真武汤合当归芍药散治疗糖尿病肾病(G4A3期)水肿患者临床观察及对尿AQP2的影响

The Effect of Zhenwu Decoction and Danggui Shaoyao Powder on Patients with Edema of Diabetic Kidney Disease(G4A3 Stage)and its Effect on Urinary AQP2

目的:观察真武汤合当归芍药散对脾肾阳虚夹瘀型糖尿病肾脏病G4A3期患者的疗效。方法:选取脾肾阳虚夹瘀型糖尿病肾脏病G4A3期患者64例,以随机法分为对照组和试验组各32例,另外选取20例健康者作为健康组。对照组予以常规西药治疗,试验组予常规西药+真武汤合当归芍药散治疗,疗程为4周。记录治疗前后水肿及症状积分、血清白蛋白(ALB)、24 h尿蛋白定量(24 hUTP)、肾小球滤过率(eGFR)、血浆抗利尿素(AVP)、尿水通道蛋白2(AQP2)的变化情况,并进行统计学分析。结果:糖尿病肾脏病(DKD)组尿液AQP2明显高于健康组(P<0.05)。与治疗前相比,两组患者eGFR均无明显改变(P>0.05),24 h UTP、ALB均较治疗前改善,差异具有统计学意义(P<0.05),尿液AQP2、血浆AVP较治疗前均有下降(P<0.05)。治疗后试验组24 hUTP、ALB改善水平均优于对照组(P<0.05),试验组尿AQP2下降程度大于对照组,差异均具有统计学意义(P<0.05),两组eGFR比较差异无统计学意义(P>0.05)。两组患者治疗后水肿积分疗效、中医证候疗效及临床疗效均有改善,试验组优于对照组,差异具有统计学意义(P<0.05)。尿AQP2与水肿积分呈正相关,与eGFR呈负相关。结论:真武汤合当归芍药散联合常规西药治疗可能通过下调糖尿病肾病脾肾阳虚夹瘀证患者的AQP2的水平,影响肾脏对水的排泄,从而达到降低尿蛋白排出、改善水肿症状、稳定肾功能的目的。

Objective:To explore the effect of Zhenwu Decoction and Danggui Shaoyao powder on edema patients with Yang deficiency type of spleen and kidney and clip stasis diabetic nephropathy(G4A3 stage).Methods:64 patients with Yang deficiency type of spleen and kidney and clip stasis diabetic nephropathy(G4A3 stage)were enrolled,and randomly divided into experimental group and control group,and 20 healthy participants were enrolled as the health group.The control group were treated with standard western medicine based on guidelines for 4 weeks,and the experimental group were treated with Zhenwu Decoction and Danggui Shaoyao powder and standard western medicine based on guidelines for 4 weeks.Indicators including edema degree of integral symptom scores,24-hour urine total protein quantity,the plasma albumin,estimate glomerular filtration rate,arginine vasopressin,and urinary aquaporin-2 were collected and recorded 4weeks before and 4 weeks after treatment.Data were analyzed by SPSS.Results:Before treatment,urinary AQP2 in the diabetic kidney disease group were significantly higher than those in the health group(P<0.05).After treatment,eGFR were no significant decline(P>0.05).Compared to those before treatment,ALB,24 h UTP in both group were all improved(P<0.05).Besides,AVP,AQP2 in the experimental group and control group were all improved comparing with those before treatment(P<0.05).After treatment,urinary ALB,24 h UTP were improved in the experimental group better than the control group(P<0.05).AQP2 in the experimental group were improved than those in the control group(P<0.05).The curative effect of edema degree of integral and Chinese medicine syndromes and effect of the two groups were improved after treatment,especially in the experimental group(P<0.05).Urinary AQP2 and edema degree of integral were positively correlated,and negatively correlated with eGFR.Conclusion:The Zhenwu Decoction and Danggui Shaoyao powder combined with western medicine may effectively reduce urinary AQP2 of patients with diabetic kidney disease(G4A3)of Yang deficiency type of spleen and kidney and clip stasis,so as to achieve the purpose of reducing urinary protein excretion,improving edema symptoms and stabilizing renal function.