真武汤对糖尿病肾病患者血管内皮生长因子及尿蛋白排泄率的影响

The Effects of Spleen-Yang Strengthening Decoction on Vascular Endothelial Growth Factor and Urinary Protein Excretion Rate in Patients With Diabetic Nephropathy

目的：分析真武汤对糖尿病肾病患者血管内皮生长因子及尿蛋白排泄率的影响。方法：将本院收治的70例2型糖尿病肾病患者根据入院顺序随机分为对照组（35例）和治疗组（35例）,2组患者均接受糖尿病教育、糖尿病饮食,内科口服降糖药物或者皮下注射胰岛素治疗（剂量依照患者血糖水平而设定）;合并高血压者加用硝苯地平缓释片,10~20 mg,2次/d;合并高脂血症者加服辛伐他汀,20 mg/d。治疗组在对照组基础上运用真武汤,2组均以8周为1个疗程,比较2组治疗前后蛋白尿排泄率（u AER）及VEGF蛋白和mRNA的变化。结果：1）2组经过治疗u AER均较治疗前改善,其中治疗组改善的幅度更为明显（P〈0.05）,说明真武汤可明显改善糖尿病肾病患者的u AER,在一定程度上抑制了糖尿病肾病病情的进展。2）经过治疗2组的VEGF蛋白和mRNA表达均有所下降,其中治疗组下降的趋势较对照组明显（P〈0.05）,说明联合使用中药方可以使VEGF在蛋白和基因层面上均收到抑制。3）u AER与VEGF水平呈非正态分布,使用Spearman法进行相关参数相关性分析,结果发现u AER与VEGF的表达存在正相关性。结论：真武汤可降低糖尿病肾病患者血清VEGF水平,同时降低u AER,是其保护肾功能的可能作用机制之一。

Objective：To analyze the impact of Spleen-yang Strengthening Decoction on vascular endothelial growth factor and urinary protein excretion rate in patients with diabetic nephropathy.Methods：Seventy cases of patients with Type 2 Diabetic nephropathy who were received and treated in our hospital were randomly divided into the control group（35 cases） and the observation group（35 cases） according to admission order,both of the two groups received Diabetes Education,Diabetic diet,internal medicine oral hypoglycemic agents or subcutaneous injections of insulin（the dose were set according to blood glucose levels of the patients）;the patients who combined with hypertension were added nifedipine sustained release tablets,10~20 mg,2 times/day.The patients who combined with hyperlipidemia were added Simvastatin,20 mg/day.The observation group used Self,prepared kidney invigorating decoction on the basis of the control group.Both groups had 8 weeks for a course of treatment,urinary protein excretion rate（uAER） and the protein and mRNA change of VEGF in the two groups were compared before and after the treatment.Results：1） uAER improved in the two groups after treatment compared to before the treatment,the range of improvement in the observation group was more obvious（P0.05）.This illustrated that Self,prepared kidney invigorating decoction can obviously significantly improve uAER of the patients with diabetic nephropathy,inhibited the progression of diabetic nephropathy in a certain extent.2） after treatment,protein and mRNA expression of VEGF in the two groups decreased,the downward trend in the observation group were more obvious than the control group（P 0.05）,illustrated the combine use of prescription could suppress the VEGF in the protein and gene levels.3） uAER and VEGF levels were in abnormal distribution,correlation analysis were proceed on relevant parameters by the method of Spearman,the results found that uAER had positive correlation with the expression of VEGF.Conclusion：Spleen-yang Strengthening Decoction can reduce the serum VEGF level in patients with diabetic nephropathy,and can reduce uAER at the same time,which could possibly be the mechanism of action to protect renal function.