补肾益肝活血汤治疗肝肾阴虚兼血瘀证糖尿病肾病Ⅲ期患者临床疗效及对肾小管损伤标志物的影响

Effects of Bushen Yigan Huoxue Decoction(补肾益肝活血汤) on Third Stage of Diabetic Kidney Disease with Syndrome of Liver-kidney Yin Deficiency and Blood Stasis and Influence on Renal Tubular Injury Markers

目的观察补肾益肝活血汤治疗肝肾阴虚兼血瘀证糖尿病肾病(DKD)Ⅲ期患者临床疗效及对肾小管损伤标志物的影响。方法将90例肝肾阴虚兼血瘀证DKDⅢ期患者采用随机数字表法随机分为观察组45例和对照组45例。对照组给予西医常规治疗,观察组在对照组基础上加用自拟补肾益肝活血汤治疗,疗程均为4周。比较两组患者临床疗效,观察两组患者治疗前后中医证候积分、糖代谢指标[空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)]、肾功能指标[尿白蛋白排泄率(UAER)、血肌酐(Scr)、估算肾小球滤过率(eGFR)]、肾小管损伤指标[β2微球蛋白(β2-MG)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、肾损伤分子1(KIM-1)]水平。结果治疗4周后观察组临床有效率(93.33%)显著高于对照组(77.78%),差异有统计学意义(P<0.05)。与对照组比较,治疗4周后观察组中医证候积分、FPG、2hPG、HbAlc、UAER、Scr水平显著降低和eGFR水平显著升高(P<0.05)。与对照组比较,治疗4周后观察组血清β2-MG、KIM-1、NAG表达水平显著降低(P<0.05)。结论补肾益肝活血汤联合西医常规治疗肝肾阴虚兼血瘀证DKDⅢ患者临床效果显著,能够有效改善中医临床症状、血糖代谢水平和肾功能水平,降低血清β2-MG、KIM-1、NAG表达水平,减轻肾小管损伤,延缓肾脏组织进行性加重,值得临床应用。

Objective To evaluate clinical efficacy of Bushen Yigan Huoxue Decoction(补肾益肝活血汤)on third stage of diabetic kidney disease(DKD)with syndrome of liver-kidney Yin deficiency and blood stasis and influence on renal tubular injury markers.Methods 90 patients in third stage of DKD with syndrome of liver-kidney Yin deficiency and blood stasis were randomly divided into observation group(n=45)and control group(n=45).The control group was given routine treatment of Western medicine,and the observation group was given self-made Bushen Yigan Huoxue Decoction on the basis of the control group.The course of treatment covered for four weeks.The clinical efficacy was compared between two groups.The TCM syndrome score,glucose metabolism indexes[fasting plasma glucose(FPG),2 h postprandial blood glucose(2 h PG),glycosylated hemoglobin(HbA1c)],renal function indexes[urinary albumin excretion rate(UAER),serum creatinine(Scr),estimated glomerular filtration rate(eGFR)],renal tubular injury indexes[β2-microglobulin(β2-MG),N-acetyl beta-D-glucosaminidase(NAG),kidney injury molecule-1(KIM-1)]were observed before and after treatment between two groups.Results After four weeks of treatment,the clinical effective rate of the observation group(93.33%)was higher than that of the control group(77.78%),and the difference was statistically significant(P<0.05).Compared with the control group,the TCM syndrome score,FPG,2 h PG,HbAlc,UAER,Scr levels in the observation group were significantly decreased and eGFR levels were significantly increased after four weeks of treatment(P<0.05).Compared with the control group,the expression levels of serumβ2-MG,KIM-1,NAG in the observation group were significantly decreased after 4 weeks of treatment(P<0.05).Conclusion Bushen Yigan Huoxue Decoction combined with conventional Western medicine has a significant clinical effect on third stage of diabetic kidney disease with syndrome of liver-kidney Yin deficiency and blood stasis.It can effectively improve clinical symptoms,blood glucose metabolism and renal function,reduce the expression levels of serumβ2-MG,KIM-1,NAG,reduce renal tubular injury,and delay the progressive aggravation of renal tissue,which is worthy of clinical application.