荆防当归补血汤对早期糖尿病肾病临床疗效、氧化应激状态及肾功能的影响研究

Effect of Jingfang Danggui Buxue Decoction(荆防当归补血汤)on Clinical Curative Effect,Oxidative Stress State and Renal Function in Patients with Early Diabetic Nephropathy

目的观察荆防当归补血汤治疗早期糖尿病肾病(DN)的疗效,以及对患者氧化应激状态和肾功能的影响。方法选取2018年1月—2020年11月南京医科大学康达学院第一附属医院(连云港市第一人民医院)门诊收治的94例早期DN患者,按照1∶1比例简单随机化分为两组,各47例。对照组予以西医常规疗法,观察组在对照组基础上加用荆防当归补血汤。比较两组疗效、不良反应发生率、治疗前后中医证候积分、血清微小RNA(miR)-148b-3p、miRNA-21水平、氧化应激指标[丙二醛(MDA)、脂质过氧化氢(LHP)、超氧化物歧化酶(SOD)]、足细胞损伤(尿Podocin、Nephrin、Mindin含量)及血糖、肾功能指标[糖化血红蛋白(HbAlc)、空腹血糖(FBG)、尿微量白蛋白(mALB)、尿白蛋白排泄率(UAER)、mALB与肌酐比值(mALB/Cr)]。结果(1)观察组总有效率91.49%(43/47)高于对照组74.47%(35/47)(P<0.05);(2)观察组治疗12周后尿浊[(1.19±0.40)分]、气短[(1.11±0.32)分]、倦怠乏力[(1.33±0.30)分]、咽干口燥[(1.08±0.29)分]低于对照组(P<0.05);(3)观察组治疗12周后血清LHP、MDA水平低于对照组,血清SOD水平高于对照组(P<0.05);(4)观察组治疗12周后血清miR-148b-3p、miRNA-21水平低于对照组(P<0.05);(5)观察组治疗12周后尿Podocin、Nephrin、Mindin含量低于对照组;(6)观察组治疗12周后HbAlc、FBG、尿mALB、UAER、mALB/Cr低于对照组(P<0.05);(7)两组不良反应发生率比较差异无统计学意义(P>0.05)。结论荆防当归补血汤治疗早期DN,疗效确切,能有效减轻临床症状,调节氧化应激,降低血清miR-148b-3p、miRNA-21水平,减轻足细胞损伤,调控血糖,改善肾功能,具有一定安全性。

Objective To observe the curative effect of Jingfang Danggui Buxue Decoction(荆防当归补血汤)in the treatment of early diabetic nephropathy(DN)as well as its effect on the oxidative stress state and renal function of patients.Methods From January 2018 to November 2020,94 patients with early DN were selected from the outpatient clinic of the hospital.According to the simple randomization ratio of 1∶1,they were divided into two groups,each with 47 cases.The control group received conven-tional western medicine therapy and the observation group added Jingfang Danggui Buxue Decoction on the basis of the control group.The efficacy,incidence of adverse reactions,TCM syndrome scores,serum levels of microRNA(miR)-148b-3p and miRNA-21,oxidative stress indicators[malondialdehyde(MDA),lipid hydrogen peroxide(LHP),superoxide dismutase(SOD)],podocyte damage(podocin,nephrin and mindin in urine)and blood glucose,renal function indexes[glycated hemoglo-bin(HbAlc),fasting blood glucose(FBG),microalbuminuria(mALB),urinary albumin excretion rate(UAER),ratio of mALB to creatinine(mALB/Cr)]before and after treatment were compared between the two groups.Results(1)The total effective rate of the observation group was 91.49%(43/47),higher than that[74.47%(35/47)]of the control group(P<0.05).(2)After 12 weeks of treatment,the scores of urine turbidity[(1.19±0.40)points],burnout[(1.11±0.32)points],shortness of breath[(1.33±0.30)points],dry throat and dry mouth[(1.08±0.29)points]of the observation group were lower than those of the control group(P<0.05).(3)The serum levels of LHP and MDA in the observation group after 12 weeks of treatment were lower than those of the control group and the level of serum SOD was higher than that of the control group(P<0.05).(4)The serum levels of miR-148b-3p and miRNA-21 in the observation group after 12 weeks of treatment were lower than those in the con-trol group(P<0.05).(5)After 12 weeks of treatment in the observation group,the levels of podocin,nephrin and mindin in u-rine were lower than those of the control group(P<0.05).(6)After 12 weeks of treatment in the observation group,the levels of HbAlc,FBG,urine mALB,UAER and mALB/Cr were lower than those of the control group(P<0.05).(7)There was no signifi-cant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Jingfang Danggui Buxue De-coction is effective in treating early DN,which can effectively reduce the clinical symptoms,regulate the oxidative stress and re-duce the serum levels of miR-148b-3p and miRNA-21,alleviate the podocyte damage,regulate the blood glucose and improve the renal function,and it has certain safety.