the serum UAER and CRP levels and down-regulating expressions of TGF-β1, and VEGF.