木丹颗粒联合ARB类药物对2型糖尿病肾病患者肾脏血流动力学及肾素-血管紧张素-醛固酮系统影响

Effects of Mudan Granules combined with ARBs on renal hemodynamics and renin-angiotensin-aldosterone system in patients with type 2 diabetic nephropathy

目的探讨木丹颗粒联合ARB类药物对2型糖尿病肾病患者肾脏血流动力学和肾素-血管紧张素-醛固酮系统(RAAS)的影响。方法将86例2型糖尿病肾病患者随机平均分为对照组和试验组,每组43例。2组患者均接受常规基础治疗,对照组在常规治疗基础上加用缬沙坦,试验组在常规治疗基础上联合使用木丹颗粒和缬沙坦,2组疗程均为12周。观察2组治疗前后血糖、肾功能、肾脏血流动力学以及RAAS相关指标的变化情况。结果 2组治疗后的空腹血糖(FPG)、糖化血红蛋白(HbA 1c)、尿蛋白排泄率(UAER)、肌酐(SCr)、尿素氮(BUN)、尿微量白蛋白(UAlb)水平及血浆肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)和醛固酮(ALD)水平均明显降低(P均<0.05),且试验组各指标的改善情况均优于对照组(P均<0.05);2组治疗后双肾主动脉(MRA)和叶间动脉(IRA)的收缩期最大血流速度(Vsmax)、舒张期最低血流速度(Vdmin)明显增加(P均<0.05),阻力指数(RI)和搏动指数(PI)明显降低(P均<0.05),且试验组各指标改善情况均明显优于对照组(P均<0.05)。结论木丹颗粒联合ARB类药物可有效改善2型糖尿病肾病患者的糖代谢及肾功能,疗效确切,机制可能与改善肾血流动力学,阻断RAAS过程有关。

Objective It is to investigate the effects of Mudan granules combined with ARBs on renal hemodynamics and renin-angiotensin-aldosterone system（ RAAS） in patients with type 2 diabetic nephropathy. Methods 86 patients with type 2 diabetic nephropathy were randomly divided into control group and test group,43 cases in each group. Both groups received conventional basic treatment. On the basis of routine treatment,the control group was treated with valsartan,the test group was treated with Mudan granules and valsartann. The duration of treatment in both groups was 12 weeks. The changes of blood glucose,renal function,renal hemodynamics,and RAAS-related indicators before and after treatment were observed in both groups. Results The levels of fasting blood glucose（ FPG）,Hb A1 c,creatinine（ SCr）,urea nitrogen（ BUN）,urinary microalbumin（ UAlb） and plasma renin activity,Ang Ⅱ,ALD,urinary protein excretion rate（ UAER） after treatment were significantly decreased in both groups（ P＜0. 05）,and the improvement of each index in the experimental group was better than the control group（ P＜0. 05）; The maximum systolic velocity（ Vsmax）,diastolic minimum velocity（ Vdmin） was increased（ P＜0. 05）,the resistance index（ RI） and the pulsatility index（ PI） of both renal aorta（ MRA） and interlobar artery（ IRA） were significantly decreased in both groups after treatment（ P＜0. 05）,and the improvement of each index in the experimental group was significantly better than that in the control group（ P＜0. 05）.Conclusion Mudan granule combined with ARBs can effectively improve the glucose metabolism and renal function in patients with type 2 diabetic nephropathy,and the curative effect is definite. The mechanism may be related to improving renal hemodynamics and blocking RAAS process.