血必净治疗糖尿病肾病的疗效观察及机制探讨:基于倾向性评分匹配的回顾性队列研究

Therapeutic effects and mechanism of Xuebijing in the treatment of diabetic nephropathy:a retrospective cohort study based on propensity score matching

目的:研究血必净治疗糖尿病肾病(DN)的疗效及作用机制。方法:抽取2015年1月至2019年12月在常熟市第一人民医院中医科住院治疗的84例DN患者,通过1:1倾向性评分匹配后,最终纳入血必净组及对照组各36例。两组均给予控制血糖及血压、调节血脂、饮食治疗,维持水电解质平衡,保护其他脏器功能等常规综合性治疗。血必净组在此基础上加用血必净治疗,对照组则加用等量的生理氯化钠溶液进行对照。检测并比较两组治疗7 d后的24 h蛋白尿、血肌酐(Scr)、血尿素氮(BUN)、尿β2微球蛋白(β2-MG)、激活凝血时间(ACT)、血栓率(CR)、血小板功能(PF)、炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、白细胞介素-6(IL-6)]及血液流变学指标的变化。结果:治疗后,血必净组24 h蛋白尿、Scr、BUN、尿β2-MG、TNF-α、IL-1、IL-6、ACT、CR、全血低切黏度、全血高切黏度、血小板聚集率及红细胞聚集指数均较对照组下降更显著(P<0.05)。且两组均无不良事件发生。结论:血必净能通过抑制炎性因子、调节凝血功能及血液流变学等方面改善DN的临床指标,且安全可靠。

Objective To study the effects and mechanism of Xuebijing in the treatment of diabetic nephropathy(DN).Methods A total of 84 patients with DN who were hospitalized in the Department of Traditional Chinese Medicine of Changshu First People’s Hospital from January 2015 to December 2019 were included.After 1∶1 tendency score matching,36 patients were enrolled in the Xuebijing group,and 36 patients in the control group.Both groups were given routine comprehensive treatment,such as controlling blood glucose and blood pressure,regulating blood lipid and diet,maintaining water electrolyte balance and protecting other organ functions.On this basis,the Xuebijing group was treated with Xuebijing,while the control group was treated with the same dosage of normal saline.The changes of 24-hour proteinuria,serum creatine(Scr),blood urea nitrogen(BUN),microglobulin-β2(β2-MG),active coagulation time(ACT),coagulation rate(CR),platelet function(PF),tumor necrosis factor-α(TNF-α),interleukin-1(IL-1),interleukin-6(IL-6)and hemorheological indexes were detected and compared between the two groups 7 days after treatment.Results After treatment,24-hour proteinuria,Scr,BUN,β2-MG,TNF-α,IL-1,IL-6,ACT,CR,whole blood low shear viscosity,whole blood high shear viscosity,platelet aggregation rate and red blood cell aggregation index in the Xuebijing group decreased more significantly than those in the control group(P<0.05).There was no adverse event in either group.Conclusions Xuebijing can improve the clinical indexes of DN by inhibiting inflammatory factors,regulating coagulation function and hemorheology.And it is safe and reliable.