芪地肾康汤联合前列地尔在糖尿病肾病治疗中的应用及对血清sICAM-1、尿CTGF水平的影响研究

Value of Qidi Shenkang Decoction(芪地肾康汤)Combined with Alprostadil in Treatment of Diabetic Nephropathy and Its Effect on Serum sICAM-1 and Urinary CTGF Levels

目的评价芪地肾康汤联合前列地尔在糖尿病肾病治疗中的应用价值及对血清sICAM-1、尿CTGF水平的影响。方法按照随机对照法将2019年3月—2021年1月来医院治疗的糖尿病肾病患者258例分为观察组(129例)和对照组(129例)。对照组依据《中国2型糖尿病防治指南(2017年版)》标准规范治疗,静脉推注前列地尔,10μg/次,1次/d。观察组采用芪地肾康汤联合前列地尔治疗。两组分别治疗12周。比较两组患者治疗前后肾功能指标,包括血肌酐(SCr)、尿素氮(BUN)、尿蛋白排泄率(UAER)水平,比较两组治疗前后血清中可溶性细胞黏附分子-1(sICAM-1)及尿结缔组织生长因子(CTGF)水平,比较中医证候积分变化和治疗总有效率。结果两组治疗后夜尿频多、尿浊、腰膝酸软、倦怠乏力、面浮肢肿、咽干舌燥等中医证候积分较治疗前降低,对照组组治疗后夜尿频多、尿浊、腰膝酸软、倦怠乏力、面浮肢肿、咽干舌燥等中医证候积分高于观察组(P<0.05);两组治疗后肾功能指标Scr、BUN和UAER较治疗前降低,观察组治疗后肾功能指标Scr、BUN和UAER低于对照组(P<0.05);两组治疗后血清sICAM-1及尿CTGF水平较治疗前降低,观察组降低幅度优于对照组(P<0.05);观察组治疗总有效率高于对照组(P<0.05)。结论芪地肾康汤可有效改善糖尿病肾病患者的临床症状,阻断血清sICAM-1与尿CTGF的合成与表达,改善肾功能,延缓病情进展,提高治疗疗效,值得临床进一步研究探讨。

Objective To evaluate the effect of Qidi Shenkang Decoction(芪地肾康汤)combined with alprostadil in the treatment of diabetic nephropathy value and the influence of the serum levels of sICAM-1 and urinary CTGF.Methods According to the randomized controlled method from March 2019 to January 2021 in the hospital,258 patients with diabetic nephropathy were divided into observation group(129 cases)and control group(129 cases).The control group was treated according to the standard specification of Chinese Guidelines for The Prevention and Treatment of Type 2 Diabetes(2017 Edition),intravenously injected alprostadil,10μg/time,once a day.The observation group adopted Qidi Shenkang Decoction combined with.The two groups were both treated for 12 weeks.The renal function indexes,including serum creatinine(SCR),urea nitrogen(BUN),urinary protein excretion rate(UAER),the levels of soluble cell adhesion molecule 1(SICAM-1)in serum and urinary connective tissue growth factor(CTGF)were compared between two groups before and after treatment,and the changes of TCM syndrome scores and the total effective rate were compared between two groups.Results After treatment,the scores of TCM symptoms such as frequent nocturnal urination,turbid urine,sore waist and knees,fatigue,swollen face and floating limbs,dry throat and dry tongue in the two groups were lower than those before treatment,while the scores of TCM symptoms such as frequent nocturnal urination,turbid urine,sore waist and knees,fatigue,swollen face and floating limbs,dry throat and dry tongue in the control group were higher than those in the observation group(P<0.05).The renal function indexes SCR,BUN and UAER in the observation group were lower than those in the control group(P<0.05).After treatment,the levels of serum sICAM-1 and urinary CTGF in the observation group were lower than those in the control group(P<0.05).The total effective rate of the observation group was higher than that of the control group(P<0.05).Conclusion Qidi Shenkang Decoction can effectively improve the clinical symptoms of diabetic nephropathy patients,block the synthesis and levels of serum SICAM-1 and urinary CTGF,improve renal function,delay the progression of the disease and improve the therapeutic effect,worthy of further clinical research and discussion.