自拟建中补肾消癥汤联合达格列净对糖尿病肾病患者肾纤维化及肾上腺髓质素表达的影响  

Effects of Self-made Jianzhongbushenxiaozheng decoction combined with dapagliflozin on renal fibrosis and expression of adrenomedullin in patients with diabetic nephropathy

作　　者：姜赫 刘武 陈皓 张诏 Jiang He;Liu Wu;Chen Hao;Zhang Zhao(School of Traditional Chinese Medicine,Shandong University of Traditional Chinese Medicine,Shandong Province,Jinan 250014,China;不详)

机构地区：[1]山东中医药大学中医学院,250014 [2]中国中医科学院望京医院,100102

出　　处：《疑难病杂志》2022年第3期277-281,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：国家自然科学基金面上项目(81273635);山东省自然科学基金面上项目(ZR2020MH344);山东省中医药科技发展计划项目(2019-0043)。

摘　　要：目的探讨自拟建中补肾消癥汤联合达格列净对糖尿病肾病患者肾纤维化及肾上腺髓质素表达的影响。方法选取2019年9月—2021年6月在中国中医科学院望京医院就诊的糖尿病肾病患者86例,根据随机数字表法分为对照组、观察组,各43例,对照组给予达格列净等西药常规治疗,观察组在对照组基础上给予自拟建中补肾消癥汤治疗。治疗2个月后,观察2组临床疗效,治疗前后的中医证候评分(肢体浮肿、神疲乏力、口渴多饮、腰膝酸痛、纳减便溏、皮肤瘀斑、脘腹胀满),肾功能指标[血肌酐(SCr)、血尿素氮(BUN)、内生肌酐清除率(CCr)、24 h尿蛋白定量],血糖水平[空腹血糖(FPG)、糖化血红蛋白(HbA_(1c))],肾纤维化指标[血清Ⅲ型前胶原(PCⅢ)、层黏蛋白(LN)、骨形态发生蛋白-7(BMP-7)]及肾上腺髓质素(ADM)表达水平。结果观察组治疗后总有效率高于对照组(88.37%vs.62.79%,χ^(2)=8.495,P<0.05);治疗2个月后,2组患者中医证候评分均降低,且观察组显著低于对照组(t=13.441、21.787、6.556、11.955、9.266、9.653、4.412,均P<0.001);SCr、BUN、24 h尿蛋白定量,FPG、HbA_(1c),PCⅢ、LN水平降低,CCr、BMP-7、ADM水平升高,且观察组改善均显著优于对照组(t/P=10.005/<0.001、10.206/<0.001、6.688/<0.001、3.436/0.001、2.470/0.016、11.020/<0.001、9.586/<0.001、6.008/<0.001、3.037/0.003、10.870/<0.001)。结论自拟建中补肾消癥汤联合达格列净治疗糖尿病肾病患者临床疗效显著,可改善患者肾纤维化过程,促进ADM表达,提高患者肾功能。Objective To investigate the effect of Self-made Jianzhongbushenxiaozheng decoction combined with dapagliflozin on renal fibrosis and adrenomedullin expression in patients with diabetic nephropathy.Methods A total of 86 patients with diabetic nephropathy who were treated in Wangjing Hospital of Chinese Academy of Chinese Medical Sciences from September 2019 to June 2021 were selected and divided into control group and observation group according to the random number table method,with 43 cases in each group.The control group was given dapagliflozin and other western medicine.Routine treatment,the observation group was given the Self-made Jianzhongbushenxiaozheng decoction on the basis of the control group.The clinical efficacy of the two groups was observed,the TCM syndrome scores before and after treatment(limb edema,mental fatigue,thirst and excessive drinking,waist and knee pain,loss of appetite and loose stools,skin ecchymosis,abdominal fullness),renal function indexes(serum creatinine(SCr),blood urea nitrogen(BUN),endogenous creatinine clearance rate(CCr),24-hour urine protein quantification],blood glucose level[fasting blood glucose(FPG),glycated hemoglobin(HbA_(1c))],renal fibrosis index[serum III The expression levels of procollagen type(PCⅢ),laminin(LN),bone morphogenetic protein-7(BMP-7)]and adrenomedullin(ADM).Results The total effective rate in the observation group after treatment was higher than that in the control group(88.37%vs.62.79%,χ^(2)=8.495,P<0.05).After treatment,the TCM syndrome scores of the two groups were decreased,and the observation group was lower than the control group(t/P=13.441/<0.001,21.787/<0.001,6.556/<0.001,11.955/<0.001,9.266/<0.001,9.653/<0.001,4.412/<0.001).SCr,BUN,24 h urine protein quantification,FPG,HbA_(1c),PCⅢ,LN levels decreased,endogenous creatinine clearance(CCr),BMP-7,ADM levels increased,and the improvement in the observation group was better than that in the control group(t/P=10.005/<0.001,10.206/<0.001,6.688/<0.001,3.436/0.001,2.470/0.016,11.020/<0.001,9.586

关 键 词：糖尿病肾病 肾纤维化 建中补肾消癥汤 达格列净 纤维化指标 肾上腺髓质素 治疗疗效 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]