滋肾降糖丸联合西药治疗气阴两虚证糖尿病肾病(G3aA2期)的临床观察及对Galectin-3的影响
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摘要
【目的】观察滋肾降糖丸治疗气阴两虚证糖尿病肾病(G3aA2期)患者的疗效及其对血清半乳糖凝集素-3(Galectin-3)水平的影响。【方法】将60例患者随机分为观察组和对照组,每组各30例。对照组给予西医常规治疗,观察组在西医常规治疗基础上加服滋肾降糖丸,疗程1个月。观察2组患者治疗前后中医证候积分及收缩压(SBP)和舒张压(DBP),肾功能指标[血肌酐(Scr)、肾小球滤过率(eGFR)],尿蛋白指标[尿微量白蛋白肌酐比值(UACR)],糖代谢指标[空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)],脂代谢指标[甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)]和血清Galectin-3水平的变化情况。【结果】(1)治疗后,2组患者的中医证候总积分及SBP和DBP均较治疗前明显下降(P <0.01),且观察组对中医证候总积分及SBP和DBP的下降作用均明显优于对照组(P <0.01或P <0.05)。(2)治疗后,2组患者的Scr、UACR水平均较治疗前明显下降(P <0.01),eGFR水平均治疗前明显升高(P <0.01),且观察组对Scr、UACR水平的下降作用及对eGFR水平的升高作用均明显优于对照组(P <0.01或P <0.05)。(3)治疗后,2组患者的FPG、2hPG、FINS、HbAlc、HOMA-IR等各项糖代谢指标均较治疗前明显下降(P <0.01),且观察组对上述各项糖代谢指标的下降作用均明显优于对照组(P <0.01或P <0.05)。(4)治疗后,2组患者的TG、TC和LDL-C等各项脂代谢指标均较治疗前明显下降(P <0.01),且观察组对上述各项脂代谢指标的下降作用均明显优于对照组(P <0.05)。(5)治疗后,2组患者的血清Galectin-3水平均较治疗前明显下降(P <0.01),且观察组对血清Galectin-3水平的下降作用明显优于对照组(P <0.05)。【结论】滋肾降糖丸联合西医常规治疗糖尿病肾病(G3aA2期)气阴两虚证患者,具有较好疗效,可有效改善症状,降低血压,改善肾功能,降低尿蛋白,改善糖脂代谢,减轻胰岛素抵抗,并可降低血清Galectin-3水平。
Objective To observe the clinical efficacy of Zishen Jiangtang Pills(ZJP)in treating diabetic kidney disease(G3aA2 stage)patients with Qi-Yin deficiency syndrome,and to observe the effect on serum Galectin-3 level. Methods Sixty diabetic kidney disease(G3aA2 stage)patients with Qi-Yin deficiency syndrome were randomly divided into observation group and control group,30 cases in each group. The control group was given conventional western medicine treatment,while the observation group took ZJP orally on the basis of conventional western medicine treatment.The course of treatment covered for one month. Before and after treatment, we observed the scores of traditional Chinese medicine(TCM)symptoms,systolic blood pressure(SBP),diastolic blood pressure(DBP),renal function indicators of serum creatinine(Scr)and estimated glomerular filtration rate(eGFR),urinary protein indicator of urinary micro-albumin-to-creatinine ratio(UACR),glucose metabolism indexes of fasting plasma glucose(FPG),2-hour postprandial blood glucose(2hPG),glycosylated hemoglobin(HbA1c), fasting insulin(FINS)and homeostasis model assessment-insulin resistance index(HOMA-IR),lipid metabolism indexes of triglyceride(TG), total cholesterol(TC)and low-density lipoprotein cholesterol(LDL-C),and serum Galectin-3 level in the two groups. Results(1)After treatment,the overall scores of TCM symptoms,SBP and DBP in the two groups were decreased significantly(P < 0.01 compared with those before treatment),and the decrease in the observation group was superior to that in the control group(P < 0.01 or P <0.05).(2)After treatment, Scr and UACR levels were decreased and eGFR was increased in the two groups significantly(P < 0.01 compared with those before treatment),and the decrease of Scr and UACR as well as the increase of eGFR in the observation group was superior to that in the control group(P < 0.01 or P < 0.05).(3)After treatment, glucose metabolism indexes of FPG, 2hPG, FINS, HbAlc, HOMA-IR in the two groups were decreased significantly(P < 0.01 compared with those before treatment),and the decrease in the observation group was superior to that in the control group(P < 0.01 or P < 0.05).(4)After treatment,lipid metabolism indexes of TG, TC and LDL-C in the two groups were decreased significantly(P < 0.01 compared with those before treatment),and the decrease in the observation group was superior to that in the control group(P < 0.05).(5)After treatment,serum Galectin-3 level in the two groups was decreased significantly(P < 0.01 compared with that before treatment),and the decrease in the observation group was superior to that in the control group(P < 0.05).Conclusion ZJP combined with western medicine is effective for the treatment of diabetic kidney disease(G3aA2 stage)patients with Qi-Yin deficiency syndrome,and the combined therapy can significantly relieve symptoms,decrease blood pressure, improve renal function, reduce urinary protein, ameliorate glucose and lipid metabolism,alleviate insulin resistance,and decrease the level of serum Galectin-3.
Objective To observe the clinical efficacy of Zishen Jiangtang Pills(ZJP)in treating diabetic kidney disease(G3aA2 stage)patients with Qi-Yin deficiency syndrome,and to observe the effect on serum Galectin-3 level. Methods Sixty diabetic kidney disease(G3aA2 stage)patients with Qi-Yin deficiency syndrome were randomly divided into observation group and control group,30 cases in each group. The control group was given conventional western medicine treatment,while the observation group took ZJP orally on the basis of conventional western medicine treatment.The course of treatment covered for one month. Before and after treatment, we observed the scores of traditional Chinese medicine(TCM)symptoms,systolic blood pressure(SBP),diastolic blood pressure(DBP),renal function indicators of serum creatinine(Scr)and estimated glomerular filtration rate(eGFR),urinary protein indicator of urinary micro-albumin-to-creatinine ratio(UACR),glucose metabolism indexes of fasting plasma glucose(FPG),2-hour postprandial blood glucose(2hPG),glycosylated hemoglobin(HbA1c), fasting insulin(FINS)and homeostasis model assessment-insulin resistance index(HOMA-IR),lipid metabolism indexes of triglyceride(TG), total cholesterol(TC)and low-density lipoprotein cholesterol(LDL-C),and serum Galectin-3 level in the two groups. Results(1)After treatment,the overall scores of TCM symptoms,SBP and DBP in the two groups were decreased significantly(P < 0.01 compared with those before treatment),and the decrease in the observation group was superior to that in the control group(P < 0.01 or P <0.05).(2)After treatment, Scr and UACR levels were decreased and eGFR was increased in the two groups significantly(P < 0.01 compared with those before treatment),and the decrease of Scr and UACR as well as the increase of eGFR in the observation group was superior to that in the control group(P < 0.01 or P < 0.05).(3)After treatment, glucose metabolism indexes of FPG, 2hPG, FINS, HbAlc, HOMA-IR in the two groups were decreased significantly(P < 0.01 compared with those before treatment),and the decrease in the observation group was superior to that in the control group(P < 0.01 or P < 0.05).(4)After treatment,lipid metabolism indexes of TG, TC and LDL-C in the two groups were decreased significantly(P < 0.01 compared with those before treatment),and the decrease in the observation group was superior to that in the control group(P < 0.05).(5)After treatment,serum Galectin-3 level in the two groups was decreased significantly(P < 0.01 compared with that before treatment),and the decrease in the observation group was superior to that in the control group(P < 0.05).Conclusion ZJP combined with western medicine is effective for the treatment of diabetic kidney disease(G3aA2 stage)patients with Qi-Yin deficiency syndrome,and the combined therapy can significantly relieve symptoms,decrease blood pressure, improve renal function, reduce urinary protein, ameliorate glucose and lipid metabolism,alleviate insulin resistance,and decrease the level of serum Galectin-3.
引文
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[4]Kikuchi Y,Kobayashi S,Hemmi N,et al.Galectin-3-positive cell infiltration in human diabetic nephropathy[J].Nephrol Dial Transpl,2004,19(3):602.
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[10]郑筱萸.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002.
[11]Haudek K C,Spronk K J,Voss P G,et al.Dynamics of galectin-3 in the nucleus and cytoplasm[J].Biochim Biophys Acta,2010,1800(2):180.
[12]Díazalvarez L,Ortega E.The many roles of galectin-3,a multifaceted molecule,in innate immune responses against pathogens[J].Mediat Inflamm,2017,2017(8):9247574.
[13]Ohkura T,Fujioka Y,Nakanishi R,et al.Low serum galectin-3 concentrations are associated with insulin resistance in patients with type 2 diabetes mellitus[J].Diabetol Metab Syndr,2014,6(1):1.
[14]Weigert J,Neumeier M,Wanninger J,et al.Serum galectin-3is elevated in obesity and negatively correlates with glycosylated hemoglobin in type 2 diabetes[J].J Clin Endocrinol Metab,2010,95(3):1404.
[15]Song G F,Sun H L,Han P X,et al.Increased serum galectin-3levels are associated with the development of type 2 diabetic nephropathy:a novel marker for progression[J].Int J Clin Exp Med,2018,11(7):7156.
[16]Li P P,Liu S N,Lu M,et al.Hematopoietic-derived galectin-3causes cellular and systemic insulin resistance[J].Cell,2016,167(4):973.
[17]杨霓芝,王立新,廖平平.248例糖尿病肾病患者分期辨证分析[J].广州中医药大学学报,1998,15(4):260.
[18]高彦彬,刘铜华,李平.糖尿病肾病中医防治指南[J].中国中医药现代远程教育,2011,9(4):151.
[2]Sharma D,Bhattacharya P,Kalia K,et al.Diabetic nephropathy:new insights into established therapeutic paradigms and novel molecular targets[J].Diabetes Res Clin Pract,2017,128:91.
[3]高俊丽,朱赟洁,王巍巍,等.中医辨治糖尿病肾病的研究进展[J].四川中医,2019,37(1):216.
[4]Kikuchi Y,Kobayashi S,Hemmi N,et al.Galectin-3-positive cell infiltration in human diabetic nephropathy[J].Nephrol Dial Transpl,2004,19(3):602.
[5]Tan K,Cheung C,Lee C,et al.Galectin-3 is independently associated with progression of nephropathy in type 2 diabetes mellitus[J].Diabetologia,2018(Suppl 3):1.
[6]吕文山,董砚虎,钱荣立.糖尿病的诊断和分型[J].中国糖尿病杂志,2000,35(1):60.
[7]中华医学会.临床诊疗指南肾脏病学分册[M].北京:人民卫生出版社,2001:106.
[8]Stevens P E,Levin A.Evaluation and management of chronic kidney disease:synopsis of the kidney disease:improving global outcomes 2012 clinical practice guideline[J].Ann Intern Med,2013,158(11):825.
[9]中华中医药学会肾病分会.糖尿病肾病诊断、辨证分型及疗效评定标准(试行方案)[J].上海中医药杂志,2007,41(7):7.
[10]郑筱萸.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002.
[11]Haudek K C,Spronk K J,Voss P G,et al.Dynamics of galectin-3 in the nucleus and cytoplasm[J].Biochim Biophys Acta,2010,1800(2):180.
[12]Díazalvarez L,Ortega E.The many roles of galectin-3,a multifaceted molecule,in innate immune responses against pathogens[J].Mediat Inflamm,2017,2017(8):9247574.
[13]Ohkura T,Fujioka Y,Nakanishi R,et al.Low serum galectin-3 concentrations are associated with insulin resistance in patients with type 2 diabetes mellitus[J].Diabetol Metab Syndr,2014,6(1):1.
[14]Weigert J,Neumeier M,Wanninger J,et al.Serum galectin-3is elevated in obesity and negatively correlates with glycosylated hemoglobin in type 2 diabetes[J].J Clin Endocrinol Metab,2010,95(3):1404.
[15]Song G F,Sun H L,Han P X,et al.Increased serum galectin-3levels are associated with the development of type 2 diabetic nephropathy:a novel marker for progression[J].Int J Clin Exp Med,2018,11(7):7156.
[16]Li P P,Liu S N,Lu M,et al.Hematopoietic-derived galectin-3causes cellular and systemic insulin resistance[J].Cell,2016,167(4):973.
[17]杨霓芝,王立新,廖平平.248例糖尿病肾病患者分期辨证分析[J].广州中医药大学学报,1998,15(4):260.
[18]高彦彬,刘铜华,李平.糖尿病肾病中医防治指南[J].中国中医药现代远程教育,2011,9(4):151.