加减补阳还五汤对早期糖尿病肾病临床疗效及足细胞损伤的保护作用  

Clinical Effects of Modified Buyang Huanwutang(补阳还五汤) on Early Diabetic Kidney Disease and Podocyte Injury

作　　者：杨帆[1] 马赟[2] 刘利飞 白璐 边东 王开爽 陈志强 YANG Fan;MA Yun;LIU Lifei;BAI Lu;BIAN Dong;WANG Kaishuang;CHEN Zhiqiang(Hebei University of Chinese Medicine,Shijazhuang 050091;Hebei Provincial Hospital of Traditional Chinese Medicine,Shijiazhuang 050011;The Third Hospital of Hebei Medical University,Shijiazhuang 050051)

机构地区：[1]河北中医学院,石家庄050091 [2]河北省中医院,石家庄050011 [3]河北医科大学第三医院,石家庄050051

出　　处：《中药药理与临床》2025年第1期106-110,共5页Pharmacology and Clinics of Chinese Materia Medica

基　　金：河北省政府资助省级临床医学优秀人才项目(编号:2016034829);河北省重点研发计划项目(编号:20377711D);河北省自然科学基金项目(编号:H2022423320,H2022423342);河北省中医药管理局科研计划项目(编号:2023119)。

摘　　要：目的:观察加减补阳还五汤对早期糖尿病肾病(Diabetic Kidney Disease, DKD)临床疗效及足细胞损伤的保护作用。方法:将128例符合纳入标准的DKD患者随机分为对照组和观察组,各64例。对照组应用西医基础治疗,观察组在对照组基础上联合口服加减补阳还五汤中药汤剂,两组患者连续用药8 w后,比较两组患者临床疗效、中医证候积分、糖脂代谢指标、血液流变学、尿白蛋白排泄率(UAER)、24 h尿蛋白定量(24 h-UTP)、肾功能、足细胞损伤、纤溶酶原激活物抑制剂-1(PAI-1)、组织型纤溶酶原激活剂(t-PA)的含量及不良反应发生情况。结果:经治疗,观察组总有效率明显高于对照组(P<0.05)。两组患者中医证候积分、糖脂代谢指标、血液流变学、足细胞损伤指标、UAER、24 h-UTP、PAI-1的含量明显降低(P<0.05),t-PA含量明显升高(P<0.05),且以观察组中医证候积分、血液流变学、足细胞损伤指标、UAER、24 h-UTP、PAI-1的含量降低更明显(P<0.05),t-PA含量升高更明显(P<0.05)。此外,对照组尿素氮(BUN)、肌酐(Scr)含量与治疗前相比无明显差异(P>0.05),而观察组BUN、Scr含量与治疗前相比明显下降(P<0.05)。结论:加减补阳还五汤治疗DKD的疗效确切,可有效降低患者尿蛋白,调节糖脂代谢,改善血液流变学,保护足细胞,延缓DKD进展,且安全性良好。Objective:To observe the clinical effects of modified Buyang Huanwutang(补阳还五汤) on early diabetic kidney disease(DKD) and podocyte injury. Methods:A total of 128 DKD patients who met the inclusion criteria were randomized into control and observation groups(n=64). The control group was treated with western medicine, and the observation group with modified Buyang Huanwutang combined with western medicine. The treatment in both groups lasted for 8 weeks. The clinical efficacy, traditional Chinese medicine(TCM) symptom scores, glucose and lipid metabolism indexes, hemorheology, urinary albumin excretion rate(UAER),24-hour urine total protein(24h-UTP),renal function, podocyte injury, expression of plasminogen activator inhibitor 1(PAI-1) and tissue plasminogen activator(t-PA),and incidence of adverse reactions were compared between the two groups. Results:After treatment, the total response rate in the observation group was higher than that in the control group(P<0.05). The TCM symptom scores, glucose and lipid metabolism indexes, hemorheology, podocyte injury indexes, UAER,24-UTP,and PAI-1 expression were decreased in both groups(P<0.05),while the expression of t-PA was increased(P<0.05) after treatment. Moreover, the changes of TCM symptom scores, hemorheology, podocyte injury indexes, UAER,24-UTP,PAI-1 and t-PA expression were more significant in the observation group than in the control group(P<0.05). After treatment, the urea nitrogen(BUN) and creatinine(Scr) presented no significant changes in the control group(P>0.05) and declined in the observation group(P<0.05). Conclusion:Modified Buyang Huanwutang has definite therapeutic effect in the treatment of DKD. It can effectively reduce urinary protein, regulate glucose and lipid metabolism, improve hemorheology, and protect podocytes to delay the progression of DKD without increasing adverse reactions.

关 键 词：加减补阳还五汤 糖尿病肾病 临床疗效 足细胞损伤 

分 类 号：R259[医药卫生—中西医结合] R277.5[医药卫生—中医内科学]