黄芪益肾颗粒联合司维拉姆对维持性血液透析患者疗效和TLR4、NF⁃κB的影响

Effect of Huangqi Yishen Granules combined with sevelamer on TLR4 and NF⁃κB in pa⁃tients with maintenance hemodialysis

目的探讨黄芪益肾颗粒联合司维拉姆对维持性血液透析(MHD)患者疗效和Toll样受体4(TLR4)、核转录因子⁃κB(NF⁃κB)的影响。方法分析2019年1月至2022年11月在六安市六安世立医院本收治的118例MHD患者临床资料,按不同治疗手段将其分为对照组(n=52)和联合组(n=66)。对照组接受常规治疗+司维拉姆(0.8 g/次,3次/d);联合组接受常规治疗+司维拉姆+黄芪益肾颗粒(15 g/次,2次/d);两组均持续治疗2个月。统计分析两组临床疗效、治疗前与治疗2个月后肾功能[24 h尿蛋白排泄率(UPE)、血肌酐(SCr)、血尿素氮(BUN)]、微炎症状态[白细胞介素(IL)⁃6、中性粒细胞/淋巴细胞比值(NLR)、肿瘤坏死因子⁃α(TNF⁃α)]、TLR4、NF⁃κB mRNA水平及不良反应发生率。结果治疗2个月后,联合组总有效率显著高于对照组,差异有统计学意义(χ^(2)=5.449,P<0.05)。两组治疗前UPE、SCr、BUN水平均比较差异无统计学意义(P>0.05);治疗后两组UPE、SCr、BUN均降低,且联合组更低,差异有统计学意义(P<0.05)。两组治疗前IL⁃6、NLR、TNF⁃α水平均比较差异无统计学意义(P>0.05);治疗后两组IL⁃6、NLR、TNF⁃α均降低,且联合组更低,差异有统计学意义(P<0.05)。两组治疗前TLR4、NF⁃κB mRNA水平比较差异无统计学意义(P>0.05);治疗后两组TLR4、NF⁃κB mRNA均降低,且联合组更低,差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义(P=0.903)。结论黄芪益肾颗粒联合司维拉姆能够提高MHD患者治疗效果,改善其肾功能与微炎症状态,这可能与抑制TLR4、NF⁃κB水平表达有关。

Objective To investigate the effect of Huangqi Yishen granule combined with sevelamer on the efficacy and Toll⁃like receptor 4(TLR4)and nuclear transcription factor⁃κB(NF⁃κB)in patients with maintenance hemodialysis(MHD).Methods The clinical data of 118 MHD patients admitted to Luan City Lu'an World Hospital from January 2019 to November 2022 were retrospectively analyzed.They were divided into a control group(n=52)and a combined group(n=66)according to different treatment methods.The control group received routine treatment+sevelamer(0.8 g/time,3 times/d).The combined group received routine treatment+sevelamer+Huangqi Yishen Granules(15 g/time,2 times/d),both groups were treated for 2 months.The clinical efficacy,renal function[24 h urinary protein excretion rate(UPE),serum creatinine(SCr),blood urea nitrogen(BUN)],microinflammatory state[interleukin(IL⁃6),neutrophil/lymphocyte ratio(NLR),tumor necrosis factor⁃a(TNF⁃a)],TLR4,NF⁃κB mRNA levels and incidence of adverse reactions were statistically analyzed before and 2 months after treatment in the two groups.Results After 2 months of treatment,the total effective rate of the combined group was significantly higher than that of the control group,and the difference was statistically significant(χ^(2)=5.449,P<0.05).After treatment,UPE,SCr and BUN in the two groups decreased,and those in the combined group were lower,the differences were statistically significant(t=5.953,2.900,8.309,P<0.05).After treatment,IL⁃6,NLR,and TNF⁃αin both groups decreased,and those in the combined group were lower,the differences were statistically significant(t=4.956,3.841,5.098,P<0.05).There was no significant difference in TLR4 and NF⁃κB mRNA levels between the two groups before treatment(t=1.526,0.622,P>0.05).After treatment,TLR4 and NF⁃κB mRNA in both groups decreased,and those in the combined group were lower,the differences were statistically significant(t=4.714,4.494,P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(χ^(2)=0.015,P=0.903).Conclusion Huangqi Yishen Granule combined with sevelamer can improve the therapeutic effect on MHD patients.This combination has been shown to enhance renal function and reducemicro⁃inflammatory states.These improvements may be linked to the suppression of TLR4 and NF⁃κB expression.