黄芪改善早期2型糖尿病肾病患者尿L-FABP的效果观察

Clinical effect of Astragalus membranaceus in improving urinary liver-type fatty acid binding protein in patients with early-stage type 2 diabetic nephropathy

目的:观察黄芪对2型糖尿病患者早期肾损害标志物尿肝脏型脂肪酸结合蛋白(L-FABP)的影响。方法:将62例2型糖尿病气虚证患者随机分为治疗组(32例)和对照组(30例)。对照组予西医常规治疗,治疗组在对照组基础上加用黄芪颗粒治疗。治疗3周后观察2组L-FABP、尿β_(2)微球蛋白(β_(2)-MG)、尿微量白蛋白与尿肌酐比值(ACR)、糖化白蛋白、中医证候积分等指标的变化。并观察尿L-FABP与体质量指数(BMI)、糖代谢、肾功能指标的相关性。结果:糖尿病患者尿L-FABP的表达较健康人高,其与总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、尿β_(2)-MG、胱抑素C呈正相关,与尿β_(2)-MG的相关性最大。2组治疗后尿L-FABP、β_(2)-MG、ACR、中医证侯积分较治疗前均下降,且治疗组尿L-FABP、ACR、中医证候积分下降更为明显,差异均有统计学意义(P<0.05或P<0.01)。结论:尿L-FABP在2型糖尿病患者中的表达较健康人高,是早期预测糖尿病肾病的生物学标志物,其水平与血脂中的TG、TC、LDL-C相关,与尿β_(2)-MG、胱抑素C呈正相关,与尿β_(2)-MG的相关性最大。黄芪可改善2型糖尿病气虚证患者的早期肾损害,降低尿L-FABP、ACR水平,改善气虚症状。

Objective:To investigate the effect of Astragalus membranaceus on urinary liver-type fatty acid binding protein(L-FABP),a marker for early kidney injury,in patients with type 2 diabetes.Methods:A total of 62 patients with type 2 diabetes with Qi deficiency syndrome were randomly divided into treatment group with 32 patients and control group with 30 patients.The patients in the control group were given conventional Western medicine treatment,and those in the treatment group were given Astragalus membranaceus granules in addition to the treatment in the control group.After 3 weeks of treatment,the two groups were observed in terms of the changes in L-FABP,urinaryβ_(2)-microglobulin(β_(2)-MG),urinary microalbumin-to-creatinine ratio(ACR),glycated albumin,and traditional Chinese medicine(TCM)syndrome score.The correlation of urinary L-FABP with body mass index,glucose metabolism,and renal function markers was analyzed.Results:The expression of urinary L-FABP in diabetic patients was higher than that in the healthy population and was positively correlated with total cholesterol,triglyceride,low-density lipoprotein cholesterol,urinaryβ_(2)-MG,and cystatin C,with the strongest correlation between urinary L-FABP and urinaryβ_(2)-MG.After treatment,both groups had significant reductions in urinary L-FABP,β_(2)-MG,ACR,and TCM syndrome score,and the treatment group had significantly greater reductions in urinary L-FABP,ACR,and TCM syndrome score than the control group(P<0.05 or P<0.01).Conclusion:The expression of urinary L-FABP in type 2 diabetic patients is higher than that in the healthy population,and it is a biomarker for predicting type 2 diabetic nephropathy in the early stage.The level of urinary L-FABP is correlated with the blood lipid parameters TG,TC,and LDL-C and is positively correlated with urinaryβ_(2)-MG and cystatin C,with the strongest correlation between urinary L-FABP and urinaryβ_(2)-MG.Astragalus membranaceus can improve early kidney injury in patients with type 2 diabetes with Qi deficiency syndrome,reduce the levels of urinary L-FABP and ACR,and improve the symptoms of Qi deficiency.