大补元煎加味对早中期糖尿病肾病气阴两虚夹瘀证患者微炎症状态及肾纤维化相关生长因子的影响

The Influence of Supplemented Major Origin-Nourishing Decoction on Microinflammation and Growth Factors Related to Renal Fibrosis in Patients with Qi Yin Deficiency and Stasis Syndrome in Early and Middle Stage Diabetic Nephropathy

目的:观察大补元煎加味对早中期糖尿病肾病气阴两虚夹瘀证患者微炎症状态及肾纤维化相关生长因子的影响。方法:选取2020年7月至2021年6月北京市西城区广外医院治疗的糖尿病肾病患者80例,按照随机数字表法分为治疗组和常规组,每组40例。常规组给予常规西医治疗,治疗组在常规组治疗的基础上给予大补元煎加味治疗。观察两组患者治疗前后可溶性糖基化终末产物受体(soluble receptor for advanced glycation end products,sRAGE)、甘肽过氧化物酶(glutathione peroxidase,GSH-Px)、核苷酸结合寡聚化结构域样受体3(nucleotide-binding oligomerization domain-like receptor protein 3,NLRP3)、晚期糖基化终末产物(Advanced glycosylation endproducts,AGEs)、NADPH氧化酶4(nadph oxidase4,NOX4)、转化生长因子-β(transforming growth factor-β,TGF-β)、核因子-κB(nuclear factor kappa-B,NF-κB)、单核细胞趋化蛋白-1(monocyte chemotactic protein 1,MCP-1)、结缔组织生长因子(connective tissue growth factor,CTGF)、中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)、Dickkopf相关蛋白1(dickkopf related protein 1,DKK1)、糖化血红蛋白(hemoglobinA1c,HbA1c)、可溶性肿瘤坏死因子受体1(soluble tnf receptor 1,sTNFR-1)、空腹血糖(fasting plasma glucose,FPG)、尿白蛋白排泄率(urinary albumin excretion rates,UAER)、肾阻力指数(resistive Index,RI)、肾动脉收缩期最大流速(maximum systolic velocity,Vsmax)、肾全血流量(renal blood flow,RBF)变化情况及临床疗效。结果:治疗组治疗后HbA1c、UAER、FPG水平低于常规组(P<0.05);治疗阻治疗后MCP-1、NLRP3、NGAL、NF-κB低于常规组(P<0.05);治疗组治疗后sRAGE、GSH-Px水平高于常规组,AGEs、NOX4水平低于常规组(P<0.05);治疗组治疗后CTGF、DKK1、TGF-β、sTNFR-1水平低于常规组(P<0.05);治疗组治疗后Vsmax、RBF高于常规组,RI低于常规组(P<0.05);治疗阻有效率为97.50%,常规组有效率为85.00%,治疗组有效率高于常规组(P<0.05)。结论:大补元煎加味治疗早中期糖尿病肾病气阴两虚夹瘀证,可调节患者HbA1c、UAER、FPG水平,抑制机体微炎症状态,减少氧化应激损伤,改善肾纤维化相关生长因子水平,改善肾血流动力学,提升临床疗效。

Objective:To observe the influence of Supplemented Major Origin-Nourishing Decoction on microinflammation and growth factors related to renal fibrosis in patients with qi yin deficiency and stasis syndrome in early and middle stage diabetic nephropathy.Methods:A total of 80 diabetic nephropathy patients treated in Beijing Xicheng District Guangwai Hospital from July 2020 to June 2021 were selected and divided into the treatment group and the routine group according to the random number table method,with 40 cases in each group.The routine group was given conventional Western medicine treatment,while the treatment group was given Supplemented Major Origin-Nourishing Decoction on the basis of the routine group.Then the changes in soluble receptor for advanced glycation end products(sRAGE),glutathione peroxidase(GSH-Px),nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3),advanced glycosylation endproducts(AGEs),nadph oxidase4(NOX4),transforming growth factor-β(TGF-β),nuclear factor kappa-B(NF-κB),monocyte chemotactic protein 1(MCP-1),connective tissue growth factor(CTGF),neutrophil gelatinase-associated lipocalin(NGAL),dickkopf related protein 1(DKK1),hemoglobinAlc(HbAlc),soluble tnf receptor 1(sTNFR-1),fasting plasma glucose(FPG),urinary albumin excretion rates(UAER),resistive index(RI),maximum systolic velocity(Vsmax),renal blood flow(RBF)before and after treatment and the clinical efficacy were observed in the two groups.Results:After treatment,the levels of HbAlc,UAER and FPG in the treatment group were lower than those in the routine group(P<0.05).MCP-1,NLRP3,NGAL and NF-κB in the treatment group were lower than those in the routine group(P<0.05).The levels of sRAGE and GSH-Px in the treatment group were higher than those in the routine group,while the levels of AGEs and NOX4 in the treatment group were lower than those in the routine(P<0.05).The levels of CTGF,DKK1,TGF-βand sTNFR-1 in the treatment group were lower than those in the routine group(P<0.05).Vsmax and RBF in the treatment group were higher than those in the routine group,while RI was lower than that in the routine group(P<0.05).The effective rate of the treatment group was 97.50%,while that of the routine group was 85.00%.The effective rate of the treatment group was higher than that of the routine group(P<0.05).Conclusion:In the treatment of qi and yin deficiency with stasis syndrome in early and middle stage diabetic nephropathy,Supplemented Major Origin-Nourishing Decoction can regulate the levels of HbAlc,UAER and FPG in patients,inhibit the micro-inflammatory state of the body,reduce oxidative stress damage,improve the level of growth factors related to renal fibrosis,renal hemodynamics,and enhance clinical efficacy.