参芪通脉方防治糖尿病肾病患者自体动静脉内瘘早期失功的疗效及对纤溶系统功能、脂质代谢与转化生长因子-β_(1)的影响

Efficacy of Shenqi Tongmai Decoction in the prevention and treatment of early failure of autologous arteriovenous fistula in patients with diabetic nephropathy and its effect on the function of fibrinolytic system,lipid metabolism and TNF-β_(1)

目的观察参芪通脉方防治糖尿病肾病(DN)患者自体动静脉内瘘(AVF)早期失功的疗效及对纤溶系统功能、脂质代谢与转化生长因子-β_(1)(TGF-β_(1))的影响。方法将2017年3月—2019年3月在内蒙古医科大学附属医院接受AVF血液透析的86例终末期DN患者随机分为2组,对照组43例于内瘘成熟首次透析后给予阿司匹林干预,观察组43例在对照组基础上给予参芪通脉方干预,疗程均为12周。记录2组AVF早期失功发生率,观察2组AVF使用前及使用6周、12周后内瘘血流速度与内瘘静脉血管内径、纤溶指标、脂代谢指标与血清TGF-β_(1)的变化。结果观察组AVF使用12周AVF早期失功发生率为16.3%(7/43),对照组为32.6%(14/43),观察组明显低于对照组(P<0.05)。与AVF使用前比较,2组AVF使用6周、12周后内瘘血流速度均减慢(P均<0.05),内瘘静脉血管内径均缩短(P<0.05),但观察组上述指标均优于对照组(P均<0.05)。与AVF使用前比较,2组AVF使用6周、12周后的纤维蛋白原(FIB)、D-二聚体水平均明显增高(P均<0.05),但观察组上述时间的FIB、D-二聚体水平均明显低于对照组(P均<0.05)。与AVF使用前比较,2组AVF使用6周、12周后的三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、TGF-β_(1)水平均明显增高(P均<0.05),高密度脂蛋白胆固醇(HDL-C)水平均明显降低(P均<0.05),但观察组上述时间的TG、TGF-β_(1)水平均明显低于对照组(P均<0.05),HDL-C水平高于对照组(P<0.05)。结论参芪通脉方可显著降低DN患者AVF早期失功发生率,有效维持AVF功能,机制可能与调节纤溶功能、脂质代谢紊乱及TGF-β_(1)表达水平有关。

Objective It is to observe the curative effect of Shenqi Tongmai Recipe in preventing and treating the early failure of autologous arteriovenous fistula(AVF)in patients with diabetic nephropathy(DN)and its effect on the function of fibrinolytic system,lipid metabolism and transforming growth factor-β_(1)(TGF-β_(1)).Methods 86 patients with end-stage DN who underwent AVF hemodialysis in the Affiliated Hospital of Inner Mongolia Medical University from March 2017 to March 2019 were randomly divided into 2 groups.43 patients in the control group were given aspirin intervention after the first dialysis after the internal fistula was mature.43 patients in the observation group was treated with Shenqi Tongmai Decoction on the basis of the control group,both groups were treated for 12 weeks.The incidence of early failure of AVF in the two groups was recorded,and the changes in the blood flow velocity of the internal fistula,the internal diameter of the internal fistula venous vessel,fibrinolysis indexes,lipid metabolism indexes and serum TGF-β_(1)before AVF,6 weeks,and 12 weeks after application of AVF were observed in the two groups.Results The incidence of early AVF failure in the observation group was 16.3%(7/43),and that in the control group was 32.6%(14/43),the observation group was significantly lower than the control group(P<0.05).Compared with before AVF,the blood flow speed of the internal fistula were slowed down,and the internal diameter of the internal fistula vein was shortened after 6 weeks and 12 weeks of AVF in the two groups(P<0.05),but the above indicators of the observation group were better than the control group(P<0.05).Compared with before AVF,the levels of fibrinogen(FIB)and D-dimer of the two groups were significantly increased after 6 weeks and 12 weeks of AVF(P<0.05),but the levels of FIB and D-dimer of the observation group at the above time were significantly lower than the control group(P<0.05).Compared with before AVF,the levels of triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),and TGF-β_(1)of the two groups were significantly increased(P<0.05),high-density lipoprotein cholesterol(HDL-C)were significantly reduced after 6 weeks and 12 weeks of AVF(P<0.05),but the levels of TG and TGF-β_(1)in the observation group were significantly lower than those of the control group(P<0.05),and the level of HDL-C was significantly higher at the above time than the control group(P<0.05).Conclusion Shenqi Tongmai Decoction can significantly reduce the incidence of early AVF failure in patients with DN and effectively maintain the function of AVF.The mechanism may be related to the regulation of fibrinolytic function,lipid metabolism disorder and TGF-β_(1)expression.