健脾养阴固涩方对糖尿病肾病气阴两虚证患者临床疗效及足细胞的保护作用  

Clinical Effect of Jianpi Yangyin Guse Decoction on Podocin and Nephrin and Its Protection Against Podocyte Injury in Diabetic Nephropathy Patients with Qi and Yin Deficiency

作　　者：涂海涛[1] 黎颖[2] 宋娜[2] 罗苑苑[1] 周鑫[2] 沈创鹏[1] TU Hai-tao;LI Ying;SONG Na;LUO Yuan-yuan;ZHOU Xin;SHEN Chuang-peng(The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China)

机构地区：[1]广州中医药大学第一附属医院,广州510405 [2]重庆市中医院,重庆400021

出　　处：《中国实验方剂学杂志》2022年第9期103-109,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：广东省教育厅青年创新人才类(自然科学)项目(2018KQNCX043);重庆市科研院所绩效激励引导专项(cstc2020jxjl130010);重庆市科卫联合中医药技术创新与应用发展项目青年项目(2020ZY3600)。

摘　　要：目的:观察健脾养阴固涩方对糖尿病肾病(DN)患者的临床疗效及对足细胞的保护作用。方法:选取2017年1月至2020年1月收治的DNⅢ和Ⅳ期、辨证为气阴两虚证患者120例,随机分为观察组和对照组,另招募正常组20例。两组给予基础治疗,观察组在对照组基础上加服健脾养阴固涩方中药汤剂,经过3个月治疗,检测中医症型积分、24 h尿蛋白定量(24 h UP)、尿微量白蛋白/尿肌酐(UACR)、肝肾功能、D-二聚体、糖化血红蛋白(HbA1C)、尿液中足细胞裂孔膜蛋白(Nephrin)、膜蛋白(Podocin)、α-平滑肌肌动蛋白(α-SMA)排泄量的变化情况,并与正常组进行比较,进行统计分析。结果:观察组的中医症型积分在治疗后显著优于对照组(P<0.01)。观察组治疗后第2、3个月24 h UP、UACR和肾功能水平较同组治疗前均显著下降,观察组治疗后第3个月24 h UP、UACR和肾功能水平明显低于同期对照组(P<0.05)。观察组治疗后各月的Podocin、Nephrin排泄量和第2、3个月α-SMA水平较同组治疗前下调;与对照组比较,观察组治疗后各月的Podocin、Nephrin排泄量和第3个月α-SMA水平下调(P<0.05)。治疗前后两组患者的安全性指标D-二聚体和肝功能无明显变化,差异无统计学意义;HbA1C水平观察组治疗后较对照组上调(P<0.05)。结论:健脾养阴固涩方对DN患者具有良好的临床疗效,其作用机制可能与下调足细胞标志蛋白Podocin、Nephrin和α-SMA排泄量有关。Objective:To observe the clinical effect of Jianpi Yangyin Guse decoction on patients with diabetic nephropathy(DN),and to explore its protection against podocyte injury.Method:The enrolled120 DN patients at stagesⅢandⅣand diagnosed with Qi and Yin deficiency from January 2017 to January2020 were randomly divided into observation group and control group.During the same period,20 healthy volunteers were recruited as the normal group.In addition to the basic treatment in control group,patients in the observation group were given Jianpi Yangyin Guse decoction,and the course of treatment lasted for 3 months.The traditional Chinese medicine(TCM)syndrome score,24 h urine protein(24 h UP),urine albumin-tocreatinine ratio(UACR),liver and renal functions,D-dimer,hemoglobin A1c(HbA1c),urine podocin and nephrin andα-smooth muscle actin(α-SMA)excretion of the two groups were observed before and after treatment,and the changes were statistically analyzed and compared with those in the normal group.Result:After treatment,the reduction of TCM syndrome score in the observation group was more significant than that in the control group(P<0.01).The 24 h UP level,UACR and renal function in the observation group in the 2nd and3rd months after treatment were lower than the conditions before treatment(P<0.05),and those in the 3rdmonth after treatment were decreased compared with the conditions in the control group during the same period.The levels of podocin and nephrin in each month and theα-SMA excretion in the 3rd month after treatment in the observation group were down-regulated compared with the conditions before treatment and in the control group(P<0.05),and the observation group had reducedα-SMA excretion in the 2nd month after treatment compared with before treatment.There were no marked changes in D-dimer and liver function of the two groups before and after treatment.The level of HbA1c in the observation group was higher than that in the control group after treatment(P<0.05).Conclusion:Jianpi Yangyin Guse decoction ha

关 键 词：糖尿病肾病 健脾养阴固涩方 足细胞损伤 足突蛋白 肾素蛋白 

分 类 号：R242[医药卫生—中医临床基础] R285.5[医药卫生—中医学]