健脾固肾化瘀方治疗脾肾两虚夹瘀型糖尿病肾脏病的疗效及对相关生物标志物的影响  

Curative effect of Jianpi Gushen Huayu Decoction in the treatment of spleen and kidney deficiency and blood stasis syndrome diabetic kidney disease and its effect on related biomarkers

作　　者：苏秀海[1] 孙文娟 姚彬 于文霞[1] SU Xiuhai;SUN Wenjuan;YAO Bin;YU Wenxia(Department of Diabetes,Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine Hebei,Cangzhou 061000,China)

机构地区：[1]河北省沧州中西医结合医院糖尿病科,沧州061000

出　　处：《天津中医药》2024年第5期565-570,共6页Tianjin Journal of Traditional Chinese Medicine

基　　金：河北省中医药管理局科研计划项目(2020469);苏秀海全国名老中医药专家传承工作室(国中医药人教函【2022】75号)。

摘　　要：[目的]探讨健脾固肾化瘀方联合氯沙坦钾片治疗脾肾两虚夹瘀型糖尿病肾脏病(DKD)的临床疗效以及其对患者血清基质金属蛋白酶-9(MMP-9)、单核细胞趋化因子-1(MCP-1)和血管内皮生长因子(VEGF)水平的影响。[方法]选择沧州中西医结合医院2019年1月—2021年5月纳入80例脾肾两虚夹瘀型DKD患者作为研究对象,采用随机数字表法分成观察组与对照组各40例。观察组给予健脾固肾化瘀方联合氯沙坦钾片治疗,对照组单用氯沙坦钾片治疗,连续治疗12周后观察两组临床疗效。治疗前后检测受试者血糖[空腹血糖(FPG)、餐后2 h血糖(2 h PG)和糖化血红蛋白(HbA1c)]、血脂[总胆固醇(TC)、三酰甘油(TG)和低密度脂蛋白胆固醇(LDL-C)]及肾功能指标[尿微量白蛋白/尿肌酐比值(UACR)、肌酐(SCr)和尿素氮(BUN)]。选用酶联免疫吸附法测定血清MMP-9、MCP-1和VEGF水平。并统计两组不良反应情况。[结果]观察组总有效率为92.50%(37/40),较对照组72.50%(29/40)有所提高(P<0.05)。两组治疗后FPG、2 h PG和HbA1c均较治疗前降低(P<0.05),且均以观察组的改善更显著(P<0.01)。两组治疗后血清TC、TG和LDL-C浓度均较治疗前下降(P<0.05),且均以观察组的改善更显著(P<0.01)。两组治疗后UAER和血清SCr、BUN水平均较治疗前降低(P<0.05),且均以观察组的改善更显著(P<0.01)。两组治疗后血清MMP-9水平均较治疗前升高(P<0.05),血清MCP-1、VEGF浓度均较治疗前下降(P<0.05);且治疗后,观察组对血清MMP-9水平的升高作用及对血清MCP-1、VEGF水平的降低作用较对照组更显著(P<0.01)。所有患者均无明显不良反应发生。[结论]应用健脾固肾化瘀方联合氯沙坦钾片治疗脾肾两虚夹瘀型DKD能安全有效地上调患者MMP-9表达水平,下调MCP-1、VEGF表达水平,改善肾功能,整体疗效确切。[Objective]To investigate the clinical efficacy of Jianpi Gushen Huayu Decoction combined with losartan potassium tablets in the treatment of spleen and kidney deficiency and blood stasis syndrome diabetic kidney disease and its effect on serum matrix metalloproteinase-9(MMP-9),monocyte chemoattractant protein-1(MCP-1)and vascular endothelial growth factor(VEGF)levels.[Methods]From January 2019 to May 2021,80 patients with DKD of spleen and kidney deficiency and blood stasis type admitted to our hospital were selected as the research objects.They were divided into observation group and control group by random number table method,with 40 cases in each group.The observation group was treated with Jianpi Gushen Huayu Decoction combined with losartan potassium tablets,and the control group was treated with losartan potassium tablets alone.The clinical efficacy of the two groups was observed after 12 weeks of continuous treatment.Blood glucose[fasting plasma glucose(FPG),2 h postprandial blood glucose(2 h PG)and glycosylated hemoglobin(HbA1c)],blood lipids[total cholesterol(TC),triglyceride(TG)and low density lipoprotein cholesterol(LDL-C)]and renal function indexes[urinary albumin excretion rate(UACR),creatinine(SCr)and urea nitrogen(BUN)]were detected before and after treatment.Serum MMP-9,MCP-1 and VEGF levels were measured by enzyme-linked immunosorbent assay.The side effects of the two groups were counted.[Results]The total effective rate of the observation group was 92.50%(37/40),which was significantly higher than that of the control group[72.50%(29/40)](P<0.05).After treatment,FPG,2h PG and HbA1c in the two groups were significantly lower than those before treatment(P<0.05),and the improvement in the observation group was more significant(P<0.01).After treatment,the serum TC,TG and LDL-C concentrations in the two groups were significantly lower than those before treatment(P<0.05),and the improvement in the observation group was more significant(P<0.01).After treatment,UAER and serum SCr and BUN levels in the t

关 键 词：健脾固肾化瘀方 糖尿病肾脏病 脾肾两虚夹瘀型 基质金属蛋白酶-9 单核细胞趋化因子-1 血管内皮生长因子 

分 类 号：R587.1[医药卫生—内分泌]