糖肾康颗粒对糖尿病肾病患者血清同型半胱氨酸及脂质代谢紊乱的影响

Effects of Tangshenkang Granule on Serum Homocysteine and Lipid Metabolism Disorders in Patients with Diabetic Nephropathy

目的观察糖肾康颗粒对糖尿病肾病(diabetic nephropathy,DN)气阴两虚血瘀证患者血清同型半胱氨酸(homocysteine,Hcy)及脂质代谢紊乱的干预作用。方法将60例DN气阴两虚血瘀证患者随机分为试验组和对照组各30例,在降压治疗基础上,试验组给予糖肾康颗粒冲服,对照组给予缬沙坦胶囊口服。治疗16周后,检测尿微量白蛋白/尿肌酐比值(urine albumin-to-creatinine ratio,UACR)、24h尿蛋白(24-hour proteinuria,24hUpro)、血肌酐(serum creatinine,SCr)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、血清Hcy、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)、载脂蛋白-A1(apolipoprotein A1,ApoA1)、载脂蛋白-B(apolipoprotein B,ApoB)。结果试验组疾病疗效显著优于对照组(P<0.05)。两组患者治疗后UACR、24hUpro、SCr均较治疗前显著降低(P<0.05),eGFR较治疗前显著升高(P<0.05);且试验组治疗后UACR和24hUpro降低值显著大于对照组(P<0.05)。试验组血清Hcy、TC、LDL-C、ApoB与治疗前比较均显著降低(P<0.05),而对照组治疗后血清Hcy、TC、LDL-C、ApoB均无明显变化(P>0.05),试验组治疗后Hcy、LDL-C、ApoB降低值显著大于对照组(P<0.05)。结论糖肾康颗粒降低DN气阴两虚血瘀证患者蛋白尿、改善肾功能的作用机制与改善高半胱氨酸血症和脂质代谢紊乱有关。

Objective To observe the effects of Tangshenkang Granule on serum homocysteine （Hcy） and lipid metabolism disorders in diabetic nephropathy （DN） patients with deficiency of both qi and yin and blood stasis. Methods A total of 60 DN patients with deficiency of both qi and yin and blood stasis were randomly and equally divided into experimental group and control group. On the basis of antihypertensive therapy, the experimental group was orally given Tangshenkang Granule, while the control group was o- rally given valsartan capsules. After 16 weeks of treatment, the following indices were measured for both groups： urine albumin-to-creatinine ratio （UACR）, 24-hour urinary protein （24hUPro）, serum creatinine （SCr）, estimated glomerular filtration rate （eGFR）, serum Hcy, total cholesterol （TC）, triglyceride （TG）, low-density lipoprotein cholesterol （LDL-C）, high-density lipoprotein cholesterol （HDL-C）, apoli-poprotein A1, and apolipoprotein B （ApoB）. Results The experimental group had a significantly better clinical outcome than the control group （P〈0.05）. After treatment, both groups showed significant decreases in UACR, 24hUP, and SCr （P^0. 05） and an increase in eGFR （P〈0. 05）, and the experimental group had significantly greater decreases in UACR and 24hUPro than the control group （P〈0. 05）. After treat- ment, there were significant decreases in serum Hcy, TC, LDL-C, and ApoB for the experimental group （P〈0. 05）, but not the control group （P〉0.05）. And the experimental group had significantly greater decreases in Hcy, LDL-C, and ApoB than the control group （P〈0.05）. Conclusion For DN patients with deficiency of both qi and yin and blood stasis, Tangshenkang Granule can reduce proteinuria and improve renal function. Its mechanism of action may be related to reducing hyperhomocysteinemia and lipid metabolism disorders.