肾络安方治疗肥胖型早期糖尿病肾病临床观察

Clinical observation of Shenluoan Decoction for treating obese patients with early diabetic nephropathy

目的观察肾络安方对肥胖型早期糖尿病肾病(DN)的治疗效果并探讨其可能的机制。方法将106例肥胖型早期DN患者随机分为对照组及治疗组,对照组53例患者采用常规治疗及厄贝沙坦口服,治疗组53例患者在此基础上加用肾络安方。治疗6个月后,比较两组治疗前后症状、腰围、血清肌酐(SCr)、血尿素氮(BUN)、总胆固醇(TC)、三酰甘油(TG)、空腹血糖(FBG)、足细胞标记蛋白(PCX)、尿肾病蛋白(nephrin)、尿白蛋白、尿肌酐(UCr)。结果 102例患者完成实验,治疗组总有效率(90.00%)明显高于对照组(67.31%)(P<0.05)。两组患者腰围治疗前后无差异(P>0.05)。治疗组治疗后SCr、TC、TG较本组治疗前及对照组治疗后明显降低(P<0.05)。治疗组治疗后UPCX/UCr、UNephrin/UCr、尿白蛋白/SCr(UACR)显著低于本组治疗前及对照组治疗后(P<0.05)。UPCX/UCr、UNephrin/UCr、UACR两两呈正相关。结论肾络安方结合西医基础治疗肥胖型DN有较好疗效,其机制可能与保护肾脏,减少足细胞PCX、Nephrin排泄有关。

Objective To observe the therapeutic effects and possible mechanism of Shenluoan Decoction on the obese patients with early diabetic nephropathy. Methods Obese patients with early diabetic nephropathy （106 cases） were randomly assigned into control group （n = 53, treated by Irbesartan） and treatment group （n = 53, treated by Shenluoan Decoction combined with Irbesartan）, and the conventional Western therapy was given to all the patients in both groups. The changes of therapeutic efficacy, Chinese medicine syndrome, such as waistline, serum creatinine （SCr）, blood urea nitrogen （BUN）, total cholesterol （TC）, triglyeride （TG）, fasting blood glucose （FBG）, urinary podocalyxin （PCX）, urinary nephrin, urinary albumin, and urine creatinine were detected before and after 6 months treatment. Results The experiment was completed with 102 cases. The total effective rate in the treatment group （90.00%） was significantly higher than that of control group （67.31%） （P 〈 0.05）. There was no statistical significance in waistline between the two groups （P 〉 0.05）. After the treatment, the levels of SCr, TC, and TG were reduced significantly in the treatment group （P 〈 0.05）, and showed significant difference compared with those in the control group （P 〈 0.05）. The levels ofUPCX/UCR, UNephrin/UCR, and UACR were decreased with significant differences compared with those before treatment and in the control group, respectively （P 〈 0.05）. UPCX/UCR, UNephrin/UCR, and UACR showed positive correlation. Conclusion The combination of Shenluoan Decoction and Irbesartan has a better effect than the single use of Irbesartan on the obese patients with early diabetic nephropathy. Its mechanism may be related to providing some renal protection and reducing the PCX and nephrin excretion.