加减益肾化瘀方对早中期慢性肾功能衰竭患者结缔组织生长因子、骨形成蛋白7、丙二醛、总抗氧化能力及超氧化物歧化酶水平的影响

Effect of Modified Yishen Huayu Prescription on CTGF,BMP-7,MDA,TAC,and SOD Levels in Patients with Early and Mid-term Chronic Renal Failure

目的探讨加减益肾化瘀方对早中期慢性肾功能衰竭患者结缔组织生长因子(Connective tissue growth factor,CTGF)、骨形成蛋白7(Bone Morphogenetic Protein-7,BMP-7)、丙二醛(Serum malondialdehyde,MDA)、总抗氧化能力(Total antioxidant capacity,TAC)及超氧化物歧化酶(Superoxide dismutase,SOD)水平的影响。方法选取2018年1月—2020年6月期间南京中医药大学常熟附属医院/常熟市中医院肾内科收治的80例早中期慢性肾功能衰竭患者为研究对象,按随机数字表法将其分为研究组和对照组,每组各40例。对照组给予氯沙坦钾治疗,研究组在对照组治疗的基础上给予加减益肾化瘀方治疗。治疗6个月后,观察比较两组患者治疗前后中医证候(浮肿难消,腰酸膝软,畏寒肢冷,口唇色暗,腰痛,面色晦暗或黧黑,夜尿频多)积分,肾功能[肾小球滤过率(eGFR)、肌酐、尿素氮、24 h尿蛋白定量],CTGF、BMP-7、MDA、SOD水平变化情况,临床疗效及安全性。结果治疗后研究组总稳定率95.00%(38/40)高于对照组72.50%(29/40),差异有统计学意义(P<0.05)。治疗后两组患者浮肿难消,腰酸膝软,畏寒肢冷,口唇色暗,腰痛,面色晦暗或黧黑,夜尿频多评分均较治疗前降低,差异有统计学意义(P<0.05);且研究组浮肿难消,腰酸膝软,畏寒肢冷,口唇色暗,腰痛,面色晦暗或黧黑,夜尿频多评分均较对照组降低,差异有统计学意义(P<0.05)。治疗后两组患者肌酐、尿素氮、24 h尿蛋白定量水平均较治疗前降低,eGFR水平均较治疗前升高,差异有统计学意义(P<0.05);且研究组肌酐、尿素氮、24 h尿蛋白定量水平较对照组降低,eGFR水平较对照组升高,差异有统计学意义(P<0.05)。治疗后两组患者CTGF、MDA水平均较治疗前降低,BMP-7、TAC及SOD水平均较治疗前升高,差异有统计学意义(P<0.05);且研究组CTGF、MDA水平较对照组降低,BMP-7、TAC及SOD水平较对照组升高,差异有统计学意义(P<0.05)。治疗过程中,两组患者均未出现不良反应,且心电图、肝功能、粪便检查均正常。结论早中期慢性肾功能衰竭患者采用加减益肾化瘀方治疗效果显著,能够调节CTGF、BMP-7、MDA、TAC及SOD水平,值得临床推广使用。

Objective To investigate the effect of modified Yishen Huayu Prescription on connective tissue growth factor(CTGF)and bone morphogenetic protein 7(BMP-7),malondialdehyde(MDA),total antioxidant capacity(TAC),and superoxide dismutase(SOD)of patients with early and mid-term chronic renal failure(CRF).Methods Eighty patients with early and mid-term CRF admitted to the Department of Nephrology,Changshu Affiliated Hospital of Nanjing University of Chinese Medicine/Changshu Hospital of Traditional Chinese Medicine from January 2018 to June 2020 were selected as the subjects,and divided into a control group and a study groupbythe random number table method,with 40 cases in each group.Patients in the control group were treated with losartan potassium,and those in the study group were additionally treated with modified Yishen Huayu Prescriptionbased on the control group.After 6 months of treatment,the traditional Chinese meidince(TCM)syndrome scores(refractory edema,sour waist and soft knees,cold limbs,dark lips,lumbago,dim complexion,and frequent nocturia),renal functions[glomerular filtration rate(GFR),creatinine,urea nitrogen,and 24 h urine protein quantification],the levels of CTGF,BMP-7,MDA,and SOD,clinical efficacy,and safetyof patients in thetwo groups before and after treatmentwere compared.Results Aftertreatment,the total effective rate in the study group was 95.00%(38/40),which was higher than 72.50%(29/40)in the control group(P<0.05).After treatment,the scores of refractory edema,sour waist and soft knees,cold limbs,dark lips,lumbago,dim complexion,and frequent nocturia of patients in the two groups were lower than those before treatment(P<0.05),and the scores in the study group were lower than those in the control group(P<0.05).The levels of creatinine,urea nitrogen,and 24 h urine protein quantification in the two groups decreased after treatment,whereas the level of GFR increased(P<0.05).The levels of creatinine,urea nitrogen,and 24 h urine protein quantification in the study group were lower than those in the control group,whereas the level of GFR was higher than that in the control group(P<0.05).The levels of CTGF and MDA of patients in the two groups decreased after treatment,whereas the levels of BMP-7,TAC,and SOD increased(P<0.05).The levels of CTGF and MDA in the study group were lower than those in the control,whereas the levels of BMP-7,TAC,and SOD were higher than those in the control group(P<0.05).During treatment,no adverse reaction was observed in the two groups,and the electrocardiogram(ECG),liver functions,and fecal examination were all normal.Conclusion The modified Yishen Huayu Prescriptionhas a significant effect on the treatment of patients with early and mid-term CRF,which regulates the levels of CTGF,BMP-7,MDA,TAC,and SOD,and is worthy of clinical application.