通络地龟汤对糖尿病肾病Ⅳ期患者非杓型血压和尿钠排泄及肾素-血管紧张素-醛固酮系统的影响研究  

Effect of Tongluo Digui Decoction on Non-dipper Blood Pressure,Urinary Sodium Excretion,and Reninangiotensin-aldosterone System in Patients with StageⅣDiabetic Kidney Disease

作　　者：庞欣欣 石秀杰 张雅歌 彭紫凝 邢玉凤 韩佳瑞[2] PANG Xinxin;SHI Xiujie;ZHANG Yage;PENG Zining;XING Yufeng;HAN Jiarui(Department of Nephrology,Henan Province Hospital of TCM/The Second Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450002,China;The Second Clinical Medical College,Henan University of Chinese Medicine,Zhengzhou 450046,China)

机构地区：[1]河南省中医院河南中医药大学第二附属医院肾病科,河南省郑州市450002 [2]河南中医药大学第二临床医学院,河南省郑州市450046

出　　处：《中国全科医学》2021年第15期1943-1950,1958,共9页Chinese General Practice

基　　金：河南省重点研发与推广专项(科技攻关)(202102310505,202102310171);国家中医临床研究基地科研项目(2019JDZX068,2019JDZX2119);河南省中医药拔尖人才培养项目(2019ZYBJ17);全国名老中医药专家传承工作室设立分站项目。

摘　　要：背景糖尿病肾病(DKD)已成为世界范围内终末期肾脏病的首要病因,非杓型血压是DKD进展的独立危险因素,但目前尚缺乏有效干预手段,而中医药治疗DKD及非杓型血压具有一定优势。目的探讨通络地龟汤对DKDⅣ期患者非杓型血压、尿钠排泄及肾素-血管紧张素-醛固酮系统(RAAS)的影响。方法选择2019年1月—2020年3月在河南省中医院(河南中医药大学第二附属医院)肾病科、内分泌科门诊就诊或住院的DKDⅣ期患者80例,采用随机数字表法分为对照组和观察组,每组40例。对照组患者采用西医常规治疗,观察组患者在对照组基础上加用通络地龟汤治疗;两组患者疗程均为8周。比较两组患者治疗前后肾功能指标〔血肌酐、尿素氮、24 h尿蛋白定量、估算肾小球滤过率(eGFR)〕、糖化血红蛋白、24 h动态血压、血压变异性、非杓型血压比例、24 h尿钠及血浆肾素、血管紧张素Ⅱ受体、醛固酮水平,计算杓型血压逆转率并记录两组患者治疗期间不良反应发生情况。结果所有患者完成8周随访,无中途退出或脱落病例。与对照组相比,观察组患者治疗后血肌酐、24 h尿蛋白定量、24 h平均舒张压(24 hDBP)、夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP)、夜间收缩压变异性(nSBPCV)、夜间舒张压变异性(nDBPCV)降低,eGFR升高(P<0.05)。与治疗前相比,两组患者治疗后血肌酐、尿素氮、24 h尿蛋白定量、糖化血红蛋白、24 h平均收缩压(24 hSBP)、日间平均收缩压(dSBP)、日间收缩压变异性(dSBPCV)、nSBPCV降低,eGFR升高,且观察组患者治疗后nSBP、nDBP、24 h平均收缩压变异性(24 hSBPCV)、nDBPCV降低(P<0.05)。观察组患者治疗后非杓型血压比例低于对照组及治疗前,杓型血压逆转率高于对照组(P<0.05)。与治疗前相比,两组患者治疗后血浆醛固酮水平降低,观察组患者治疗后24 h尿钠升高(P<0.05)。两组患者治疗期间均未出现明显Background Diabetic kidney disease(DKD)has become the leading cause of end-stage renal disease worldwide,whose development is independently associated with non-dipper blood pressure,but there is a lack of curative treatments.Traditional Chinese medicine treatment is considered to have potentials to treat DKD and non-dipper blood pressure.Objective To explore the effect of Tongluo Digui decoction on non-dipper blood pressure,urinary sodium excretion,and renin-angiotensin-aldosterone system(RAAS)in patients with stageⅣDKD.Methods From January 2019 to March 2020,a total of 80 outpatients and inpatients with stageⅣDKD were selected from the Departments of Nephrology and Endocrinology,Henan Province Hospital of TCM/The Second Affiliated Hospital of Henan University of Chinese Medicine,and were equally randomized into control group and observation group by random number table,receiving conventional Western treatment,and conventional Western treatment with Tongluo Digui decoction for 8 weeks,respectively.Pre-and post-treatment indicators of renal function(including Scr,BUN,24-hour urine protein quantification and eGRF),HbA1c,24-hour ambulatory blood pressure,blood pressure variability,percentage of non-dipper blood pressure,24-hour urinary sodium,and plasma levels of renin,angiotensinⅡreceptor and aldosterone as well as calculated reverse rate of non-dipper blood pressure were compared between the two groups.The incidence of adverse reactions during treatment was recorded.Results There were no dropouts,all cases completed the follow-up.Compared to baseline,mean levels of post-treatment Scr,BUN,24-hour urine protein quantification,HbA1c,24 hSBP,dSBP,dSBPCV and nSBPCV significantly lowered but eGFR increased in the two groups,moreover mean levels of post-treatment nSBP,nDBP,24 hSBPCV and nDBPCV significantly lowered in observation group(P<0.05).The mean levels of post-treatment Scr,24-hour urine protein quantification,24 hDBP,nSBP,nDBP,nSBPCV and nDBPCV lowered more significantly and mean post-treatment eGFR level i

关 键 词：糖尿病肾病 肾素-血管紧张素系统 醛固酮 通络地龟汤 血压 尿钠排泄 

分 类 号：R587.24[医药卫生—内分泌]