益肾通络汤治疗慢性肾小球肾炎脾肾气虚血瘀证的临床疗效  

Clinical Observation of Yishen Tongluo Decoction in Treating Chronic Glomerulonephritis with Spleen and Kidney Qi Deficiency and Blood Stasis Syndrome

作　　者：宋静莹 吕彦辉[1] 王春杰 杨凤文[2] SONG Jing-ying;LYU Yan-hui;WANG Chun-jie;YANG Feng-wen(Chengde Central Hospital,The Second Affiliated Hospital of Chengde Medical College,Chengde 067000,China;Hebei Provincial Hospital of Traditional Chinese Medicine,Shijiazhuang 050007,China)

机构地区：[1]承德市中心医院,承德医学院附属第二医院,河北承德067000 [2]河北省中医院,石家庄050007

出　　处：《中国实验方剂学杂志》2021年第14期93-98,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河北省重点研发计划项目(182777238)。

摘　　要：目的:观察益肾通络汤治疗慢性肾小球肾炎(CGN)脾肾气虚血瘀证的临床疗效及抗炎、抗纤维化作用机制。方法:将120例患者按随机数字表法分为对照组和观察组各60例。两组均给予口服缬沙坦胶囊,160 mg/次,1次/d,双嘧达莫片,50 mg/次,3次/d。对照组口服无比山药丸,9 g/次,2次/d;观察组内服益肾通络汤,1剂/d。两组均连续治疗4个月。检测治疗前后24 h尿蛋白定量(24 h UTP),肌酐(SCr),尿素氮(BUN),血清胱抑素C(CysC),肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6),IL-17,干扰素-γ(IFN-γ),转化生长因子-β_(1)(TGF-β_(1)),结缔组织生长因子(CTGF),基质金属蛋白酶-9(MMP-9),金属蛋白酶组织抑制剂-1(TMP-1)和低氧诱导因子-1α(HIF-1α)水平,进行治疗前后脾肾气虚兼血瘀证评分,监测尿蛋白、尿红细胞(RBC)。结果:观察组24 h UTP,SCr,BUN和CysC水平均低于对照组(P<0.01);观察组脾肾气虚兼血瘀证评分低于对照组(P<0.01);观察组患者TNF-α,IL-6,IL-17和IFN-γ水平均低于对照组(P<0.01);观察组TGF-β_(1),CTGF,TMP-1和HIF-1α水平均低于对照组(P<0.01),MMP-9水平高于对照组(P<0.01);观察组临床疗效有效率为88.33%(53/60),高于对照组的73.33%(44/60)(χ^(2)=4.356,P<0.05)。结论:在西医常规治疗的基础上,益肾通络汤治疗CGN脾肾气虚兼血瘀证患者,能减轻蛋白尿程度,改善中医证候,并具有抗炎和抗肾纤维化作用,从而起到保护肾功能、延缓肾功能不全的进展,具有较好的临床疗效。Objective:To observe the clinical efficacy as well as anti-inflammatory and anti-fibrosis mechanism of Yishen Tongluo decoction in the treatment of chronic glomerulonephritis(CGN)with spleen and kidney Qi deficiency and blood stasis syndrome.Method:According to the random number table method,one hundred and twenty patients were divided into control group(60 cases)and observation group(60 cases).The two groups were given oral valsartan capsules,160 mg/time,1 time/day,and dipyridamole tablets orally,50 mg/time,3 times/day.Patients in control group additionally took Wubi Shanyao pills orally,9 g/time,2 times/day,while patients in observation group additionally took Yishen Tongluo decoction orally,1 dose/day.Both groups were treated continuously for four months.Before and after treatment,24 h urine total protein(24 h UTP),creatinine(SCr),urea nitrogen(BUN),serum cystatin C(CysC),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),IL-17,interferon-γ(IFN-γ),transforming growth factor-β_(1)(TGF-β_(1)),connective tissue growth factor(CTGF),matrix metalloproteinase-9(MMP-9),tissue inhibitor of metalloproteinases(TMP-1)and hypoxia inducible factor-1α(HIF-1α)levels were detected in both groups.The scores of spleen and kidney Qi deficiency and blood stasis syndrome were graded.Urine protein,and urine red blood cells(urinary RBC)were monitored.Result:The 24 h UTP,SCr,BUN and CysC levels of the observation group were lower than those of the control group(P<0.01).The score of spleen and kidney Qi deficiency and blood stasis syndrome in the observation group was lower than that in the control group(P<0.01).The levels of TNF-α,IL-6,IL-17 and IFN-γin the observation group were lower than those in the control group(P<0.01).The levels of TGF-β_(1),CTGF,TMP-1 and HIF-1αin the observation group were lower than those in the control group(P<0.01).While MMP-9 level was higher than that in control group(P<0.01).The clinical effective rate was 88.33%(53/60)in the observation group,higher than 73.33%(44/60)in the control group(χ

关 键 词：慢性肾小球肾炎 脾肾气虚 血瘀证 益肾通络汤 真武汤 大黄䗪虫丸 炎症因子 肾纤维化 

分 类 号：R289[医药卫生—方剂学] R256[医药卫生—中药学]