健肾化瘀汤联合前列地尔对早期糖尿病肾病血液流变学及肾功能的影响

Effect of Jianshen Huayu Decoction(健肾化瘀汤)Combined with Alprostadil on Hemorrheology and Renal Function in Patients with Early Diabetic Nephropathy

目的探究健肾化瘀汤联合前列地尔对早期糖尿病肾病(DN)患者血液流变学及肾功能的影响。方法选取2018年10月—2019年10月98例早期DN患者进行前瞻性研究,采用随机数字表法分为对照组和研究组,每组49例。两组入院后均行常规治疗,于此基础上给予对照组前列地尔,给予研究组健肾化瘀汤联合前列地尔。比较两组治疗效果、不良反应发生率、治疗前后中医证候积分、血清鞘氨醇激酶1(SphK1)和1-磷酸鞘氨醇(S1P)水平、肾功能指标[尿微量白蛋白排泄率(UAER)、血尿素氮(BUN)、血肌酐(Scr)]、血液流变学指标(血浆黏度、红细胞聚集指数、全血黏度低切)、炎性因子[白介素6(IL-6)、单核细胞趋化蛋白-1(MCP-1)、转化生长因子-β1(TGF-β1)]。结果研究组治疗总有效率(93.88%,46/49)高于对照组(77.55%,38/49)(P<0.05);研究组治疗1个月、3个月后中医证候积分及血清SphK1、S1P水平低于对照组(P<0.05);研究组治疗1个月、3个月后UAER、BUN、Scr水平低于对照组(P<0.05);研究组治疗1个月、3个月后血浆黏度、红细胞聚集指数、全血黏度低切低于对照组(P<0.05);研究组治疗1个月、3个月后血清IL-6、MCP-1、TGF-β1水平低于对照组(P<0.05);两组不良反应总发生率比较差异无统计学意义(P>0.05)。结论采用健肾化瘀汤联合前列地尔治疗早期DN患者能进一步改善血液流变学指标,抑制SphK1/S1P信号通路,从而有效降低机体炎症反应,促进肾功能改善,减轻患者临床症状,疗效显著,且具有一定安全性。

Objective To investigate the effect of Jianshen Huayu Decoction(健肾化瘀汤)combined with alprostadil on hemorrheology and renal function in patients with early diabetic nephropathy(DN).Methods From October 2018 to October 2019,98 patients with early DN in our hospital were prospectively studied.They were divided into a control group and a research group by a random number table method,49 cases in each group.After admission,both groups received conventional treatment.On this basis,the control group was given alprostadil,and the study group was given Jianshen Huayu Decoction combined with alprostadil.The treatment effect,incidence of adverse reactions,TCM syndrome scores before and after treatment,serum levels of sphingosine kinase 1(SphK1)and sphingosine 1-phosphate(S1P),renal function indexes[urine microalbumin excretion rate(UAER),blood urea nitrogen(BUN),blood creatinine(Scr)],blood rheology indicators(plasma viscosity,erythrocyte aggregation index,whole blood viscosity low cut)and inflammatory factors[interleukin 6(IL-6),monocyte chemoattractant protein-1(MCP-1),transforming growth factor-β1(TGF-β1)]before and after treatment were compared between the two groups.Results The total effective rate in the study group(93.88%,46/49)was higher than that in the control group(77.55%,38/49)(P<0.05).The TCM syndrome score and serum levels of SphK1 and S1P in the study group after 1 and 3 months of treatment were lower than those of the control group(P<0.05).The levels of UAER,BUN and Scr in the study group were lower than those in the control group after 1 and 3 months of treatment(P<0.05).The plasma viscosity,erythrocyte aggregation index and low-viscosity of whole blood viscosity of the study group after 1 and 3 months of treatment were lower than those of the control group(P<0.05).The serum levels of IL-6,MCP-1 and TGF-β1 in the study group were lower than those in the control group after 1 and 3 months of treatment(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion The use of Jianshen Huayu Decoction combined with alprostadil to treat patients with early DN can further improve hemorheological parameters and inhibit SphK1/S1P signaling pathway.Therefore,it can effectively reduce the body's inflammatory response,promote the improvement of renal function,reduce the clinical symptoms of patients and has a significant effect and certain safety.