当归四逆汤合四妙丸治疗糖尿病肾病对中医证候积分及Wnt/β-catenin信号通路的影响

Effects of Danggui Sini Decoction(当归四逆汤)Combined with Simiao Pill(四妙丸)on Scores of TCM Syndromes and Wnt/β-catenin Signaling Pathways in Diabetic Nephropathy

目的探讨当归四逆汤合四妙丸治疗糖尿病肾病(diabetic nephropathy,DN)对中医证候积分及Wnt/β-链蛋白(β-catenin)信号通路的影响。方法选取该院2021年1月—2023年10月DN患者124例,随机数字表法分为观察组与对照组,每组62例患者,对照组给予常规西医治疗,在此基础上,观察组加用当归四逆汤合四妙丸,治疗3个月,比较两组疗效差异、临床症状积分、血糖血脂水平、肾功能、炎性及氧化应激指标水平、外周血单个核细胞Wnt/β-catenin信号通路表达及不良反应发生情况。结果观察组治疗有效率96.77%(60/62)高于对照组85.48%(53/62)(P<0.05);治疗后观察组中医证候积分低于对照组(P<0.05);观察组治疗后空腹血糖(fasting blood glucose,FBG)、糖化血红蛋白(glycosylated hemoglobin,HbAlC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、甘油三酯(triglyceride,TG)水平低于对照组(P<0.05);观察组治疗后血清胱抑素(levels of serum cystatin,Cys-C)及β2微球蛋白(β2 microglobulin,β2-MG)、尿微量白蛋白(urinary microalbumin,ALB)、白蛋白排泄率(urinary albumin excretion rate,UAER)水平低于对照组(P<0.05);观察组治疗后血清肿瘤坏死因子α(tumor necrosis factorα,TNF-α)、丙二醛(malondialdehyde,MDA)、白细胞介素-6(interleukin-6,IL-6)水平低于对照组,超氧化物岐化酶(superoxide dismutase,SOD)表达水平高于对照组(P<0.05);观察组治疗后外周血Wnt、Tcf-4、β-catenin mRNA表达低于对照组(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论当归四逆汤合四妙丸的应用有利于改善DN患者临床症状,有效调节患者糖脂代谢,减轻机体炎性与氧化应激反应,调控Wnt/β-catenin信号通路,进而改善患者肾功能,效果显著,安全性高。

Objective The aim of this study was to explore the effects of Danggui Sini Decoction(当归四逆汤)combined with Simiao Pill(四妙丸)on scores of TCM syndromes and Wnt/β-catenin signaling pathways in diabetic nephropathy(DN).Methods A total of 124 patients with DN in the hospital were enrolled and randomly divided into control group and observation group,62 cases in each group.The control group was treated with routine western medicine,while the observation group was additionally treated with Danggui Sini Decoction and Simiao Pill on basis of control group between January 2021 and October 2023.All were treated for 3 months.The curative effect,the scores of clinical symptoms,blood glucose and lipid,renal function,inflammatory and oxidative stress indexes,the expressions of peripheral blood Wnt/β-catenin signaling pathways and occurrence of adverse reactions were compared between the two groups.Results The response rate of treatment was higher in the observation group than that in the control group(96.77%vs 85.48%,P<0.05).After treatment,the scores of TCM syndromes were lower in the observation group than those in the control group(P<0.05),the levels of fasting blood glucose(FBG),glycosylated hemoglobin(HbAlC),low-density lipoprotein cholesterol(LDL-C)and triglyceride(TG)were lower in the observation group(P<0.05),the levels of serum cystatin(Cys-C),urinary microalbumin(ALB)andβ2 microglobulin(β2-MG)and urinary albumin excretion rate(UAER)were also lower in the observation group(P<0.05).After treatment,the levels of serum tumor necrosis factorα(TNF-α),malondialdehyde(MDA)and interleukin-6(IL-6)were lower in the observation group than those in the control group,while the level of superoxide dismutase(SOD)was higher in the observation group(P<0.05).After treatment,mRNA levels of peripheral blood Wnt,Tcf-4 andβ-catenin were lower in the observation group than those in the control group(P<0.05).The difference in the incidence of adverse reactions between the two groups was not statistically significant(P>0.05).Conclusion Danggui Sini Decoction combined with Simiao Pill is beneficial to improve clinical symptoms in DN patients,effectively regulate glucose and lipid metabolism,relieve inflammatory and oxidative stress response,regulate Wnt/β-catenin signaling pathways,and thus improve renal function,which has significant curative effect and high safety.