中药黄芪当归合剂对肾病综合征肾损伤的保护作用及对代谢紊乱的影响  

The effect of Astragali and Angelica on nephrotic syndrome and its mechanisms of action

作　　者：王海燕[1] 李惊子[1] 潘缉圣[1] 邹万忠[1] 李晓玫[1] 章友康[1] 朱世乐[1] 黄海长[1] 王叔咸 

机构地区：[1]北京大学第一医院肾脏内科肾脏病研究所,北京100034

出　　处：《北京大学学报（医学版）》2002年第5期542-552,共11页Journal of Peking University:Health Sciences

基　　金：国家自然科学基金 ( 3 9670 90 9;3 9970 92 9);卫生部科研基金 ( 94 1 2 76)资助

摘　　要：为明确黄芪、当归在肾病综合征 (nephroticsyndrome ,NS)治疗中的作用、适应证及其作用机制 ,我们从临床和实验两方面进行了系统的研究。 (1)黄芪当归合剂对肾脏的保护作用 :各种肾脏疾病慢性病变经过肾硬化、纤维化 ,最终发展成为终末期肾衰竭。如何阻断这一发展通路已成为国际肾脏病界研究的热点。本研究选用慢性嘌呤霉素肾病模型 ,以目前公认具有肾脏保护作用的血管紧张素转化酶抑制剂 (ACEI)作为阳性对照 ,经 12周给药观察后处死 ,收集血、尿、肾脏标本进行检测。结果显示模型鼠肾脏呈慢性炎症 ,肾小球硬化和小管间质纤维化。黄芪当归合剂 (A&A)治疗明显减轻肾功能恶化和组织学损伤 ,肾小球硬化指数和小管间质损伤指数下降与肾功能损伤减轻呈正相关 (r=0 .80 ,P <0 .0 0 1和r=0 .85 ,P <0 .0 0 1)。细胞外基质Ⅲ、Ⅳ型胶原 ,纤连蛋白和层粘连蛋白明显减少。这种抗纤维化作用与ACEI相似 ,但肾局部的血管紧张素Ⅱ水平不下降 (5 6 .5 3± 7.0 3vs 76 .6 2± 12 .88pg/mg蛋白 ,P <0 .0 5 )。然而 ,A&A治疗组的肾脏转化生长因子 β1(TGF β1) (0 .0 5 17± 0 .0 2 4 8vs 0 .110 0± 0 .0 2 6 1,P <0 .0 5 )和骨桥蛋白 (OPN ,0 .0 10 5± 0 .0 0 5 3vs 0 .115± 0 .0 34,P <0 .0 5 )表达 ,单核The mixture of two Chinese herbs, Astragalus an d Angelica (A&A), has been used f or the treatment of nephritic syndrome (NS) in China for years. The effectivenes s of these two herbs has been proved in traditional Chinese clinical practice. I n early 1950's, the effect of Astragalus and Angelica in treatment of NS had been evaluated in our department and got positive conclusion. Based on th is in vestigation, we systematically studied with both clinical and experimental metho ds, to elucidate the curative effect, mechanism and indication of the mixture of these two Chinese herbs. (1)Renoprotective effects of Astragalus and Angelica :progressive renal disease is a common result of diverse etiologies defined by th e fact that there are renal fibrosis and sclerosis, accompanied by a progressiv e decline in renal function despite the elimination or amelioration of the initi ating stimulus. How to block the pass way is a prime objective in clinical nephr ology.Chronic puromycin nephrosis rats were randomly divided into NS control ( n =7), A&A ( n =7) (3 ml·d -1 ) or ACEI ( n =7) (enalapril 10 mg·k g -1 ·d -1 ) treated groups. After 12 weeks, serum, urine and renal tissue were collected for study. In untreated rats, chronic renal injury progressed with marked fibrosis at the e nd of 12 we eks. A&A obviously ameliorated deterioration of renal function and improved hist ologic changes. The expression of type Ⅲ, Ⅳ collagen, fibronecti n and laminin was significantly decreased. This anti-fibrosis effect w as com parable to ACEI. In A&A group, the renal local angiotensin Ⅱ (Ang Ⅱ) level (56 .53±7.03) remained as high as in NS untreated rats (76.62±12.88), but rena l Ang Ⅱ level (34.36±4.89) and ACE activity were significantly decreased in AC EI group. However, in A&A treated rats, the overexpression of TGF-β 1 (0.051 7 ±0.024 8 vs 0.110 0±0.026 1, P <0.05) and OPN(0.010 5±0.005 3 vs 0.115±0.034 , P <0.05), ED-1 positive cells (12.8±10

关 键 词：肾变病综合征 中医药疗法 黄芪 当归 药理学 

分 类 号：R277.52[医药卫生—中医学]