小柴胡汤合五苓散对维持性腹膜透析患者残余肾功能的保护及对腹膜纤维化、微炎症状态的影响
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摘要
目的:观察小柴胡汤合五苓散对维持性腹膜透析(PD)患者残余肾功能的保护及对腹膜纤维化、微炎症状态的影响。方法:选取重庆市中医院自2016年6月至2017年6月收治的65例PD患者作为观察对象,按照随机数字表法分为对照组32例,研究组33例。对照组给予常规治疗,研究组给予常规治疗+小柴胡汤合五苓散治疗,治疗前、治疗3个月采空腹静脉血,测定血肌酐(SCr),尿素氮(BUN)水平。采集尿液,记录24 h尿量,使用比色法检测24 h尿蛋白定量水平(24 h UP),计算肾小球滤过率(e GFR),残余肾功能(RRF),其中RRF采用残余肾肌酐清除率表示。使用化学发光法检测炎症因子,包括白细胞介素-6(IL-6),白细胞介素-8(IL-8)和肿瘤坏死因子-α(TNF-α)水平。采用酶联免疫吸附试验(ELISA)测定血清Janus激酶(Janus Kinase,JAK) 2,信号传导及转录激活因子(STAT) 3水平。采用蛋白免疫印迹法检测E-钙黏蛋白(E-cadherin),α-肌动蛋白(α-SMA)水平。结果:治疗前两组RRF比较差异均无统计学意义,治疗后研究组RRF明显优于对照组(P <0. 05)。治疗后研究组24 h UP低于对照组,日均尿量高于对照组(P <0. 05)。治疗后研究组IL-6,IL-8,TNF-α水平均明显低于对照组(P <0. 05),研究组JAK2,STAT3水平均低于对照组(P <0. 01)。对照组腹透液中的上皮细胞E-cadherin蛋白表达量较本组治疗前显著降低(P <0. 01),α-SMA蛋白表达量较本组治疗前显著升高(P <0. 01),研究组治疗前后E-cadherin,α-SMA蛋白表达量无明显变化。结论:小柴胡汤合五苓散能够保护PD患者的残余肾功能,其机制可能与其改善腹膜纤维化进程,减轻机体的微炎症状态有关,具有较高的应用价值。
Objective: To observe the protective effect of Xiao Chaihutang and Wulingsan on residual renal function in patients with maintenance peritoneal dialysis( PD) and investigate its effect on peritoneal fibrosis and microinflammation. Method: The 65 patients with PD who were admitted to our hospital from June 2016 to June 2017 were enrolled in the study,and divided into control group( 32 cases) and study group( 33 cases)according to the random number table. The control group received routine treatment. The study group received routine treatment + Xiao Chaihutang and Wulingsan. The fasting venous blood was taken before treatment and3 months after treatment to measure serum creatinine( SCr) and urea nitrogen( BUN). Urine was collected; 24 hour urine volume was recorded; 24 h urine protein( 24 h UP) was measured by colorimetry; glomerular filtration rate( eGFR) was calculated; residual renal function( RRF) was expressed with residual renal creatinine clearance. Inflammatory factors were detected by using chemiluminescence,including interleukin-6( IL-6),interleukin-8( IL-8),and tumor necrosis factor-α( TNF-α) levels. Serum Janus Kinase( JAK) 2 as well as signal transducer and activator of transcription( STAT) 3 levels were determined by double antibody sandwich enzymelinked immunosorbent assay( ELISA). E-cadherin and α-smooth muscle actin( α-SMA) levels were determined by Western blot. Result: Before treatment,there was no significant difference in the residual renal function between two groups. After treatment,the residual renal function of the study group was significantly better than that of control group( P < 0. 05). After treatment,24 h UP of study group was lower than that of control group,and the daily average urine volume was higher than that of control group( P < 0. 05). After treatment,the levels of IL-6,IL-8 and TNF-α in study group were lower than those in control group( P < 0. 05); the levels of JAK2 and STAT3 in study group were significantly lower than those in control group( P < 0. 01). The expression of E-cadherin protein in the dialysate of control group was significantly decreased after treatment( P < 0. 01),and the expression level of α-SMA protein was significantly increased after treatment( P < 0. 01); however,study group had no significant changes in the expression of E-cadherin and α-SMA protein after treatment. Conclusion: Xiao Chaihutang and Wulingsan can protect the residual renal function of PD patients,and the mechanism may be related to the improvement of peritoneal fibrosis and the reduction of micro-inflammation of the body,showing a high application value.
Objective: To observe the protective effect of Xiao Chaihutang and Wulingsan on residual renal function in patients with maintenance peritoneal dialysis( PD) and investigate its effect on peritoneal fibrosis and microinflammation. Method: The 65 patients with PD who were admitted to our hospital from June 2016 to June 2017 were enrolled in the study,and divided into control group( 32 cases) and study group( 33 cases)according to the random number table. The control group received routine treatment. The study group received routine treatment + Xiao Chaihutang and Wulingsan. The fasting venous blood was taken before treatment and3 months after treatment to measure serum creatinine( SCr) and urea nitrogen( BUN). Urine was collected; 24 hour urine volume was recorded; 24 h urine protein( 24 h UP) was measured by colorimetry; glomerular filtration rate( eGFR) was calculated; residual renal function( RRF) was expressed with residual renal creatinine clearance. Inflammatory factors were detected by using chemiluminescence,including interleukin-6( IL-6),interleukin-8( IL-8),and tumor necrosis factor-α( TNF-α) levels. Serum Janus Kinase( JAK) 2 as well as signal transducer and activator of transcription( STAT) 3 levels were determined by double antibody sandwich enzymelinked immunosorbent assay( ELISA). E-cadherin and α-smooth muscle actin( α-SMA) levels were determined by Western blot. Result: Before treatment,there was no significant difference in the residual renal function between two groups. After treatment,the residual renal function of the study group was significantly better than that of control group( P < 0. 05). After treatment,24 h UP of study group was lower than that of control group,and the daily average urine volume was higher than that of control group( P < 0. 05). After treatment,the levels of IL-6,IL-8 and TNF-α in study group were lower than those in control group( P < 0. 05); the levels of JAK2 and STAT3 in study group were significantly lower than those in control group( P < 0. 01). The expression of E-cadherin protein in the dialysate of control group was significantly decreased after treatment( P < 0. 01),and the expression level of α-SMA protein was significantly increased after treatment( P < 0. 01); however,study group had no significant changes in the expression of E-cadherin and α-SMA protein after treatment. Conclusion: Xiao Chaihutang and Wulingsan can protect the residual renal function of PD patients,and the mechanism may be related to the improvement of peritoneal fibrosis and the reduction of micro-inflammation of the body,showing a high application value.
引文
[1]彭彦平,周平,燕丽香.左卡尼汀联合中药对腹膜透析患者残余肾功能、微炎症状态及营养状况的影响[J].现代中西医结合杂志,2016,25(18):1997-1999.
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[9]郭园园. Wnt/β-catenin信号通路在腹膜透析腹膜间皮细胞转分化中的作用及机制研究[D].长沙:中南大学,2012.
[10]于秀梅,谷右天.自拟益肾泄浊汤联合血液透析治疗尿毒症疗效及对肾功能的影响[J].中国中医急症,2017,26(10):1806-1808.
[11]孙亦兵,王莹,温红梅.不同残余肾功能对行腹膜透析尿毒症患者微炎症状态的影响[J].新乡医学院学报,2014,31(5):351-352,355.
[12]刘干炎,王国斌,陈帮明,等.排毒保肾丸联合缬沙坦对腹膜透析患者残余肾功能的保护作用[J].中国实验方剂学杂志,2015,21(16):192-196.
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[14]罗健华,邓跃毅,钟逸斐,等.补肾健脾方保护腹膜透析患者残余肾功能的前瞻性随机对照研究[J].临床肾脏病杂志,2015,15(8):461-464.
[15]田露露,熊飞.肾经水肿汤对腹膜透析患者残余肾功能的影响[J].湖北中医杂志,2016,38(7):1-3.
[16]林莉,李真真,黄静.前列地尔联合百令胶囊辅助腹膜透析对慢性肾衰竭患者残余肾功能及营养状况的影响[J].现代中西医结合杂志,2018,27(1):58-61.
[17]程锦绣,陆继芳,李玥欣,等.尿毒清颗粒联合氯沙坦钾对腹膜透析患者微炎症状态及腹膜功能的影响[J].实用临床医药杂志,2017,21(23):46-49.
[18]严小玲,唐剑萍,贺汉军,等.参麦注射液联合厄贝沙坦对腹膜透析患者微炎症状态及营养状态的影响[J].海南医学院学报,2017,23(21):2941-2944,2948.
[19] Kaneko K,Hamada C,Tomino Y. Peritoneal fibrosis intenvention[J]. Perit Dial Int,2007,27(2):S82-86.
[20] Aroeira L S,Aguilera A,Sanchez-Tbmero J A,et al.Epithelial to mesenchymal transition and peritoneal membrane failure in peritoneal dialysis patients:pathologic significance and potential therapeutic interventions[J]. J Am Soc Nephrol 2007,18(9):13-16.
[21] LIU F,ZONG M,WEN X,et a1. Silencing of histone deacetylase 9 expression in podocytes attenuates kidney injury in diabetic nephropathy[J]. Sci Rep,2016,6(4):676-679.
[22]杜浩昌,陈英兰,周健淞.培本祛瘀冲剂对脾肾虚衰、湿浊瘀阻型慢性肾衰患者肾功能和微炎症状态的影响[J].中国实验方剂学杂志,2012,18(1):234-236.
[23]王身菊,朱美凤,邓祥军,等.保元排毒丸对维持性血液透析患者残余肾功能的影响[J].中成药,2016,38(1):46-49.
[24]李攀,常风云.肾康注射液对尿毒症血液透析患者残余肾功能的影响[J].中国实验方剂学杂志,2015,21(9):200-203.
[2]马世兴,陈卫红.益肾活血汤辅助治疗对维持性血液透析患者颈动脉内膜中层厚度、氧化应激指标及微炎症状态的影响[J].辽宁中医药大学学报,2017,19(12):121-123.
[3]孔祥栋,邵国民,许金华,等.厄贝沙坦对腹膜透析患者微炎症状态及残余肾功能的影响[J].中国现代医生,2016,54(20):10-12,21.
[4]田园,陈文.血浆白蛋白变化对行腹膜透析治疗的终末期肾病患者的残余肾功能的影响[J].实用临床医药杂志,2017,21(17):229-230.
[5]田信奎.腹膜透析饮食蛋白摄入、营养与透析充分性[D].北京:北京大学,2006.
[6]王海燕.慢性肾脏病及透析的临床实践指南[M].北京:人民卫生出版社,2003:203-208.
[7]中华人民共和国卫生部.中药新药临床研究指导原则[J].北京:中国医药科技出版社,2002:165-169.
[8]彭晓艳,王海云,李阳,等.自动化腹膜透析治疗终末期肾病患者长期生存分析[J].中华肾脏病杂志,2017,33(10):152-156.
[9]郭园园. Wnt/β-catenin信号通路在腹膜透析腹膜间皮细胞转分化中的作用及机制研究[D].长沙:中南大学,2012.
[10]于秀梅,谷右天.自拟益肾泄浊汤联合血液透析治疗尿毒症疗效及对肾功能的影响[J].中国中医急症,2017,26(10):1806-1808.
[11]孙亦兵,王莹,温红梅.不同残余肾功能对行腹膜透析尿毒症患者微炎症状态的影响[J].新乡医学院学报,2014,31(5):351-352,355.
[12]刘干炎,王国斌,陈帮明,等.排毒保肾丸联合缬沙坦对腹膜透析患者残余肾功能的保护作用[J].中国实验方剂学杂志,2015,21(16):192-196.
[13] Brosius F C,Alpers C E. New targets for treatment of diabetic nephropathy:what we have learned from animal models[J]. Curr Opin Nephrol Hypertens,2012,22(1):17-25.
[14]罗健华,邓跃毅,钟逸斐,等.补肾健脾方保护腹膜透析患者残余肾功能的前瞻性随机对照研究[J].临床肾脏病杂志,2015,15(8):461-464.
[15]田露露,熊飞.肾经水肿汤对腹膜透析患者残余肾功能的影响[J].湖北中医杂志,2016,38(7):1-3.
[16]林莉,李真真,黄静.前列地尔联合百令胶囊辅助腹膜透析对慢性肾衰竭患者残余肾功能及营养状况的影响[J].现代中西医结合杂志,2018,27(1):58-61.
[17]程锦绣,陆继芳,李玥欣,等.尿毒清颗粒联合氯沙坦钾对腹膜透析患者微炎症状态及腹膜功能的影响[J].实用临床医药杂志,2017,21(23):46-49.
[18]严小玲,唐剑萍,贺汉军,等.参麦注射液联合厄贝沙坦对腹膜透析患者微炎症状态及营养状态的影响[J].海南医学院学报,2017,23(21):2941-2944,2948.
[19] Kaneko K,Hamada C,Tomino Y. Peritoneal fibrosis intenvention[J]. Perit Dial Int,2007,27(2):S82-86.
[20] Aroeira L S,Aguilera A,Sanchez-Tbmero J A,et al.Epithelial to mesenchymal transition and peritoneal membrane failure in peritoneal dialysis patients:pathologic significance and potential therapeutic interventions[J]. J Am Soc Nephrol 2007,18(9):13-16.
[21] LIU F,ZONG M,WEN X,et a1. Silencing of histone deacetylase 9 expression in podocytes attenuates kidney injury in diabetic nephropathy[J]. Sci Rep,2016,6(4):676-679.
[22]杜浩昌,陈英兰,周健淞.培本祛瘀冲剂对脾肾虚衰、湿浊瘀阻型慢性肾衰患者肾功能和微炎症状态的影响[J].中国实验方剂学杂志,2012,18(1):234-236.
[23]王身菊,朱美凤,邓祥军,等.保元排毒丸对维持性血液透析患者残余肾功能的影响[J].中成药,2016,38(1):46-49.
[24]李攀,常风云.肾康注射液对尿毒症血液透析患者残余肾功能的影响[J].中国实验方剂学杂志,2015,21(9):200-203.