摘要
目的研究真武汤加味治疗糖尿病肾脏疾病(Diabetic kidney,DKD)患者的临床疗效及对其肾损伤、氧化应激及炎症因子的影响。方法选取2021年1月—2023年6月期间广州中医药大学附属宝安中医院收治的80例糖尿病肾病综合征患者,按随机数字表法随机分为对照组与治疗组,每组各40例。对照组给予西药治疗,治疗组在此基础上应用真武汤加味治疗。治疗8周后,观察比较两组患者临床疗效、不良反应情况,治疗前后中医证候积分,肾功能指标[血肌酐(Serum creatinine,Scr)、尿素氮(Blood urea nitrogen,BUN)、24 h尿蛋白(24 h urine protein,24 h UTP)、白蛋白(Albumin,ALB)]、肾损伤标志物[尿中性粒细胞明胶酶相关脂质运载蛋白(Neutrophil gelatinase-associated lipocalin,NGAL)、肾损伤分子1(Kidney injury molecule 1,KIM-1)、血清胱抑素C(Cystatin C,CysC)]、氧化应激指标[超氧化物歧化酶(Superoxide dismutase,SOD)、丙二醛(Malondialdehyde,MDA)]及炎症因子[白介素-8(Interleukin-8,IL-8)、白介素-18(Interleukin-18,IL-18)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)]变化。结果治疗后两组患者中医证候积分较治疗前降低,差异有统计学意义(P<0.05);且治疗组患者中医证候积分较对照组明显降低,差异有统计学意义(P<0.05)。治疗后两组患者Scr、BUN、24 h UTP指标均较治疗前降低,ALB指标均较治疗前升高,差异有统计学意义(P<0.05);且治疗组患者Scr、BUN、24 h UTP指标均较对照组明显降低,ALB指标较对照组明显升高,差异有统计学意义(P<0.05)。治疗后两组患者尿NGAL、尿KIM-1及血清CysC水平均较治疗前降低,差异有统计学意义(P<0.05);且治疗组患者尿NGAL、尿KIM-1及血清CysC水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者SOD指标均较治疗前升高,MDA指标均较治疗前降低,差异有统计学意义(P<0.05);且治疗组患者SOD指标明显高于对照组,MDA指标明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清IL-8、IL-18及TNF-α水平均较治疗前降低,差异有统计学意义(P<0.05);且治疗组患者血清IL-8、IL-18及TNF-α水平均较对照组明显降低,差异有统计学意义(P<0.05)。治疗后治疗组临床总有效率90.00%(36/40)明显高于对照组75.00%(30/40),差异有统计学意义(P<0.05)。治疗期间,两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论真武汤加味治疗糖尿病肾病综合征可提高临床疗效,保护肾功能,减轻氧化应激及炎症反应。
Objective To investigate the clinical efficacy of modified Zhenwu Decoction in the treatment of diabetic nephropathy and its effects on renal injury,oxidative stress,and inflammatory factors.Methods A total of 80 pa tients with diabetic nephrotic syndrome admitted to the Shenzhen Bao′an Traditional Chinese Medicine Hospital Group affiliated to Guangzhou University of Chinese Medicine from January 2021 to June 2023 were collected,and they were randomly divided into a control group and a treatment group by the random number table method,with 40 patients in each group.The control group was treated with western medicine,while the treatment group was treated with modified Zhenwu Decoction on this basis.The clinical efficacy and adverse reactions were observed 8 weeks later.Changes were found in traditional Chinese medicine(TCM)syndrome scores,the renal function indicators[serum creatinine(Scr),blood urea nitrogen(BUN),24-hour urine protein(24 h UTP),and serum albumin(ALB)],renal injury markers[urinary neutrophil gelatinase-associated lipocalin(NGAL),kidney injury molecule 1(KIM-1),and serum cystatin C(CysC)],oxidative stress indicators[superoxide dismutase(SOD)and malondialdehyde(MDA)],and inflammatory factors[interleukin-8(IL-8),interleukin-18(IL-18),and tumor necrosis factorα(TNF-α)]before and after the treatment.Results After treatment,TCM syndrome scores of the two groups were lower than those before treatment,and the differences were statistically significant(P<0.05).In addition,the TCM syndrome scores of patients in the treatment group were significantly lower than those in the control group with statistically significant differences(P<0.05).The levels of Scr,BUN,and 24 h UTP of the two groups after treatment were lower than those before treatment,while ALB became higher,with the differences being statistically significant(P<0.05).The Scr,BUN,and 24 h UTP of patients in the treatment group were significantly lower than those in the control group,while ALB increased greatly in the treatment group compared with the control group,and the differences were statistically significant(P<0.05).The levels of urinary NGAL,urinary KIM-1,and serum CysC after treatment were all lower than those before treatment in the two groups,and the differences were statistically significant(P<0.05).Additionally,the levels of urinary NGAL,urinary KIM-1,and serum CysC in patients of the treatment group were significantly lower than those of the control group with statistically significant differences(P<0.05).After treatment,the SOD levels of the two groups increased,while the MDA levels decreased compared with those before treatment,and the differences were statistically significant(P<0.05).The SOD level and the MDA level in the treatment group were higher and lower than those in the control group,respectively,with statistically significant differences(P<0.05).The serum IL-8,IL-18,and TNF-αlevels in the two groups after treatment were lower than those before treatment with statistically significant differences(P<0.05),and their levels were lower in the treatment group than in the control group,whose differences were statistically significant(P<0.05).After treatment,the total clinical effective rate of 90.00%(36/40)in the treatment group was much higher than that of 75.00%(30/40)in the control group,and the difference was statistically significant(P<0.05).The difference in the incidence of adverse reactions during the treatment between the two groups was not statistically significant(P>0.05).Conclusion The modified Zhenwu Decoction can improve the clinical efficacy in the treatment of diabetic nephrotic syndrome,protect renal function,and reduce oxidative stress and inflammatory reaction.
作者
文浩维
徐健婷
曾纪斌
WEN Hao-wei;XU Jian-ting;ZENG Ji-bin(Department of Diabetes,Shenzhen Bao′an Traditional Chinese Medicine Hospital Group Affiliated to Guangzhou University of Chinese Medicine,Shenzhen Guangdong 518101)
出处
《世界中西医结合杂志》
2024年第10期2032-2037,共6页
World Journal of Integrated Traditional and Western Medicine
基金
深圳市宝安区卫生基础研究项目(2020JD511)。
关键词
糖尿病肾病
肾病综合征
真武汤
肾损伤
氧化应激
炎症
Diabetic Nephropathy
Nephrotic Syndrome
Zhenwu Decoction
Renal Injury
Oxidative Stress
Inflammation
