芪地糖肾颗粒对糖尿病肾脏疾病患者蛋白尿的治疗及其对尿裂隙素、足细胞素的作用

Qidi Tangshen Granule exerts beneficial effects on proteinuria in patients with diabetes kidney disease and its mechanism of intervening urinary nephrin and podocin

目的研究芪地糖肾颗粒治疗慢性肾脏病(CKD)3期的糖尿病肾脏疾病(DKD)气阴两虚、瘀热阻络证患者蛋白尿的临床疗效和对尿足细胞裂孔膜蛋白(裂隙素、足细胞素)的影响。方法选取64例CKD3期DKD气阴两虚、瘀热阻络证患者,用随机数字表法分为试验组及对照组,每组各32例。试验组予基础治疗(降血糖、降血压、降血脂,配合饮食指导)和芪地糖肾颗粒,对照组予基础治疗和安慰剂。疗程共3个月。比较2组临床疗效、中医证候疗效,以及治疗前后尿白蛋白肌酐比(UACR)、血糖、血脂、尿裂隙素、尿足细胞素的变化,评价安全性。结果试验组与对照组临床疗效总有效率分别为77.42%(24/31)和24.14%(7/29)、中医证候疗效有效率分别为64.52%(20/31)和37.93%(11/29),试验组疗效均优于对照组,差异有统计学意义(P<0.05)。试验组治疗后UACR较对照组降低(P<0.05),尿足细胞素增加程度较对照组减低(P<0.05)。在研究过程中2组均无明显不良反应。结论芪地糖肾颗粒可减少CKD3期DKD气阴两虚、瘀热阻络证患者尿蛋白排泄,作用机制可能与其对肾小球的保护作用有关。

Objective We aimed to investigate the clinical efficacy of Qidi Tangshen(QDTS)Granule in treating proteinuria in chronic kidney disease(CKD)stageⅢ,diabetes kidney disease(DKD)patients with syndrome of dual deficiency of qi and yin or stagnation of heat and blood stasis.We also analyzed the effects of QDTS Granule on podocyte slit pore membrane protein(nephrin and podocin).Methods In total,64 CKD stageⅢ,DKD patients with dual deficiency of qi and yin or stagnation of heat and blood stasis were divided into two groups by random number table(32 cases in each group).The experimental group was given basic treatment(lowering blood glucose,blood pressure,and blood lipid levels and providing dietary guidance)and QDTS Granule,while the control group was given basic treatment and the same dosage of placebo.The course of treatment lasted for three months.The clinical efficacy,the effective rate of TCM symptoms,the urine albumin-to-creatinine ratio(UACR),blood glucose levels,blood lipid levels,and urinary nephrin and podocin levels were compared between the two groups.Results The total effective rates of clinical efficacy in the experimental group and the control group were 77.42%(24/31)and 24.14%(7/29),while the effective rate of TCM symptoms were 64.52%(20/31)and 37.93%(11/29),respectively(P<0.05).After treatment,UACR was significantly decreased in the experimental group(P<0.05).The increase in urinary podocin levels was smaller in the experimental group than in the control group(P<0.05).No obvious adverse reactions were reported during the study.Conclusion QDTS Granule is effective in the treatment of DKD patients with microalbuminuria who have dual deficiency of both qi and yin or stagnation of heat and blood stasis and could reduce urinary protein excretion,which might be related to the protective effect of QDTS Granule on glomeruli.