肝豆灵汤治疗肝豆状核变性早期肾损害临床观察

Efficacy observation of Gandouling decoction on hepatolenticular degeneration-caused early renal damage

目的:观察肝豆灵汤治疗痰瘀互结型肝豆状核变性患者早期肾损害的临床疗效。方法:选取安徽中医药大学第一附属医院符合肝豆状核变性早期肾损害诊断的住院患者70例,随机分为两组各35例。两组均予二巯基丙磺酸钠常规治疗,对照组另予百令胶囊,治疗组予肝豆灵汤口服,6天为1个疗程,共治疗4个疗程。观察两组患者临床疗效,比较治疗前后两组患者24小时尿铜、肾功能指标[肌酐(CREA)、尿素氮(BUN)、胱抑素C(CysC)]、尿系列蛋白指标[尿视黄醇结合蛋白(URBP)、尿β_(2)微球蛋白(Uβ_(2)-MG)、尿转铁蛋白(UTRF)、尿免疫球蛋白G(UIgG)、尿微量白蛋白(mALB)、尿α_(1)微球蛋白(Uα_(1)-MG)、尿N-乙酰-β-D-氨基葡萄糖苷酶(UNAG)]、24 h尿总蛋白定量(24 hUPQ)、氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-PX)、过氧化氢酶(CAT)]及不良反应发生情况等。结果:治疗后,治疗组总有效率为91.43%,优于对照组的68.57%(P﹤0.05);两组24小时尿铜在治疗后均升高(P﹤0.05),治疗组升高幅度优于对照组(P﹤0.05);治疗组CREA、CysC、BUN水平降低,降低幅度优于对照组(P﹤0.05);治疗组URBP、Uβ_(2)-MG、UTRF、UIgG、mALB、Uα_(1)-MG、UNAG、24 hUPQ、UTP值均有所下降,且治疗组下降幅度优于对照组(P﹤0.05);两组患者的SOD、GSH-PX、CAT水平均明显上升,MDA水平明显下降(P﹤0.05),且治疗组改善程度优于对照组(P﹤0.05)。结论:肝豆灵汤能有效改善痰瘀互结型肝豆状核变性早期肾损害患者的症状,促进体内排铜,保护肾功能,改善早期肾损害,临床疗效较好。

Objective:To observe the clinical efficacy of Gandouling decoction on hepatolenticular degenerationcaused early renal damage with syndrome of intermingled phlegm and blood stasis.Methods:70 cases of inpatients,who were diagnosed as hepatolenticular degeneration-caused early renal damage by The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine,were selected and randomly divided into two groups,35 cases in each group.Both groups were treated with sodium dimercaptosulphonate conventionally.In addition,the control group was treated plus with Bailing capsules,while the treatment group was treated plus with oral Gandouling decoction;6 days as a course of treatment,in total of 4 courses of treatment.The clinical efficacy of patients was observed in two groups after treatment.The changes of following indexes and the incidence of adverse reactions of patients were compared between two groups before and after treatment,such as 24-hour urinary copper,renal function indexes[creatinine(CREA),blood urea nitrogen(BUN)and cystatin C(CysC)],urinary protein series indexes[urinary retinol-binding protein(URBP),urinaryβ_(2)-microglobulin(Uβ_(2)-MG),urinary transferrin(UTRF),urinary immunog lobulinG(UIgG),microalbuminuria(mALB),urinar yα_(1)-microglobulin(Uα_(1)-MG)and urinary N-acetyl-β-D-glucosaminidase(UNAG)],24-hour urinary protein quantification(24 hUPQ),oxidative stress indexes[superoxide dismutase(SOD),malondialde hyde(MDA),glutathione peroxidase(GSH-PX)and catalase(CAT)].Results:After treatment,the total effective rate of treatment group was 91.43%,which was higher than 68.57%of control group(P﹤0.05);24-hour urinary copper increased in both groups after treatment(P﹤0.05),and the increase of treatment group was greater than that of control group(P﹤0.05);the levels of CREA,CysC and BUN of treatment group decreased significantly,and the decrease of treatment group was greater than that of control group(P﹤0.05);the values of URBP,Uβ_(2)-MG,UTRF,UIgG,mALB,Uα_(1)-MG,UNAG,24 hUPQ of treatment group decreased,and the decrease of treatment group was greater than that of control group(P﹤0.05);the levels of SOD,GSH-PX and CAT of patients increased in both groups significantly,while MDA level decreased in both groups significantly(P﹤0.05),and the improvement degree of treatment group was better than that of control group(P﹤0.05).Conclusion:Gandouling decoction can effectively improve the symptoms of patients with hepatolenticular degeneration-caused early renal damage with syndrome of intermingled phlegm and blood stasis,promote copper excretion in the body,protect renal function,and improve early renal damage.Its clinical efficacy is better.