健脾安肾汤治疗气阴两虚型糖尿病肾病疗效及对肾纤维化进程延缓作用研究

Study on Therapeutic Effect of Jianpi Anshen Decoction(健脾安肾汤)on Diabetes Nephropathy of Qi and Yin Deficiency Type and Its Delaying Effect on Progress of Renal Fibrosis

目的评价健脾安肾汤治疗气阴两虚型糖尿病肾病的疗效以及对肾纤维化进程的延缓作用研究。方法收集115例糖尿病肾病患者,患者均于2019年2月—2021年8月来武汉市中医医院肾病科就诊,对照组56例患者给予西药常规治疗,包括降糖、降压、调脂治疗,并调节饮食习惯,适当运动。口服贝那普利片,5~10 mg/次,1次/d,之后根据患者的病情逐渐增加。观察组共纳入59例患者,其治疗方案是西药常规+健脾安肾汤。两组患者分别治疗14 d。比较治疗疗效,比较两组治疗前后临床症候积分变化、血糖指标(FPG和HbA1c)、肾功能指标(尿微量蛋白、BUN和Scr)、肾纤维化因子指标(TGF-β1、TSP-1和TIMP-1)。结果观察组治疗疗效为91.53%,对照组治疗疗效为80.36%,对照组治疗疗效低于观察组(P<0.05);观察组治疗后水肿、夜尿频多、肢体酸软、周身乏力、苦干舌燥和心内烦热等中医症候积分低于对照组(P<0.05);两组治疗后FPG和HbA1c水平均较治疗前降低(P<0.05),但观察组和对照组治疗后FPG和HbA1c水平比较差异无统计学意义(P>0.05);观察组治疗后尿微量蛋白、BUN和Scr水平低于对照组(P<0.05);观察组治疗后血清TGF-β1、TSP-1和TIMP-1水平低于对照组(P<0.05)。结论健脾安肾汤可用于气阴两虚型糖尿病肾病的治疗,和西药联合使用效果更加,在降低尿白蛋白含量,降低血清TGF-β1、TSP-1和TIMP-1水平,延缓肾纤维进程,保护残余肾功能方面疗效显著,值得临床借鉴。

Objective To evaluate the effect of Jianpi Anshen Decoction(健脾安肾汤)in the treatment of diabetic nephropathy with deficiency of Qi and Yin and its effect on delaying the process of renal fibrosis.Methods A total of 115 patients with diabetic nephropathy were collected,all of whom came to the Department of Nephrology of Wuhan Hospital of Traditional Chinese Medicine from February 2019 to August 2021,and 56 patients in the control group were given conventional treatment with Western medicine,including hypoglycemic,antihypertensive and lipid-lowering treatments as well as adjusting dietary habits and exercising appropriately,with oral administration of benazepril tablets,5~10 mg/time,once a day,gradually increasing according to the patient's condition.In the observation group,59 patients were treated with Jianpi Anshen Decoction(健脾安肾汤)on the basis of the treatment of the control group.The two groups were treated for 14 daysh.The efficacy of treatment was compared,and the changes in clinical syndrome scores,blood glucose indexes[fasting blood glucose(FPG)and glycated hemoglobin(HbA1c)],renal function indicators[urine microprotein,blood urea nitrogen(BUN)and serum creatinine(Scr)]and renal fibrosis factor indexes[transforming growth factor-β1(TGF-β1),platelet reactive protein inhibitor(TSP-1)and tissue inhibitor of metalloproteinase-1(TIMP-1)]were compared between the two groups before and after treatment.Results The curative effect of the observation group was 91.53%and that of the control group was 80.36%.The curative effect of the control group was lower than that of the observation group(P<0.05).After treatment,the scores of traditional Chinese medicine(TCM)symptoms such as edema,frequent nocturia,limb soreness and weakness,general fatigue,dry tongue and heart trouble in the observation group were lower than those in the control group(P<0.05).After treatment,the levels of FPG and HbA1c in the two groups were lower than those before treatment(P<0.05),but there was no significant difference in FPG or HbA1c between the observation group and the control group after treatment(P>0.05).The levels of urinary trace protein,BUN and Scr in the observation group were lower than those in the control group after treatment(P<0.05).The serum levels of TGF-β1,TSP-1 and TIMP-1 in the observation group were lower than those in the control group(P<0.05).Conclusion Jianpi Anshen Decoction is effective in the treatment of diabetes nephropathy with deficiency of both Qi and Yin,which can significantly improve the clinical symptoms of patients,reduce the content of urinary albumin,improve the renal function,reduce the serum levels of TGF-β1,TSP-1 and TIMP-1 and can delay the process of renal fiber and protect residual renal function,worthy of clinical reference.