杞菊地黄丸加味对老年高血压早期肾损害患者肾功能的保护作用  

Protective Effect of Modified Qiju Dihuang Pills on Renal Function of Patients with Early Renal Impairment

作　　者：曹希勤[1] 刘凯 雷作汉[1] 邴雅珺[1] CAO Xi-qin;LIU Kai;LEI Zuo-han;BING Ya-jun(Gansu Provincial Hospital of Traditional Chinese Medicine(TCM),Lanzhou 730050,China;Traditional Chinese and Western Medicine College,Gansu University of TCM,Lanzhou 730000,China)

机构地区：[1]甘肃省中医院,兰州730050 [2]甘肃中医药大学中西医结合学院,兰州730000

出　　处：《中国实验方剂学杂志》2020年第10期75-81,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：甘肃省高等学校科研项目(2017A-055)。

摘　　要：目的:观察杞菊地黄丸加味对老年高血压早期肾损害(阴虚阳亢证)患者肾功能的保护作用及抗炎、抗氧化应激及改善内皮功能研究。方法:将119例患者随机按数字表法分为观察组60例和对照组59例。对照组口服缬沙坦胶囊,80 mg/次,1次/d;若血压仍不能控制,加用硝苯地平缓释片,10 mg/次,1次/d,目的是降低血压到理想标准。观察组西医治疗同对照组,内服杞菊地黄丸加味,1剂/d;对照组口服杞菊地黄丸模拟药,6 g,2次/d。两组疗程均为连续治疗16周。检测治疗前后血胱抑素C(CysC),尿N-乙酰-β-氨基葡萄糖苷酶(NAG),β2-微球蛋白(β2-MG)和尿微量白蛋白与肌酐(UACR);每日监测血压,记录治疗前后收缩压(SBP)和舒张压(DBP)水平,记录治疗期间血压的达标情况;进行治疗前后肾血流动力学检测,记录肾动脉阻力指数(RI)和搏动指数(PI);进行治疗前后阴虚阳亢证评分;检测治疗前后一氧化氮(NO),内皮素-1(ET-1),超氧化物歧化酶(SOD),谷胱甘肽过氧化物酶(GSH-Px),白细胞介素-6(IL-6),肿瘤坏死因子-α(TNF-α),脂联素(ADPN)和核转录因子-κB(NF-κB)水平。结果:观察组中医证候疗效总有效率为91.67%(55/60),高于对照组的76.27%(45/59),(χ^2=5.255,P<0.05);观察组患者SBP和DBP水平均低于对照组(P<0.05);在16周的治疗期间观察组患者的血压达标率为90.66%,高于对照组的84.13%(χ2=127.65,P<0.01);观察组患者CysC,β2-MG,NAG和UACR水平均低于对照组(P<0.01);观察组患者RI和PI水平均低于对照组(P<0.01);治疗后观察组ET-1低于对照组,NO高于对照组(P<0.01);观察组患者SOD和GSH-Px水平均高于对照组(P<0.01);观察组血清IL-6,NF-κB和TNF-α水平均低于对照组,ADPN水平高于对照组(P<0.01)。结论:在常规西医控制血压的基础上,内服杞菊地黄丸加味治疗老年高血压早期肾损害(阴虚阳亢证)患者能进一步降低血压,提高血压的达标率,具有抗炎、抗氧化应激作用,能改善血管�Objective:To observe the efficacy of modified Qiju Dihuang pills in protecting renal function of patients with early renal impairment with syndrome of Yin deficiency and Yang hyperactivity caused by hypertension and its effect in resisting inflammation and oxidative stress,and improving endothelial function.Method:Randomly divided into control group(59 cases)and observation group(60 cases)by random number table.Patients in control got valsartan capsules,80 mg/time,1 time/day.And patients whose blood pressure can’t be controlled were added with nifedipine tablets,10 mg/time,1 time/day.In addition to the therapy of control group,patients in observation group were added with modified Qiju Dihuang pills,1 dose/day.The control group took Qiju Dihuang pills.The courses of treatment were 16 weeks.And levels of cystatin C(CysC),urinary N-acetyl-β-glucosaminidase(NAG),β2 microglobulin(β2-MG),urinary microalbumin to creatinine ratio(UACR)and emodynamics of kidney were detected.Blood pressure,systolic pressure(SBP),diastolic pressure(DBP)and blood pressure renal artery resistance index(RI)and pulsatility index(PI)were recorded,and Yin deficiency and Yang hyperactivity were scored.Levels of nitric oxide(NO),endothelin-1(ET-1),superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α),adiponectin(ADPN)and nuclear factor-kappa B(NF-κB)were detected.Result:The total effective rate in observation group was 91.67%(55/60),which was higher than 76.27%(45/59)in control group(χ^2=5.255,P<0.05).Levels of SBP and DBP were lower than those in control group(P<0.05).At the 16 thweek during the treatment,the compliance rate of blood pressure was 90.66%,which was higher than 84.13%in control group(χ2=127.65,P<0.01).And levels of CysC,β2-MG,NAG,UACR,RI,PI,ET-1,SOD,GSHPx,IL-6,NF-κB and TNF-αwere lower than those in control group(P<0.01),while levels of NO,SOD and GSH-Px were higher than those in control group(P<0.01).Conclusion:In addition to the therapy for controlling blood pr

关 键 词：高血压 早期肾损害 杞菊地黄丸 阴虚阳亢证 炎症反应 氧化应激 内皮功能 肾血流动力 

分 类 号：R289[医药卫生—方剂学] R25[医药卫生—中药学]