益肾化瘀汤联合中药免疫抑制剂治疗慢性肾炎患者及对尿蛋白、肾纤维化的影响
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摘要
目的:探讨益肾化瘀汤联合中药免疫抑制剂治疗慢性肾炎患者的临床疗效及对尿蛋白、肾纤维化的影响。方法:选取2016年1月至2017年12月周口市中医院收治的慢性肾炎患者78例作为研究对象,采用随机数字表分组法分为对照组和观察组,每组39例。对照组采取低蛋白、低盐摄入、西药抗水肿、抗血小板、降脂、降压等对症治疗;观察组在对照组基础上给予益肾化瘀汤联合雷公藤多苷片治疗。比较2组治疗前后尿蛋白定量、血肌酐(Scr)、血尿素氮(BUN)、层粘连蛋白(LN)、Ⅲ型前胶原肽(PC-Ⅲ)、Ⅳ型胶原(Col-Ⅳ)、组织金属蛋白酶抑制剂-1(TIMP-1)、临床疗效及不良反应。结果:观察组总有效率(94. 87%)明显高于对照组(79. 49%),差异有统计学意义(P <0. 05);治疗前,2组尿蛋白定量、Scr、BUN、LN、PC-Ⅲ、Col-Ⅳ及TIMP-1水平比较,差异无统计学意义(P> 0. 05);与治疗前比较,2组治疗后尿蛋白定量、Scr、BUN、LN、PC-Ⅲ、Col-Ⅳ及TIMP-1水平均显著降低,差异有统计学意义(P <0. 05);观察组治疗后尿蛋白定量、Scr、BUN、LN、PC-Ⅲ、Col-Ⅳ及TIMP-1水平均低于对照组,差异有统计学意义(P <0. 05); 2组临床不良反应比较,差异无统计学意义(P> 0. 05)。结论:益肾化瘀汤联合中药免疫抑制剂可显著降低慢性肾炎患者尿蛋白量、改善肾功能、降低血清中LN、PC-Ⅲ、Col-Ⅳ及TIMP-1等肾纤维化指标,延缓肾纤维化的进程,临床疗效显著。
Objective: To investigate the clinical efficacy of Yishen Huayu Decoction combined with traditional Chinese medicine immunosuppressant in treating chronic nephritis and its effects on urinary protein and renal fibrosis. Methods: A total of 78 patients with chronic nephritis admitted to Zhoukou Hospital of Traditional Chinese Medicine from January 2016 to December 2017 were selected as the research subjects. The patients were divided into the control group and the observation group by random number table grouping method with 39 patients in each group. The control group received low protein,low salt intake,western medicine anti edema,anti platelet,lipid-lowering,and other symptomatic treatment. The observation group was treated with Yishen Huayu Decoction plus tripterygium glycosides tablets on the basis of the control group. Urine protein quantitation,serum creatinine( Scr),blood urea nitrogen( BUN),laminin( LN),procollagen peptide-III( PC-III),collagen-IV( Col-IV),tissue inhibitor of metalloproteinase-1( TIMP-1),clinical efficacy and adverse reactions were compared between the two groups before and after treatment. Results: The total effective rate of the observation group( 94. 87%) was significantly higher than that of the control group( 79. 49%),and the difference was statistically significant( P < 0. 05). There was no significant difference in urine protein quantitation,Scr,BUN,LN,PC-III,Col-IV and TIMP-1 levels between the two groups before treatment( P > 0. 05). Urinary protein quantification,Scr,BUN,LN,PC-III,Col-IV and TIMP-1 levels in the two groups were significantly decreased after treatment( P < 0. 05). The levels of urine protein,Scr,BUN,LN,PC-III,Col-IV and TIMP-1 in the observation group were significantly lower than those in the control group,and the difference was statistically significant( P < 0. 05). There was no significant difference in clinical adverse reactions between the two groups( P > 0. 05). Conclusion: Yishen Huayu Decoction combined with traditional Chinese medicine immunosuppressant can significantly reduce the amount of urine protein in patients with chronic nephritis,improve renal function index,reduce the serum LN,PC-III,Col-IV and TIMP-1 renal fibrosis indexes,delay the process of renal fibrosis. The clinical effect is significant,and can be further applied.
Objective: To investigate the clinical efficacy of Yishen Huayu Decoction combined with traditional Chinese medicine immunosuppressant in treating chronic nephritis and its effects on urinary protein and renal fibrosis. Methods: A total of 78 patients with chronic nephritis admitted to Zhoukou Hospital of Traditional Chinese Medicine from January 2016 to December 2017 were selected as the research subjects. The patients were divided into the control group and the observation group by random number table grouping method with 39 patients in each group. The control group received low protein,low salt intake,western medicine anti edema,anti platelet,lipid-lowering,and other symptomatic treatment. The observation group was treated with Yishen Huayu Decoction plus tripterygium glycosides tablets on the basis of the control group. Urine protein quantitation,serum creatinine( Scr),blood urea nitrogen( BUN),laminin( LN),procollagen peptide-III( PC-III),collagen-IV( Col-IV),tissue inhibitor of metalloproteinase-1( TIMP-1),clinical efficacy and adverse reactions were compared between the two groups before and after treatment. Results: The total effective rate of the observation group( 94. 87%) was significantly higher than that of the control group( 79. 49%),and the difference was statistically significant( P < 0. 05). There was no significant difference in urine protein quantitation,Scr,BUN,LN,PC-III,Col-IV and TIMP-1 levels between the two groups before treatment( P > 0. 05). Urinary protein quantification,Scr,BUN,LN,PC-III,Col-IV and TIMP-1 levels in the two groups were significantly decreased after treatment( P < 0. 05). The levels of urine protein,Scr,BUN,LN,PC-III,Col-IV and TIMP-1 in the observation group were significantly lower than those in the control group,and the difference was statistically significant( P < 0. 05). There was no significant difference in clinical adverse reactions between the two groups( P > 0. 05). Conclusion: Yishen Huayu Decoction combined with traditional Chinese medicine immunosuppressant can significantly reduce the amount of urine protein in patients with chronic nephritis,improve renal function index,reduce the serum LN,PC-III,Col-IV and TIMP-1 renal fibrosis indexes,delay the process of renal fibrosis. The clinical effect is significant,and can be further applied.
引文
[1]吕冬梅,吕静.中药治疗慢性肾小球肾炎临床对照研究文献分析[J].辽宁中医药大学学报,2016,18(1):181-183.
[2]任志龙,张璐,刘杰,等.转铁蛋白和尿微量蛋白应用于慢性肾小球肾炎早期诊断的临床应用价值[J].河北医学,2016,22(12):1987-1989.
[3]高正兰,兰运彤,甘华,等.疥疮相关性肾小球肾炎临床特点及病因分析[J].重庆医学,2017,46(10):1330-1332.
[4]Gao JR,Qin XJ,Jiang H,et al. Potential role of lncRNAs in contributing to pathogenesis of chronic glomerulonephritis based on microarray data[J]. Gene,2018,643:46-54.
[5]邱波,刘善军,刘志华.淡渗利湿法对慢性肾炎血清肾脏纤维化指标的影响[J].世界中医药,2016,11(11):2314-2316.
[6]冯杜金.慢性肾脏病患者血清CYFR21-1的检测及临床意义[J].浙江医学,2016,38(20):1695-1696.
[7]国家食品药品管理局.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:45-47.
[8]Gao JR,Qin XJ,Jiang H,et al. Screening and functional analysis of differentially expressed genes in chronic glomerulonephritis by whole genome microarray[J]. Gene,2016,589(1):72-80.
[9]Piyaphanee N,Ananboontarick C,Supavekin S,et al. Renal outcome and risk factors for end-stage renal disease in pediatric rapidly progressive glomerulonephritis[J]. Pediatr Int,2017,59(3):334-341.
[10]邓菲,张萍,冯静,等.来氟米特对慢性肾小球肾炎大鼠炎症介质和免疫功能的影响[J].四川大学学报:医学版,2016,47(2):217-221.
[11]Matsukura H,Sakakibara M,Sakamoto I,et al. Proteinuria rebound in Ig A nephropathy associated with obesity-related glomerulopathy[J]. CEN Case Rep,2016,5(2):131-136.
[12]王志伟.尿蛋白/肌酐、24h尿蛋白及肾功能指标检测在慢性肾病诊断中的临床价值[J].中国处方药,2016,14(3):110-111.
[13]瓜超君,马淑梅.血管紧张素Ⅱ受体拮抗剂、血管紧张素转换酶抑制剂、钙拮抗剂对原发性高血压患者血尿酸水平的影响[J].实用药物与临床,2017,20(7):793-796.
[14]Kimura S,Sekiya-Soga Y,Kato Y,et al. Effect of the angiotensin II receptor antagonist(ARB),Irbesartan,on urinary markers in hypertensive patients[J]. Nihon Jinzo Gakkai Shi,2016,58(2):104-113.
[15]黄继义,林鹰,逯富华,等.肾小管上皮细胞线粒体氧化损伤在肾间质纤维化中的病理学机制研究[J].北方药学,2016,13(1):103-105.
[16]颜帆,杨亦彬.慢性缺氧与糖尿病肾脏疾病的关系[J].贵州医药,2016,40(1):97-99.
[17]张琳琪,朱建光,汪青,等.益肾化瘀方对肾间质纤维化大鼠肾组织基质金属蛋白酶1及其抑制剂表达的影响[J].中医杂志,2016,57(15):1332-1336.
[18]解冰,江利萍,王军,等.基质金属蛋白酶-9、基质金属蛋白酶组织抑制剂-1测定在慢性肾衰竭患者中的变化[J].转化医学(连续型电子期刊),2017,4(2):37-38.
[19]王晶晶,蒋媛,储奕,等.雷公藤多苷抑制二肽肽酶I活性及其调节机制的研究[J].中国免疫学杂志,2017,33(4):537-541.
[20]谢镇林,周全安.吗替麦考酚酯多靶点免疫抑制联合雷公藤多苷对难治性肾病综合征肾功能的改善作用[J].中国医学创新,2016,13(35):117-120.
[2]任志龙,张璐,刘杰,等.转铁蛋白和尿微量蛋白应用于慢性肾小球肾炎早期诊断的临床应用价值[J].河北医学,2016,22(12):1987-1989.
[3]高正兰,兰运彤,甘华,等.疥疮相关性肾小球肾炎临床特点及病因分析[J].重庆医学,2017,46(10):1330-1332.
[4]Gao JR,Qin XJ,Jiang H,et al. Potential role of lncRNAs in contributing to pathogenesis of chronic glomerulonephritis based on microarray data[J]. Gene,2018,643:46-54.
[5]邱波,刘善军,刘志华.淡渗利湿法对慢性肾炎血清肾脏纤维化指标的影响[J].世界中医药,2016,11(11):2314-2316.
[6]冯杜金.慢性肾脏病患者血清CYFR21-1的检测及临床意义[J].浙江医学,2016,38(20):1695-1696.
[7]国家食品药品管理局.中药新药临床研究指导原则(试行)[S].北京:中国医药科技出版社,2002:45-47.
[8]Gao JR,Qin XJ,Jiang H,et al. Screening and functional analysis of differentially expressed genes in chronic glomerulonephritis by whole genome microarray[J]. Gene,2016,589(1):72-80.
[9]Piyaphanee N,Ananboontarick C,Supavekin S,et al. Renal outcome and risk factors for end-stage renal disease in pediatric rapidly progressive glomerulonephritis[J]. Pediatr Int,2017,59(3):334-341.
[10]邓菲,张萍,冯静,等.来氟米特对慢性肾小球肾炎大鼠炎症介质和免疫功能的影响[J].四川大学学报:医学版,2016,47(2):217-221.
[11]Matsukura H,Sakakibara M,Sakamoto I,et al. Proteinuria rebound in Ig A nephropathy associated with obesity-related glomerulopathy[J]. CEN Case Rep,2016,5(2):131-136.
[12]王志伟.尿蛋白/肌酐、24h尿蛋白及肾功能指标检测在慢性肾病诊断中的临床价值[J].中国处方药,2016,14(3):110-111.
[13]瓜超君,马淑梅.血管紧张素Ⅱ受体拮抗剂、血管紧张素转换酶抑制剂、钙拮抗剂对原发性高血压患者血尿酸水平的影响[J].实用药物与临床,2017,20(7):793-796.
[14]Kimura S,Sekiya-Soga Y,Kato Y,et al. Effect of the angiotensin II receptor antagonist(ARB),Irbesartan,on urinary markers in hypertensive patients[J]. Nihon Jinzo Gakkai Shi,2016,58(2):104-113.
[15]黄继义,林鹰,逯富华,等.肾小管上皮细胞线粒体氧化损伤在肾间质纤维化中的病理学机制研究[J].北方药学,2016,13(1):103-105.
[16]颜帆,杨亦彬.慢性缺氧与糖尿病肾脏疾病的关系[J].贵州医药,2016,40(1):97-99.
[17]张琳琪,朱建光,汪青,等.益肾化瘀方对肾间质纤维化大鼠肾组织基质金属蛋白酶1及其抑制剂表达的影响[J].中医杂志,2016,57(15):1332-1336.
[18]解冰,江利萍,王军,等.基质金属蛋白酶-9、基质金属蛋白酶组织抑制剂-1测定在慢性肾衰竭患者中的变化[J].转化医学(连续型电子期刊),2017,4(2):37-38.
[19]王晶晶,蒋媛,储奕,等.雷公藤多苷抑制二肽肽酶I活性及其调节机制的研究[J].中国免疫学杂志,2017,33(4):537-541.
[20]谢镇林,周全安.吗替麦考酚酯多靶点免疫抑制联合雷公藤多苷对难治性肾病综合征肾功能的改善作用[J].中国医学创新,2016,13(35):117-120.