百令胶囊影响肾血管性高血压患者Klotho基因和肾功能的机制分析

Mechanism Analysis of the Effect of Bailing Capsule on Klotho Gene and Renal Function in Patients with Renal Vascular Hypertension

目的观察百令胶囊对肾血管性高血压(RVH)患者Klotho基因和肾功能的影响。方法 142例患者按入院先后顺序随机分为常规治疗组72例和联合治疗组70例。常规治疗组剔除介入和手术病例后进行保守治疗;联合治疗组在此基础上加服百令胶囊。两组均于治疗21 d时采血分析Klotho蛋白和Klotho-mRNA表达,检测Klotho基因凋亡相关基因p21和p53表达,比较尿液中β_2微球蛋白(β2-MG)、尿微量白蛋白(m Alb)、尿白蛋白排泄率(UAER)、尿磷(UP)和静脉血尿素氮(BUN)、肌酐(SCr)、胱抑素C(Cys C)等指标;同时监测收缩压(SBP)、舒张压(DBP)和心率(HR)。结果联合治疗组总有效率为87.27%,优于常规治疗组的69.49%(P<0.05)。两组治疗21 d后,SBP、DBP和HR与治疗前均有不同程度的降低,但组间比较差别不大(P>0.05)。常规治疗组Klotho蛋白和Klotho-mRNA及凋亡相关基因p21和p53表达与治疗前比较无明显变化(均P>0.05)。联合治疗组Klotho蛋白和Klotho-mRNA与治疗前比较明显上调,p21则下调,且优于常规治疗组(均P<0.05),p53表达与治疗前比较变化不大(P>0.05)。两组治疗21 d后,SCr、BUN和Cys C与治疗前比较均显著下降(均P<0.05),且联合治疗组SCr、BUN和Cys C与常规治疗组比较下降更多(均P<0.05)。两组治疗后UAER、β2-MG和mAlb与治疗前比较均下降,而UP则增高(均P<0.05),且联合治疗组的UAER、β_2-MG、m Alb和UP改善均优于常规治疗组(均P<0.05)。结论百令胶囊通过上调K-mRNA表达,抑制肾小管上皮细胞凋亡相关基因p21表达,降低肾小管上皮细胞凋亡率,提高UP排泄而达到保护肾脏的作用,可明显提高RVH的临床疗效。

Objective： To observe the clinical effect of treating renal vascular hypertension （RVH）, and to analyse the mechanism of the effect of Bailing Capsule on Klotho gene and renal function. Methods： 142 cases of RVH were randomly divided into routine treatment group and combined treatment group according to the order of admission. The conventional therapy group was treated with conservative treatment except for the cases that needed intervention and operation treatment. The combination therapy group was given Bailing Capsule on the basis of the conventional therapy group. In 21 days of treatment,blood analysis of Klotho protein,Klotho-mRNA expres- sion,and apoptosis associated genes such as p21 and p53 expression were done. Urine beta 2 microspheres protein （β2-MG）, urinary microalbumin （mAlb）, urinary albumin excretion rate （UAER）, urine phosphorus （UP）, venous blood urea nitrogen（BUN）, creatinine （SCR）, Cystatin C （Cys C） and other indicators were compared. At the same time, systolic blood pressure （SBP） and diastolic blood pressure （DBP）, heart rate （HR） were monitored. Results： After 21 days of treatment,the expression of Klotho protein and Klotho-mRNA was up regulated and the expression of p21 was down regulated in the combination treatment group. Compared with the conventional treatment group,the result was （P〈 0.05）. Urinary mAlb,beta 2-MG,UAER decreased,BUN,Cys C and SCr decreased significantly ,UP increased ,the total efficiency was significantly improved in the combination treatment group. Compared with the conventional treatment group, the result was（P〈 0.05）. The comparison result of the expression of SBP, DBP, HR and p53 between the two groups was （P〉 0.05）. Conclusion： By increasing K-mRNA expression,Bailing Capsule inhibits the expression of p21 gene related to apoptosis of renal tubular epithelialcells,decreases the rate of apoptosis of renal tubular epithelial cells, slightly increases excretion and reaches the kidney protective effect. It can significantly improve the RVH clinical curative effect.