祛风活血方联合缬沙坦治疗IgA肾病的疗效评价及对肾小管标志性蛋白和酶的影响

Curative effect evaluation of Qufeng Huoxue decocotion combined with valsartan on IgA nephropathy and its impact on renal tubular marker proteins and enzymes

目的:评价祛风活血方联合不同剂量缬沙坦治疗IgA肾病的有效性。方法:将60例IgA肾病患者随机分为两组,A组(祛风活血方联合160 mg缬沙坦)30例,B组(祛风活血方联合80 mg缬沙坦)30例,疗程12周,两组均观察治疗前后的血压、血常规、肝肾功能、电解质等安全性指标和治疗前后血、尿TGF-β_1、尿RBP酶、尿NAG酶、尿β_2-微球蛋白(β_2-MG)、24小时尿蛋白定量及血浆白蛋白(ALB)等疗效性指标。结果:(1)治疗前两组患者年龄、性别、病程、血压、血尿素氮(BUN)和血肌酐(Scr)等临床资料差异无统计学意义(P>0.05);(2)两组治疗前后收缩压和舒张压、BUN和Scr均无明显变化(P>0.05),两组治疗前24h尿蛋白和ALB的差异无统计学意义(P>0.05),A组治疗后24h尿蛋白由(1.83±0.48)g/24h降至(1.07±0.45)g/24h,ALB由(32.79±2.27)g/L升至(37.53±2.63)g/L,差异有统计学意义(P<0.05);B组治疗后24h尿蛋白由(1.95±0.52)g/24h降至(1.47±0.57)g/24h,ALB由(32.76±2.74)g/L升至(34.01±1.92)g/L,差异有统计学意义(P<0.05);治疗后A组24 h尿蛋白明显下降,ALB明显上升,与B组相比,差异有统计学意义(P<0.05);(3)A组治疗后尿NAG由(19.29±7.03)U/L降至(13.71±6.60)U/L,尿RBP由(2.84±1.20)mg/L降至(1.40±0.63)mg/L,尿β_2-MG由(0.57±0.12)mg/L降至(0.36±0.19)mg/L,尿TGF-β_1由(329.5±42.1)pg/ml降至(221.7±32.7)pg/ml,血TGF-β_1由(231.8±99.7)pg/ml降至(123.9±67.4)pg/ml,与治疗前比较,差异有统计学意义(P<0.05),而B组治疗前、后尿NAG、尿RBP和尿β_2-MG无明显变化(P>0.05);但B组治疗后尿TGF-β_1由(326.2±40.4)pg/ml降至(268.6±65.5)pg/ml,血TGF-β_1由(228.4±98.5)pg/ml降至(161.8±91.5)pg/ml,与治疗前比较,差异有统计学意义(P<0.05);治疗后A组尿TGF-β_1和血TGF-β_1明显下降,与B组相比,差异有统计学意义(P<0.05)。结论:祛风活血方联合缬沙坦有降低蛋白尿、提升血浆白蛋白,降低肾小管标志性蛋白/酶,减轻肾小管损伤,同时提示双倍剂量的缬沙坦组疗效更优于常用剂量组。

Objective： To evaluate the clinical efficacy of Qufeng Huoxue Decoction combined with different dose of valsartan in the treatment of IgA nephropathy. Methods： Sixty patients with IgA nephropathy were randomly divided into two groups. Each group 30 cases. Both groups were treated with Qufeng Huoxue Decoction.Group A was given 160 mg of valsartan per day,when group B was given 80 mg of valsartan per day.Treatment for 12 weeks for both groups.The levels of blood pressure,blood routine,liver and kidney function,electrolyte, blood and urinary transforming growth factor-β_1（TGF-β_1）, urinary Retinol-Binding Protein（RBP）, urinary N-acetyl-β-glucosaminidase（NAG）, urinary β_2-MG, 24-hour urinary protein quantification and plasma albumin（ALB） and other security index or therapeutic effect assessment index before and after treatment were observed and compared in both groups. Results：（1） There were no significant differences in age, sex, duration, blood pressure, blood urea nitrogen（BUN） and serum creatinine（Scr） between the two groups before treatment（P 〉0.05）.（2） There was no significant difference in systolic and diastolic blood pressure, BUN and Scr between the two groups before and after treatment（P〉 0.05）. There was no significant difference in 24-hour urinary protein and ALB between the two groups before treatment（P 〉0.05）. The levels of urinary protein decreased from（1.83 ± 0.48） g/24 h to（1.07±0.45） g/24 h, and ALB increased from（32.79 ± 2.27） g/L to（37.53 ± 2.63） g/L, it has statistically significant after treatment in group A（P 〈0.05）; The urinary protein decreased from（1.95±0.52） g/24 h to（1.47±0.57） g/24 h, and the ALB increased from（32.76±2.74） g/L to（34.01±1.92） g/L, it has statistically significant after treatment in group B（P〈 0.05）; After treatment, 24 h urine protein decreased significantly, ALB increased significantly, compared with group B, the difference was statistically significant（P〈0.05）;（3） The urinary NAG decreased from（19.29±7.03） U/L to（13.71±6.60） U/L, urinary RBP decreased from（2.84±1.20） mg/L to（1.40±0.63） mg/L,（0.57±0.12） mg/L to（0.36±0.19） mg/L, urinary TGF-β_1 decreased from（329.5±42.1） pg/ml to（221.7±32.7） pg/ml,（123.8±99.7） pg/ml to（123.9±67.4） pg/ml in group A, which was significantly different from that before treatment（P 〈0.05）, but there was no significant change in urinary NAG, urinary RBP and urinary β_2-MG in group B before and after treatment（P 〉0.05）; Urinary TGF-ml decreased from（326.2±40.4） pg/ml to（268.6±65.5） pg/ml, and blood TGF-β_1 decreased from（228.4±98.5） pg/ml to（161.8±91.5） pg/ml, it has statistically significant after treatment in group B（P 〈0.05）; After treatment, the levels of TGF-β_1 and TGF-β_1 in group A were significantly lower than those in group B（P 〈0.05）. Conclusion： Qufeng Huoxue Decoction combined with valsartan has reduced proteinuria, elevated plasma albumin, reduced renal tubular marker proteins/enzymes, reduced renal tubular injury, and proved double dose of valsartan group better than the usual dose group.