益肾汤随证加减对慢性肾小球肾炎患者肾血流和尿白蛋白肌酐比值的影响

Effects of modified Yishen decoction on renal blood flow and urinary albumin-to-creatinine ratio in patients with chronic glomerulonephritis

目的:观察益肾汤随证加减在慢性肾小球肾炎(CGN)患者中的应用效果及对肾血流、尿白蛋白肌酐比值(ACR)的影响。方法:研究选取2020年9月~2022年9月106例气阴两虚型CGN患者,按随机数字表法均分为观察组53例、对照组53例,对照组予以常规对症治疗+厄贝沙坦片口服,观察组在对照组基础上联合益肾汤随证加减治疗,连续治疗12周后,评价两组患者中医症状积分、临床疗效、肾功能[血肌酐(Scr)、血尿素氮(BUN)、胱抑素(Cys-C)、尿白蛋白肌酐比值(ACR)]、炎症因子[转化生长因子β1(TGF-β1)、基质金属蛋白酶~9(MMP-9)]及肾血流动力学[收缩期峰值血流速度(PSV)、搏动指数(PI)、阻力指数(RI)]变化。结果:治疗后,两组患者面色无华、疲倦乏力、腰膝酸痛、面浮肢肿、手足心热、口干咽燥症状积分均减小(P<0.05),且观察组各症状积分较对照组低(P<0.05);观察组总有效率较对照组高(94.34%vs 79.25%)(P<0.05);两组患者Scr、BUN、Cys-C及ACR水平均降低(P<0.05),且观察组均较对照组低(P<0.05);两组患者血清TGF-β1均降低、MMP-9均升高(P<0.05),且观察组TGF-β1较对照组低、MMP-9较对照组高(P<0.05);两组肾血流PSV均升高,PI、RI均降低(P<0.05),且观察组PSV较对照组高,PI、RI较对照组低(P<0.05)。结论:益肾汤随证加减用于CGN患者治疗,可有效减轻患者中医症状、提高临床疗效,对延缓肾功能进展、降低炎症水平、改善肾血流动力学有积极意义。

Objective To observe the effects of modified Yishen decoction on renal blood flow and urinary albumin-to-creatinine ratio(ACR)in patients with chronic glomerulonephritis(CGN).Methods 106 patients with CGN of qi and yin deficiency syndrome from September 2020 to September 2022 were selected and divided into observation group(53 cases)and control group(53 cases)according to the random number table method.The control group received conventional symptomatic treatment and oral irbesartan tablets,and the observation group was given modified Yishen decoction on the basis of the control group.After 12 weeks of continuous treatment,the scores of TCM symptoms,clinical efficacy,renal function[serum creatinine(Scr),blood urea nitrogen(BUN),cystatin(Cys-C),ACR],inflammatory factors[transforming growth factorβ1(TGF-β1),matrix metalloproteinase-9(MMP-9)]and renal hemodynamics[peak systolic flow velocity(PSV),pulsatility index(PI),resistance index(RI)]were evaluated in both groups.Results After treatment,the scores of symptoms such as lusterless complexion,fatigue,waist and knee pain,puffy face and swollen limbs,feverishness in palms and soles and dry mouth and pharyngeal dryness were decreased in both groups(P<0.05),and the symptoms scores in observation group were lower than those in control group(P<0.05).The total effective rate in observation group was higher compared with that in control group(94.34%vs 79.25%)(P<0.05).The levels of Scr,BUN,Cys-C and ACR in the two groups were decreased(P<0.05),and the levels in observation group were lower compared to control group(P<0.05).Serum TGF-β1 was declined while MMP-9 was risen in both groups(P<0.05),and TGF-β1 was lower while MMP-9 was higher in observation group compared to control group(P<0.05).The renal blood flow PSV was increased in both groups while the PI and RI were decreased(P<0.05),and the PSV in observation group was higher than that in control group while the PI and RI were lower than those in control group(P<0.05).Conclusion Modified Yishen decoction can effectively reduce the TCM symptoms and enhance the clinical efficacy in patients with CGN,and it has positive significance on delaying the progression of renal function,reducing the inflammation level and improving the renal hemodynamics.