益气温阳活血利水方对心肾综合征病人氧化应激反应的影响

The Influenec of Yiqi Wenyang Huoxue Lishui Decoction on the Oxidative Stress in Patients with Cardio-renal Syndrome

目的探讨氧化应激反应与心肾综合征(CRS)发病的相关性,观察益气温阳活血利水方对心肾综合征氧化应激的作用及其对CRS病人心肾功能的影响。方法选取2014年1月—2015年7月入住我院心内科、肾内科及ICU的病人共243例,最终纳入研究232例,根据心肾功能水平将入选病人分为对照组(A组59例)、单纯心衰组(B组61例)、单纯肾衰组(C组62例)、心肾综合征组(D组61例)。对各组受试者入院24 h及应用益气温阳活血利水方满疗程后空腹抽取静脉血,分别测定病人治疗前后血清脂质过氧化物(MDA)、超氧化物歧化酶(SOD)、一氧化氮(NO)、一氧化氮合酶总活力(tNOS)、诱导型一氧化氮合酶(iNOS)活力、B型利钠肽(BNP)、心脏射血分数(EF)、内生肌酐清除率(Ccr)水平,均采用分光比色法。对照组、单纯心衰组及单纯肾衰组采用西医对症治疗,心肾综合征组在西医治疗基础上加用益气温阳活血利水方治疗,4组疗程均为20 d,疗程结束后对比4组病人心肾功能及氧化应激反应改善情况。结果 B组、C组、D组治疗前MDA、BNP水平均高于A组,SOD、tNOS、iNOS、NO、EF、Ccr水平均低于A组;D组治疗前MDA、BNP水平均高于A组、B组及C组,SOD、tNOS、iNOS、NO、EF、Ccr水平均低于A组、B组及C组,差异有统计学意义(P>0.05)。B组、C组、D组治疗后MDA、BNP水平均有所降低,SOD、tNOS、iNOS、NO、EF、Ccr水平均有所升高;D组治疗后MDA、BNP水平降低幅度均大于B组、C组,SOD、tNOS、iNOS、NO、EF、Ccr水平升高幅度均大于B组、C组,均具有统计学意义(P<0.05);A组治疗前后MDA、SOD、BNP、tNOS、iNOS、NO、EF、Ccr水平比较差异无统计学意义(P>0.05)。B组、C组、D组MDA、SOD、NO、tNOS、iNOS、BNP、EF、Ccr之间具有相关性。结论氧化应激反应与CRS发病密切相关,西药联合益气温阳活血利水方能够改善心肾综合征病人氧化应激反应,同时改善CRS病人的心肾功能。

Objective To investigate the correlation between oxidative stress and the onset of cardio-renal syndrome（ CRS）,and to observe the effect of Yiqi Wenyang Huoxue Lishui decoction（ YWHLD） on the oxidative stress and the cardiac and renal function in patients with CRS.Methods Two hundreds and thirty-two patients in the Department of Cardiology,Nephrology and ICU from January 2014 to July 2015 were enrolled in the study.The selected patients were divided into control group（ group A,n = 59）,heart failure group（ group B,n = 61）,renal failure group（ group C,n = 62）,CRS group（ group D,n = 61） according to the level of heart and kidney function.The patients were treated with routine treatment in group A,group B and group C,and YWHLD in group D for 20 days.The levels of serum malondialdehyde（ MDA）,superoxide dismutase（ SOD）,nitric oxide（ NO）,total nitric oxide synthase activity（ tNOS）,inducible nitric oxide synthase（ iNOS） activity,B type natriuretic peptide（ BNP）,ejection fraction（ EF）,endogenous creatinine clearance rate（ Ccr） were measured before and after treatment.Results The levels of MDA,and BNP in group B,group C and group D were higher than those in group A before treatment.The levels of SOD,tNOS,iNOS,NO,EF and Ccr were lower than those in group A.The levels of MDA,and BNP in group D before treatment were higher than those in group A,group B and group C（ P〈0.05）.The levels of SOD,tNOS,iNOS,NO,EF and Ccr in group D before treatment were lower than those in group A,group B and group C（ P〈0.05）.The levels of SOD,MDA,and BNP were decreased while the levels of tNOS,iNOS,NO,EF and Ccr were increased in group B,group C and group D after treatment.The levels of MDA,and BNP in group D were lower than those in group B and C,while the levels of tNOS,iNOS,NO,EF and Ccr were higher than those in group B and C（ P〈0.05）.There were no differences in the levels of MDA,SOD,BNP,tNOS,iNOS,NO,EF and Ccr in group A before and after treatment（ P〉0.05）.There was a correlation between MDA,SOD,NO,tNOS,iNOS,BNP,EF and Ccr in group B,group C and group D.Conclusion Oxidative stress is closely related to the pathogenesis of CRS.YWHLD can improve the oxidative stress and the heart and kidney function in patients with CRS.