加味黄芪赤风汤对IgA肾病气虚血瘀兼风邪热毒证患者蛋白尿及尿足细胞相关蛋白表达的影响

Effect of Modified Huangqi Chifeng Decoction(黄芪赤风汤)on Proteinuria and Urinary Podocyte-related Protein Expression in Patients with IgA Nephropathy of Qi Deficiency,Blood Stasis and Pathogenic Wind and Heat Toxin Syndrome

目的观察加味黄芪赤风汤治疗IgA肾病气虚血瘀兼风邪热毒证患者的临床疗效并探讨其可能的作用机制。方法 60例IgA肾病气虚血瘀兼风邪热毒证患者随机分为治疗组和对照组各30例。两组均给予替米沙坦片每次80mg,每日1次。治疗组给予加味黄芪赤风汤每次1袋,每天2次,对照组给予中药安慰剂每次1袋,每天2次。两组疗程均为16周。记录两组患者中医证候积分、24小时尿蛋白定量(24hU-TP)、血清肌酐(Scr)、血清丙氨酸氨基转移酶(ALT)、血清门冬氨酸氨基转移酶(AST)及尿足细胞相关蛋白尿足糖萼蛋白、肾病蛋白的表达,并评价临床疗效及中医证候疗效。结果治疗组总有效率(93.10%)明显高于对照组(65.52%,P<0.05);治疗组中医证候疗效总有效率(89.66%)明显高于对照组(13.79%,P<0.01)。与治疗前比较,两组治疗第4、8、12、16周24hU-TP均明显下降(P<0.05或P<0.01),组间比较,治疗组24hU-TP下降更明显(P均<0.01)。与治疗前比较,治疗组治疗第4、8、12、16周及对照组治疗第16周中医证候积分均有所下降(P<0.05或P<0.01)。治疗第8、12、16周组间比较,治疗组中医证候积分下降更明显(P均<0.01)。与治疗前比较,治疗组治疗第8、16周Scr明显下降(P<0.01)。两组比较治疗16周治疗组Scr下降更明显(P<0.05)。治疗组治疗后与治疗前比较,足糖萼蛋白和肾病蛋白的表达明显降低,差异具有统计学意义(P均<0.01);两组治疗后进行组间比较,治疗组两种蛋白的表达下降更明显,差异有统计学意义(P<0.05)。结论加味黄芪赤风汤可以提高IgA肾病气虚血瘀兼风邪热毒证患者的临床疗效,改善临床症状,其机制可能与保护尿足细胞有关。

Objective To explore the clinical effects of modified Huangqi Chifeng Decoction(MHCD, 黄芪赤风汤) in treatment of patients with IgA nephropathy of Qi deficiency, blood stasis and pathogenic wind and heat toxin syndrome(QDBSPWHT) as well as its possible mechanism. Methods Sixty patients with IgA nephropathy of QDBSPWHT syndrome were randomized into treatment group and control group with 30 patients in each group. Both groups were given telmisartan tablets 80 mg each time, once daily, and the treatment group was additionally administered with modified MHCD 1 bag each time, twice daily, while the control group was added with placebo of modified MHCD 1 bag each time, twice daily;the treatments of both groups lasted for 16 weeks. The scores of traditional Chinese medicine(TCM) syndromes, 24-hour urine protein quantification(24 hU-TP), serum creatinine(Scr), serum alanine aminotransferase(ALT), serum aspartate aminotransferase(AST), and expressions of urinary podocyte-associated podocalyxin and nephropathy protein were observed. The clinical effects and symptom-related clinical effects were assessed. Results The total effective rate of the treatment group was 93.10%, significantly higher than 65.52% of the control group(P<0.05);regarding the symptom-related effects, the total effective rate of the treatment group was 89.66%, which was significantly higher than 13.79% of control group(P<0.01). The levels of 24 hU-TP at the 4 th, 8 th, 12 nd, and 16 th week in both groups significantly decreased compared to those before treatment(P<0.05 or P<0.01), and more decrease was found in treatment group(P<0.01). The TCM symptoms scores of treatment group at the 4 th, 8 th, 12 nd, and 16 th week and that of control group at the 16 th week significantly decreased compared to those before treatment(P<0.05 or P<0.01), and the comparisons between groups at the 8 th, 12 nd, and 16 th week found larger scores decreases in the treatment group(P<0.01). The Scr level of treatment group significantly decreased at the 8 th and 16 th week(P<0.01), and more decrease was seen in treatment group than control group at the 16 th week(P<0.05). Both the expression of podocalyxin and that of nephin significantly decreased(P<0.01) after treatment, and the treatment group had lower expressions than control group(P<0.05). Conclusion Modified MHCD can increase the clinical effects and improve symptoms of patients with IgA nephropathy of QDBSPWHT syndrome, and the mechanism may be related to the protection of urinary podocytes.