基于miRNA探讨补肾健脾方治疗糖尿病肾病的机制研究

Study on the mechanism of Bushen Jianpi Decoction in the treatment of diabetic nephropathy based on miRNA.

目的研究基于miRNA探讨补肾健脾方治疗糖尿病肾病的机制。法前瞻性随机选取2019年10月至2020年10月广东祈福医院内分泌科收治的2型糖尿病肾病3期患者80例,按照随机数字表法分为治疗组和对照组,每组各40例。对照组予糖尿病常规治疗,治疗组在常规治疗基础上加补肾健脾方。统计分析2组患者治疗前、治疗3个月后的尿微量白蛋白、24 h尿蛋白、miRNA-93、空腹葡萄糖(FPG)、餐后2 h葡萄糖(2 h PBG)、空腹血清C肽、餐后2 h血清C肽、低密度脂蛋白胆固醇(LDC-L)、糖化血红蛋白(HbA1c)值。结果治疗前,2组患者尿微量白蛋白、24 h尿蛋白及miRNA-93表达水平比较,差异均无统计学意义(P>0.05)。治疗3个月后,治疗组患者的尿微量白蛋白、24 h尿蛋白水平分别为(0.10±0.03)g/24 h、(0.22±0.03)mg/L,显著低于对照组[(0.22±0.06)g/24 h、(0.26±0.04)mg/L],miRNA-93表达(1.84±0.05)均显著高于对照组(1.15±0.06),差异均有统计学意义(P<0.05)。治疗前,2组患者FPG、2 h PBG、空腹血清C肽、餐后2 h血清C肽、LDC-L、HbA1c水平比较,差异均无统计学意义(P>0.05)。治疗3个月后,治疗组患者的FPG、2 h PBG、LDC-L、HbA1c水平分别为(6.7±1.8)mmol/L、(9.2±1.3)mmol/L、(2.00±0.82)mmol/L、(6.40±1.90)%,显著低于对照组[(7.3±1.2)mmol/L、(11.8±1.4)mmol/L、(2.11±0.44)mmol/L、(7.60±1.30)%],空腹血清C肽、餐后2 h血清C肽水平分别为(2.38±0.21)、(3.06±1.01)μg/L,显著高于对照组[(2.10±0.44)、(2.20±0.07)μg/L],差异均有统计学意义(P<0.05)。结论在常规治疗基础上加补肾健脾方治疗糖尿病肾病可以提高miRNA-93表达水平,降低尿微量白蛋白、尿蛋白、血糖、血脂水平。miRNA可能作为中间因素参与补肾健脾方对糖尿病肾病尿微量白蛋白的调节作用。

Objective To study the mechanism of Bushen Jianpi Decoction in the treatment of diabetic nephropathy based on miRNA.Methods A prospectie,randomly selected from October 2019 to October 2020 in Department of Endocrinology,Guangdong Clifford Hospital in patients with type 2 diabetes kidney disease stage 380 cases were randomly divided into kidney and spleen group and the control group,40 cases in each group,control group routine treatment for diabetes,the treatment group on the basis of conventional treatment with kidney and spleen,statistical analysis of two groups of patients before and after treatment of urine microalbumin,24 hours urinary protein,the miRNA-93,fasting glucose,2-hours postprandial glucose(2 h PBG),fasting serum c-peptide 2 hours after meal,2 hours postprandial serum c-peptide,low-density lipoprotein cholesterol(LDC-L)and hemoglobin A1c(HbA1c)ratio.Resluts Before treatment,there was no significant difference in the expression levels of microalbumin,24-hour urinary protein and miRNA-93 between the two groups(P>0.05).After 3 months of treatment,the urine microalbumin and 24-hour urine protein levels of patients in the treatment group were(0.10±0.03)g/24 h and(0.22±0.03)mg/L,respectively,which were significantly lower than those in the control group[(0.22±0.06)g/24 h,(0.26±0.04)mg/L],the expression of miRNA-93(1.84±0.05)was significantly higher than that in the control group(1.15±0.06),and the differences were statistically significant(P<0.05).Before treatment,there was no significant difference in FPG,2 h PBG,fasting serum C-peptide,2 h postprandial serum C-peptide,LDC-L,and HbA1c levels in the two groups(P>0.05).After 3 months of treatment,the levels of FPG,2 h PBG,LDC-L and HbA1c in the treatment group were(6.7±1.8)mmol/L,(9.2±1.3)mmol/L,(2.00±0.82)mmol/L,(6.40±1.90)%,respectively,which were significantly lower than those in the control group[(7.3±1.2)mmol/L,(11.8±1.4)mmol/L,(2.11±0.44)mmol/L,(7.60±1.30)%],the levels of serum C-peptide and C-peptide 2 h after meal were(2.38±0.21)and(3.06±1.01)μg/L,respectively,which were significantly higher than those of the control group[(2.10±0.44),(2.20±0.07)μg/L],The differences were statistically significant(P<0.05).Conclusion On the basis of conventional treatment,adding Bushen Jianpi Decoction in the treatment of diabetic nephropathy can increase the expression level of miRNA-93,and reduce the level of urine microalbumin,urine protein,blood sugar and blood lipid.As an intermediate factor,miRNA is involved in the regulation effect of Bushen Jianpifang on urinary microalbumin in diabetic nephropathy.