当归补血汤合六味地黄汤对高血压肝肾阴虚证早期肾损害的防治

Preventive and Treatment Effect of Danggui Buxuetang and Liuwei Dihuang Tang on Early Hypertensive Renal Damage

目的:观察当归补血汤合六味地黄汤治疗早期高血压肾损害的临床疗效及对转化生长因子-β_1(TGF-β_1),纤溶酶原激活物抑制剂-1(PAI-1),白细胞介素-1β(IL-1β)和肿瘤坏死因子-α(TNF-α)水平的影响。方法:240例患者采用区组分层随机,以SAS软件生成的数字表法,按1∶1分为观察组和对照组各120例。基础治疗口服缬沙坦胶囊,80 mg/次,1次/d;血压未达标加用硝苯地平控释片,1片/次,1次/d。对照组采用六味地黄汤,1剂/d,分早晚2次内服;观察组采用当归补血汤合六味地黄汤,1剂/d,分早晚2次内服。两组疗程均为12周。检测尿血清β_2微球蛋白(β_2-MG),尿N-乙酰-β-氨基葡萄糖苷酶(NAG),胱抑素C(CysC)水平,微量白蛋白(mALB),血肌酐(SCr),并计算尿微量白蛋白/肌酐(UACR)和肾小球滤过率(e GFR),包括eGFR_(MDRD)和eGFR_(CKD-EPI);进行治疗前后肝肾阴虚证评分;检测治疗前后血清TGF-β_1,PAI-1,IL-1β和TNF-α水平,进行安全性评价。结果:观察组中医证候疗效总有效率为89.09%,优于对照组的77.27%,组间差异有统计学意义(χ~2=5.491,P<0.05);治疗后观察组β_2-MG,CysC,NAG,m ALB和SCr水平均低于对照组(P<0.01);治疗后观察组UACR低于对照组,eGFR_(MDRD)和eGFR_(CKD-EPI)均高于对照组(P<0.01);治疗后观察组患者血清TGF-β_1,PAI-1,IL-1β和TNF-α水平均低于对照组(P<0.01);两组患者均未发现与中药相关不良反应。结论:当归补血汤合六味地黄汤治疗早期高血压肾损害,能减临床症状,减轻早期肾损伤,延缓肾损害进展,并能调节TGF-β_1,PAI-1,IL-1β和TNF-α等因子,起到保护肾损伤的作用。

Objective： To observe the clinical effect of Danggui Buxuetang and Liuwei Dihuang Tang on early hypertensive renal damage,and its impact on levels of transforming growth factor-β_1（ TGF-β_1）,plasminogen activator inhibitor-1（ PAI-1）,interleukin^-1β（ IL^-1β） and tumor necrosis factor-α（ TNF-α）. Method： Two hundred and forty patients were divided into control group（ 120 cases） and observation group（ 120 cases） by random number table. Both groups were given valsartan capsules,80 mg / time,1 time / day,and nifedipine controlled release tablets were additionally provided to those beyond blood pressure standard,1 tablet / time,1 time / day. Control group took Liuwei Dihuang Tang,1 dose / day; Observation group took Danggui Buxuetang combined with Liuwei Dihuang Tang,1 dose / day. The course of treatment for both of the groups was 12 weeks.And levels of β_2-microglobulin（ β_2-MG）, urinary N-acetyl-β-glucosaminidase（ NAG）, cystatin（ CysC）,microalbumin（ mALB） and serum creatinine（ SCr） were detected. Urinary albumin / creatinine（ UACR） and glomerular filtration rate（ eGFR）, including eGFR_（MDRD）and eGFR_（CKD-EPI）,were calculated. Before and after treatment,scores of liver and kidney Yin deficiency were graded. Levels of TGF-β_1,PAI-1,IL^-1β and TNF-α were detected,and adverse reactions were evaluated. Result： Total effective rate of traditional Chinese medicine（ TCM）syndrome in observation group was 89. 09%,which was higher than 77. 27% in control group,with statically significant intergroup differences（ χ~2= 5. 491,P〈0. 05）. After treatment,levels of β_2-MG,Cys C,NAG,m ALB,SCr and UACR in observation group were lower than those in control group（ P〈0. 01）. And levels of eGFR_（MDRD）and eGFR_（CKD-EPI）in observation group were higher than those in control group（ P〈0. 01）. And levels of TGF-β_1,PAI-1,IL^-1β and TNF-α in observation group were lower than those in control group（ P〈0. 01）. No adverse reaction was found in both of the groups. Conclusion： Danggui Buxuetang combined with Liuwei Dihuang Tang can protect kidney by relieving clinical symptoms and early kidney injury,prolonging progress in renal damage,and regulating levels of TGF-β_1,PAI-1,IL^-1β and TNF-α.