中医辨证治疗对糖尿病肾病肾功能不全患者蛋白非酶糖基化和蛋白激酶C激活的影响
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摘要
目的:探讨中医辨证治疗糖尿病肾病肾功能不全患者对其蛋白非酶糖基化和蛋白激酶C激活的影,为糖尿病肾病肾功能不全患者的临床治疗提供参考。方法:选取2016年3月至2018年3月濮阳市中医医院收治的糖尿病肾病肾功能不全患者96例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组48例,其中对照组患者给予西医常规治疗,观察组患者在上述治疗的基础上外加中医辨证治疗,比较2组肾功能、蛋白激酶C(PKC)活性以及血糖、糖化血红蛋白水平变化,并分析2组治疗后肾脏血流相关参数的变化,观察2组临床疗效。结果:2组治疗前肾功能相关指标、PKC活性以及血糖、糖化血红蛋白水平差异无统计学意义(P> 0. 05),具有可比性。治疗后观察组患者肌酐(Scr)和尿素氮(BUN)、胞质PKC活性、胞膜PKC活性以及空腹血糖、糖化血红蛋白水平均明显下降,SCr水平升高,差异有统计学意义(P <0. 05)。与对照组比较,观察组肾主动脉(MRA)、段动脉(SRA的Vsmax差异无统计学意义(P> 0. 05),Vdmin明显升高,RI明显降低(P <0. 05); IRA的Vdmin、Vsmax明显升高,RI明显降低(P <0. 05)。观察组患者的治疗有效率为95. 83%,明显高于对照组的70. 83%,差异有统计学意义(P <0. 05)。结论:中医辨证治疗糖尿病肾病肾功能不全患者可以有效的抑制PKC通路的激活,减轻蛋白非酶糖基化的发生,纠正肾血流动力学异常,改善肾功能,效果显著。
Objective: To investigate the effects of dialectical treatment of diabetic nephropathy renal insufficiency on protein nonenzymatic glycosylation and protein kinase C activation and its relationship with hemodynamic abnormalities,and provide reference for clinical treatment of patients with diabetic nephropathy renal insufficiency. Methods: A total of 96 patients with renal insufficiency due to diabetic nephropathy were admitted to Puyang Traditional Chinese Medicine Hospital from March 2016 to March 2018 and they were randomly divided into observation group and control group,with 48 cases in each group. The control group was given routine Western medicine treatment,and the patients in the observation group were treated with the dialectical treatment of traditional Chinese medicine( TCM) based on the above-mentioned treatment. The renal function,protein kinase C( PKC) activity,and changes in blood glucose and glycosylated hemoglobin levels before and after treatment were compared between the two groups. The changes of blood flow related parameters after treatment in the two groups of patients were analyzed to observe the clinical efficacy of the two groups after treatment. Results: There was no significant difference between the two groups in terms of parameters related to renal function before treatment,PKC activity,and blood glucose and glycosylated hemoglobin levels( P > 0. 05). After treatment,the SCr,BUN,cytoplasmic PKC activity,membrane PKC activity,fasting blood glucose,and hemoglobin A1 c of the patients in the observation group significantly decreased,and Ccr levels significantly increased,which was statistically significant( P < 0. 05).Compared with the control group,Vsmax of MRA and SRA in the observation group had no significant difference( P > 0. 05),and Vdmin increased significantly,RI decreased significantly( P < 0. 05),while Vdmin,Vsmax of IRA increased significantly and RI decreased significantly( P < 0. 05). The effective rate in the observation group was 95. 83%,which was significantly higher than that in the control group( 70. 83%). The difference was statistically significant( P < 0. 05). Conclusion: The dialectical treatment of diabetic nephropathy patients with renal insufficiency can effectively inhibit the activation of PKC pathway,reduce protein nonenzymatic glycosylation,correct renal hemodynamic abnormalities,improve renal function,the effect is significant.
Objective: To investigate the effects of dialectical treatment of diabetic nephropathy renal insufficiency on protein nonenzymatic glycosylation and protein kinase C activation and its relationship with hemodynamic abnormalities,and provide reference for clinical treatment of patients with diabetic nephropathy renal insufficiency. Methods: A total of 96 patients with renal insufficiency due to diabetic nephropathy were admitted to Puyang Traditional Chinese Medicine Hospital from March 2016 to March 2018 and they were randomly divided into observation group and control group,with 48 cases in each group. The control group was given routine Western medicine treatment,and the patients in the observation group were treated with the dialectical treatment of traditional Chinese medicine( TCM) based on the above-mentioned treatment. The renal function,protein kinase C( PKC) activity,and changes in blood glucose and glycosylated hemoglobin levels before and after treatment were compared between the two groups. The changes of blood flow related parameters after treatment in the two groups of patients were analyzed to observe the clinical efficacy of the two groups after treatment. Results: There was no significant difference between the two groups in terms of parameters related to renal function before treatment,PKC activity,and blood glucose and glycosylated hemoglobin levels( P > 0. 05). After treatment,the SCr,BUN,cytoplasmic PKC activity,membrane PKC activity,fasting blood glucose,and hemoglobin A1 c of the patients in the observation group significantly decreased,and Ccr levels significantly increased,which was statistically significant( P < 0. 05).Compared with the control group,Vsmax of MRA and SRA in the observation group had no significant difference( P > 0. 05),and Vdmin increased significantly,RI decreased significantly( P < 0. 05),while Vdmin,Vsmax of IRA increased significantly and RI decreased significantly( P < 0. 05). The effective rate in the observation group was 95. 83%,which was significantly higher than that in the control group( 70. 83%). The difference was statistically significant( P < 0. 05). Conclusion: The dialectical treatment of diabetic nephropathy patients with renal insufficiency can effectively inhibit the activation of PKC pathway,reduce protein nonenzymatic glycosylation,correct renal hemodynamic abnormalities,improve renal function,the effect is significant.
引文
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[2]刘苑苹,李恒,包蓓艳,等.糖尿病肾病患者肾脏组织中尾加压素Ⅱ及转化生长因子β1的表达及意义[J].浙江医学,2018,40(1):8-11.
[3]刘阳桦.血清Cys C、Hcy、BUN、SCr水平检测对早期糖尿病肾病诊断的价值[J].贵州医药,2016,40(8):863-864,865.
[4]Wolf G.New insights into the pathophysiology of diabetic nephropathy:from haemodynamics to molecular pathology[J].Eur J Clin Invest,2004,34(12):785-796.
[5]Shahzad K,Bock F,Dong W,et al.Nlrp3-inflammasome activation in non-myeloid-derived cells aggravates diabetic nephropathy[J].Kidney Int,2015,87(1):74-84.
[6]Rinno H,Kuramoto T,Iijima T,et al.Measurement of soluble thrombomodulin in sera from various clinical stages of diabetic nephropathy[J].J Clin Lab Anal,1996,10(3):119-124.
[7]陈盛业,杨凯,董佳妮,等.益气养阴中药对糖尿病肾病患者炎症因子及血管内皮因子的影响[J].中医药信息,2016,33(1):46-49.
[8]赵立昌,尚文斌.糖尿病肾病中医辨证分型与生化指标相关性研究[J].山东中医杂志,2017,36(1):13-16.
[9]程会兰,洪刘和,许腾飞,等.中医辨证治疗老年糖尿病肾病的效果及对胰岛素抵抗的影响[J].四川中医,2015,33(2):81-83.
[10]顾红岩,冯兴中.中医药辨证治疗早期糖尿病肾病概况[J].四川中医,2017,35(6):212-214.
[11]杨婉花,张碧瑶,黄菁菁.糖尿病周围神经病变的中医辨证和治疗进展[J].世界中医药,2015,10(9):1448-1452.
[12]代丽娟,朱晓明,宋立群,等.胃肾养阴汤对糖尿病肾病Ⅲ期气阴两虚型患者UACR、UAER、尿β2-MG、hs-CRP的影响[J].中医药学报,2015,43(3):111-113.
[13]张婷婷,童安荣.糖尿病肾病中医药研究概况[J].中国民族民间医药,2017,26(7):62-65.
[14]王晓光,谭婷婷,任迪.补脾益肾活血法对糖尿病肾病患者氧化应激水平及炎症因子的影响?[J].中国中西医结合肾病杂志,2015,16(12):1063-1067.
[15]Yang J,Zhang J.Influence of protein kinase C(PKC)on the prognosis of diabetic nephropathy patients[J].Int J Clin Exp Pathol,2015,8(11):14925-14931.
[16]Hayashi D,Ueda S,Yamanoue M,et al.Amelioration of diabetic nephropathy by oral administration of d-α-tocopherol and its mechanisms[J].Biosci Biotechnol Biochem,2018,82(1):65-73.
[17]Khansari MM,Tan M,Karamian P,et al.Inter-visit variability of conjunctival microvascular hemodynamic measurements in healthy and diabetic retinopathy subjects[J].Microvasc Res,2018,118:7-11.
[18]Jha JC,Thallas-Bonke V,Banal C,et al.Podocyte-specific Nox4 deletion affords renoprotection in a mouse model of diabetic nephropathy[J].Diabetologia,2016,59(2):379-389.
[19]毕菲菲,姚岚,王敏,等.益气养阴活血通络方治疗糖尿病肾病疗效观察[J].陕西中医,2015,36(3):304-305.
[20]高兵.丹参的药理作用及临床应用分析[J].中国现代药物应用,2018,12(1):196-197.
[2]刘苑苹,李恒,包蓓艳,等.糖尿病肾病患者肾脏组织中尾加压素Ⅱ及转化生长因子β1的表达及意义[J].浙江医学,2018,40(1):8-11.
[3]刘阳桦.血清Cys C、Hcy、BUN、SCr水平检测对早期糖尿病肾病诊断的价值[J].贵州医药,2016,40(8):863-864,865.
[4]Wolf G.New insights into the pathophysiology of diabetic nephropathy:from haemodynamics to molecular pathology[J].Eur J Clin Invest,2004,34(12):785-796.
[5]Shahzad K,Bock F,Dong W,et al.Nlrp3-inflammasome activation in non-myeloid-derived cells aggravates diabetic nephropathy[J].Kidney Int,2015,87(1):74-84.
[6]Rinno H,Kuramoto T,Iijima T,et al.Measurement of soluble thrombomodulin in sera from various clinical stages of diabetic nephropathy[J].J Clin Lab Anal,1996,10(3):119-124.
[7]陈盛业,杨凯,董佳妮,等.益气养阴中药对糖尿病肾病患者炎症因子及血管内皮因子的影响[J].中医药信息,2016,33(1):46-49.
[8]赵立昌,尚文斌.糖尿病肾病中医辨证分型与生化指标相关性研究[J].山东中医杂志,2017,36(1):13-16.
[9]程会兰,洪刘和,许腾飞,等.中医辨证治疗老年糖尿病肾病的效果及对胰岛素抵抗的影响[J].四川中医,2015,33(2):81-83.
[10]顾红岩,冯兴中.中医药辨证治疗早期糖尿病肾病概况[J].四川中医,2017,35(6):212-214.
[11]杨婉花,张碧瑶,黄菁菁.糖尿病周围神经病变的中医辨证和治疗进展[J].世界中医药,2015,10(9):1448-1452.
[12]代丽娟,朱晓明,宋立群,等.胃肾养阴汤对糖尿病肾病Ⅲ期气阴两虚型患者UACR、UAER、尿β2-MG、hs-CRP的影响[J].中医药学报,2015,43(3):111-113.
[13]张婷婷,童安荣.糖尿病肾病中医药研究概况[J].中国民族民间医药,2017,26(7):62-65.
[14]王晓光,谭婷婷,任迪.补脾益肾活血法对糖尿病肾病患者氧化应激水平及炎症因子的影响?[J].中国中西医结合肾病杂志,2015,16(12):1063-1067.
[15]Yang J,Zhang J.Influence of protein kinase C(PKC)on the prognosis of diabetic nephropathy patients[J].Int J Clin Exp Pathol,2015,8(11):14925-14931.
[16]Hayashi D,Ueda S,Yamanoue M,et al.Amelioration of diabetic nephropathy by oral administration of d-α-tocopherol and its mechanisms[J].Biosci Biotechnol Biochem,2018,82(1):65-73.
[17]Khansari MM,Tan M,Karamian P,et al.Inter-visit variability of conjunctival microvascular hemodynamic measurements in healthy and diabetic retinopathy subjects[J].Microvasc Res,2018,118:7-11.
[18]Jha JC,Thallas-Bonke V,Banal C,et al.Podocyte-specific Nox4 deletion affords renoprotection in a mouse model of diabetic nephropathy[J].Diabetologia,2016,59(2):379-389.
[19]毕菲菲,姚岚,王敏,等.益气养阴活血通络方治疗糖尿病肾病疗效观察[J].陕西中医,2015,36(3):304-305.
[20]高兵.丹参的药理作用及临床应用分析[J].中国现代药物应用,2018,12(1):196-197.