参芪地黄汤化裁方联合ACEI/ARB治疗糖尿病肾病Ⅲ~Ⅳ期患者的效果及对蛋白尿、Nrf2信号通路的调节机制  

Effect of Shenqi Dihuang Decoction Huacai Prescription combined with ACEI/ARB in the treatment of patients with diabetic nephropathy stageⅢ-Ⅳand its regulatory mechanism on proteinuria and Nrf2 signaling pathway

作　　者：侯睿 胡炜 董佩[1] 胡大军[1] Hou Rui;Hu Wei;Dong Pei;Hu Dajun(The Second People's Hospital of Three Gorges University,Hubei Province,Yichang 443099,China)

机构地区：[1]三峡大学第二人民医院肾内科,湖北宜昌443099

出　　处：《疑难病杂志》2022年第6期613-618,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：湖北省教育厅项目(Q20211206)。

摘　　要：目的探讨参芪地黄汤化裁方联合血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)治疗糖尿病肾病(DN)Ⅲ~Ⅳ期患者的效果及对蛋白尿、核因子E2相关因子2(Nrf2)信号通路的调节机制。方法选取2019年1月—2021年6月三峡大学第二人民医院就诊的DNⅢ~Ⅳ期患者88例,按照随机数字表法分为对照组和观察组各44例。2组均给予基础治疗,对照组另予ACEI/ARB治疗,观察组在对照组基础上给予参芪地黄汤化裁方治疗。治疗12周后比较2组疗效,观察治疗前后中医证候积分(下肢浮肿、尿浊、倦怠乏力、腰膝酸软)、血糖指标[糖化血红蛋白(HbA_(1c))、空腹血糖(FPG)、餐后2 h血糖(2 hPG)]、肾功能指标[24 h尿蛋白定量(24 hUTP)、血肌酐(SCr)、尿素氮(BUN)、估算肾小球滤过率(eGFR)]、外周血单个核细胞(PBMC)中Nrf2信号通路相关因子[Nrf2、血红素氧合酶-1(HO-1)、醌氧化还原酶1(NQO1)]水平,以及不良反应发生率。结果治疗12周后,观察组总有效率高于对照组(88.64%vs.70.45%,χ^(2)=4.470,P=0.035);观察组双下肢浮肿、尿浊、倦怠乏力、腰膝酸软、总积分均低于对照组,差异有统计学意义(t/P=5.130/<0.001、4.179/<0.001、4.989/<0.001、8.461/<0.001、8.546/<0.001);观察组HbA_(1c)、FPG、2 hPG、24 hUTP、SCr、BUN均低于对照组(t/P=6.691/<0.001、4.769/<0.001、3.659/<0.001、4.611/<0.001、2.549/0.013、2.960/<0.001),eGFR高于对照组(t/P=4.113/<0.001);观察组PBMC中Nrf2、HO-1、NQO1相对表达量均高于对照组(t/P=6.216/<0.001、6.521/<0.001、8.196/<0.001);2组不良反应发生率比较差异无统计学意义(P>0.05)。结论参芪地黄汤化裁方联合ACEI/ARB治疗DNⅢ~Ⅳ期患者疗效显著,可明显减轻临床症状、降低血糖与蛋白尿水平、改善肾功能,还能有效调节Nrf2信号通路,且不增加药物不良反应。Objective To investigate the effect of Shenqi Dihuang Decoction combined with angiotensin-converting enzyme inhibitor(ACEI)/angiotensin II receptor blocker(ARB)in the treatment of patients with diabetic nephropathy(DN)Ⅲ to Ⅳ stages and its effects on proteinuria,nuclear Regulatory mechanisms of the factor E2-related factor 2(Nrf2)signaling pathway.Methods A total of 88 patients with DNⅢ-Ⅳstage who visited the Second People's Hospital of Three Gorges University from January 2019 to June 2021 were selected and divided into the control group and the observation group with 44 cases in each group according to the random number table method.Both groups were given basic treatment,the control group was given ACEI/ARB treatment,and the observation group was given Shenqi Dihuang Decoction Huacai Prescription on the basis of the control group.After 12 weeks of treatment,the curative effects of the two groups were compared,and the TCM syndrome scores(lower extremity edema,turbid urine,fatigue,weakness of waist and knee),blood sugar indexes[glycated hemoglobin(HbA_(1c)),fasting blood glucose(FPG),postprandial 2 h blood glucose(2 hPG)],renal function indicators[24 h urine protein quantification(24 hUTP),serum creatinine(SCr),blood urea nitrogen(BUN),estimated glomerular filtration rate(eGFR)],peripheral blood mononuclear The levels of Nrf2 signaling pathway-related factors[Nrf2,heme oxygenase-1(HO1),quinone oxidoreductase 1(NQO1)]in cells(PBMC),and the incidence of adverse reactions.Results After 12 weeks of treatment,the total effective rate in the observation group was higher than that in the control group(88.64%vs.70.45%,χ^(2)=4.470,P=0.035).The lower extremities edema,turbid urine,lassitude,soreness and weakness of waist and knee,and total score in the observation group were lower than those in the control group,and the differences were statistically significant(t/P=5.130/<0.001,4.179/<0.001,4.989/<0.001,8.461/<0.001,8.546/<0.001).HbA_(1c),FPG,2 hPG,24 hUTP,SCr,and BUN in the observation group were lower than thos

关 键 词：糖尿病肾病 参芪地黄汤化裁方 血管紧张素转换酶抑制剂 血管紧张素Ⅱ受体拮抗剂 蛋白尿 Nrf2信号通路 

分 类 号：R587.2[医药卫生—内分泌]