复方积雪草对糖尿病肾病患者肠道菌群及肾功能的影响  

The effect of compound Centella asiatica on the gut microbiota and kidney function in patients with diabetic kidney disease

作　　者：饶立科 周依娜 吴玄珠 吴建飞 杨道杰 丁国美 Rao Like

机构地区：[1]杭州市红十字会医院钱塘院区,311220

出　　处：《浙江临床医学》2025年第2期176-179,共4页Zhejiang Clinical Medical Journal

基　　金：浙江省中医药科技计划项目(2024ZL762);杭州市医药卫生科技项目(A20220865,B20200519)。

摘　　要：目的探究复方积雪草对糖尿病肾病(DKD)患者肠道菌群及肾功能的影响。方法选取2022年1月至12月在本院接受治疗的DKD患者60例作为研究对象,随机分为对照组及观察组,每组30例,对照组给予控制饮食、控制血糖等基础治疗,观察组在对照组基础治疗上给予复方积雪草治疗。入组时及治疗6个月时,收集患者粪便样本,采用16S rRNA基因测序方法检测肠道菌群丰度及多样性;并采集血液和尿液样本,检测尿微量白蛋白/尿肌酐(ACR)、24 h尿蛋白定量(24 h UPro)、血肌酐(Cr)、血尿素氮(Bun)、肾小球滤过率(GFR)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)等指标。结果观察组治疗后的ACR、24 h UPro较治疗前降低,对照组仅24 h UPro水平降低,且观察组ACR、24 h UPro的下降幅度显著大于对照组。两组治疗前后Chao1与ACE指数比较差异无统计学意义,但观察组治疗后的Shannon与Simpson指数较对照组高。在肠道菌群方面,两组治疗前后在门层次上丰度占比前三均为拟杆菌门、厚壁菌门、变形杆菌门,在属层次上丰度占比前五均为普雷沃氏菌属、巨单胞菌属、拟杆菌属、萨特氏菌属、埃希氏-志贺氏菌属。观察组治疗后拟杆菌门、厚壁菌门、普雷沃氏菌属和拟杆菌属的丰度占比上升,而变形杆菌门、萨特氏菌属和埃希氏-志贺氏菌属的丰度下降,对照组治疗前后无明显变化。此外,观察组治疗后的ACR水平与拟杆菌门和拟杆菌属的水平呈负相关。结论复方积雪草能提高DKD患者肠道菌群多样性,同时能改善患者蛋白尿,保护肾功能。Objective To explore the effects of compound Centella asiatica on the gut microbiota and kidney function in patients with diabetic kidney disease(DKD).Methods A total of 60 DKD patients treated at our hospital from January 2022 to December 2022 were selected as the study subjects and randomly divided into a control group and an observation group,each consisting of 30 cases.The control group received basic treatments such as dietary control and blood sugar control,while the observation group received basic treatments plus compound Centella asiatica treatment.At the time of enrollment and after 6 months of treatment,fecal samples were collected from the patients,and the abundance and diversity of gut microbiota were detected using 16S rRNA gene sequencing;blood and urine samples were also collected to detect the levels of urinary microalbumin/creatinine(ACR),24-hour urinary protein quantification(24 h UPro),serum creatinine(Cr),blood urea nitrogen(Bun),glomerular filtration rate(GFR),fasting plasma glucose(FPG),and glycated hemoglobin(HbA1c).Results The levels of ACR and 24 h UPro in the observation group were reduced after treatment compared to before treatment,while only the level of 24 h UPro in the control group was reduced,and the reduction in ACR and 24 h UPro in the observation group was significantly greater than that in the control group.There was no statistically significant difference in Chao1 and ACE indices between the two groups before and after treatment,but the Shannon and Simpson indices in the observation group after treatment were higher than those in the control group.In terms of gut microbiota,the top three phyla in terms of abundance before and after treatment in both groups were Bacteroidetes,Firmicutes,and Proteobacteria,and the top five genera were Prevotella,Megamonas,Bacteroides,Sutterella,and Escherichia-Shigella.After treatment,the abundance of Bacteroidetes,Firmicutes,Prevotella,and Bacteroides in the observation group increased,while the abundance of Proteobacteria,Sutterella,and Esch

关 键 词：复方积雪草 糖尿病肾病 肠道菌群 肾功能 尿蛋白 

分 类 号：R58[医药卫生—内分泌]