固本祛毒方对早期糖尿病肾病TNF-α、ET的干预性研究
详细信息    本馆镜像全文|  推荐本文 |  |   获取CNKI官网全文
摘要
目的:观察固本祛毒方对早期糖尿病肾病的临床疗效,并探讨TNF-α、ET在早期糖尿病肾病病程中的诊疗意义。方法:给予早期糖尿病肾病患者基础治疗1个月后,将符合标准的60例随机分为两组,对照组继续进行糖尿病教育、降血糖、控制血压等基础治疗,治疗组在对照组治疗基础上加用固本祛毒方,疗程为1个月。比较两组治疗前后临床症状、24 h尿蛋白、TNF-α、ET等变化。结果:治疗组在改善临床症状、降低蛋白尿、炎症分子、改善肾功能等方面均明显优于对照组(P<0.01或P<0.05)。并且在治疗过程中未发生不良反应。结论:固本祛毒方能改善早期糖尿病肾病患者的临床症状,减少炎症分子的表达及尿蛋白的排泄,延缓肾功能损害的进程。
Objective:To observe the clinical efficacy of reinvigoration and removing toxicity(RRT) in treatment of early-stage diabetic nephropathy, and to discuss the clinical significance of TNF-αand ET in the course of early-stage diabetic nephropathy.Methods: After one month of the basal treatment for patients with early-stage DN, the 60 cases of patients who measured up the test standard were divided into two groups randomly. The patients in control group were treated continuously with basal treatment including diabetic education, lowering glycemia and blood pressure et,al.While the treatment group were added tranditional Chinese medicine of reinvigoration and removing toxicity on the basis of basal treatment.The period of treatment is one month.The results of clinical symptoms, urinary albumin excretion rate(UAER), TNF-αand ET of before and after treatment were compared.Results:Treatment group was superior to the control group in improving the clinical symptoms, lowering albuminuria, inflammation marker, improving renal function abviously.There was no adverse reactions in the course of treatment. Conclusions:The method of RRT can improve the clinical symptoms of early-stage diabetic nephropathy,low the expression of inflammation marker、the elimination of albuminuria,and postpone the process of renal function damaging of early-stage diabetic nephropathy.
引文
[1]刘志红.糖尿病肾病[J].中华肾脏病杂志,2000,16(2):126-131.
    [2]刘家忠,徐焱成,朱宜莲,等.亚甲基四氢叶酸还原酶基因多态性与糖尿病肾病相关性研究[J].中华内科杂志,2001,40(8):529-532.
    [3]刘新民主编.实用内分泌学[M].第2版.北京:人民军医出版社,1997.342.
    [4]Pradhan AD, Manson JE, Rifai N, et al.C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA,2001,286 (3):327-334.
    [5]吕仁和.糖尿病及其并发症中西医诊治学[M].北京:人民卫生出版社.1997.328.
    [6]赵进喜.内分泌代谢病中西医诊治[M].沈阳:辽宁科学技术出版社,2004.198.
    [7]肖相如.糖尿病肾病的证治经验[J].辽宁中医杂志,1998,25(8):346.
    [8]朴春丽,王秀阁,杨世忠.龙胆泻肝汤加减治疗Ⅳ期糖尿病肾病30例临床研究[J].山东中医杂志,2004,23(12):714.
    [9]邱晓堂.张永杰教授从脾论治糖尿病肾病.河南中医[J],2005,25(1):26-27.
    [10]王秀珍.健脾固肾汤治疗早期糖尿病肾病40例[J].浙江中医杂志,2004,39(8):332.
    [11]唐咸玉.范冠杰教授治疗糖尿病的经验[J].中医药学刊,2006,24(2):215-216.
    [12]邱晓堂.张永杰教授从脾论治糖尿病肾病[J].河南中医,2005,25(1):26-27.
    [13]盖云,张彤.由《金匮要略》“脾能伤肾”理论谈脾与糖尿病肾病[J].中医杂志,2009,50(增刊):46-47.
    [14]王永炎.关于提高脑血管病疗效难点的思考[J].中国中西医结合杂志,1997,17(2):195-196.
    [15]赵智强.略论周肿英教授的毒邪学说及临床运用[L].南京中医药大学学报,1999,15(3):170-172.
    [16]吴深涛,武娜杰,张罡,等.化浊解毒法对2型糖尿病葡萄糖毒性作用的临床观察[J].天津中医药,2005,22(2):119-120.
    [17]孙云松.试析肾病与毒[J].江西中医学院学报,2001,13(1):33-34.
    [18]南征.消渴肾病(糖尿病肾病)研究[M].长春:吉林科学出版社,2001.3-254.
    [19]李红.糖尿病微血管病变发病机制和治疗靶点[L].浙江大学学报,2006,35(3):232-237.
    [20]丁鹤林.糖尿病肾病发病机制研究进展及防治[J].实用医学杂志,2000,16(4):266-268.
    [21]向红丁.糖尿病肾脏病变[J].国外医学内分泌学分册,2004,24(2):125-136.
    [22]Park HK, Ahn CW, LeeGT, et al. Polymorphism of aldose reductase gene and diabetic microvascular complications in type 2 diabetes mellitus. Diabetes Res Clin Pract.2002.55(2):151-157.
    [23]Inoguchi T, Yu HY, Menne J, et al. Ahered gap junction activity in cardiovascular tissues of diabetes. Med Electron Microse,2001,34(2): 86-91.
    [24]李秀钧,邬云红.糖尿病是一种炎症性疾病[J].中华内分泌代谢杂志,2003,19(4):251.
    [25]吴在德,吴肇汉.外科学[M].人民卫生出版社,2004.420.
    [26]Vlassara H. Portein glycation in the kidney:role in diaebtes and aging[J].Kidney Int,1996,49(12):1795-1814.
    [27]刘颖慧.TNF-a与糖尿病肾病[J].国外医学内分泌学分册,2002,22(4):253-254.
    [28]Tsiotra PC, TsigosC, Yfanti E, et al. Visfatin, TNF-alpha and IL-6 mRNA expression is increased in mononuclear cells from type 2 diabetic women[J]. Horm Metab Res,2007,39(10):758-763.
    [29]秦岭.炎症在糖尿病肾病发病中的作用[J].国外医学泌尿系统分册,2005,25(5):673-675.
    [30]Navarro JF, Mora-Fernandez C. The role of TNF-alpha in diabetic nephropathy:pathogenic and therapeutic implications [J]. Cytokine Growth Factor Rev,2006,17(6):441-450.
    [31]Moriwaki Y, Yamamoto T, Shibutani Y. etla. Elevated levels of interleukin-18 and tumor necrosis factor-alpha in serum of patients with type 2 diabetes mellitus:relationship with diabetic nephropathy. Metabolism,2003,52(5):605-608.
    [32]吴丹荣,张韬威,庄惠君,等.血清肿瘤坏死因子一a与糖尿病肾病的相关性研究[J].贵州医药.2005,29(9):775-778.
    [33]张伟康.TGF-β1、TNF-α和尿微量白蛋白与糖尿病肾病的关系[J].医学临床研究,2008,25(6):972-974.
    [34]Yanagisawa M, Kurihara H, Kimurs S, et al. A novel potent vasoconstriction peptide produced by vascular endothellia cella. Nature.1988,332(6163): 411.
    [35]Kohan DE. Endothelins in the kindey:physiology and pathophysiology. Am J Kidney Dis.1993,22(4):493.
    [36]王秋月,刘国宏,王春义,等.早期糖尿病肾病患者血浆内皮素、心钠素、血管紧张素Ⅱ的变化及意义[J].中国实用内科杂志.1998,18(12):722.
    [37]刘徐桂.糖尿病肾病患者治疗前后血浆ET、VEGF检测的临床意义[J].放射免疫学杂志.2005,18(6):456-457.
    [38]王亚平.2型糖尿病肾病患者血浆ET、血清TGF-p 1和VEGF检测的临床意义[J].放射免疫学杂志.2008,21(6):530-531.
    [39]Sarafidis P A.Thiazolidinediones and Diabetic Nephropathy:Need for a Closer Examination? [J].J Cardiometab Syndr,2007,2(4):297-301.
    [40]Treasure C B,Klein J L, Weintraub W S, et al. Beneficial Effects of Cholesterol-lowering Therapy on the Coronary Endothelium in Patients with Coronary Artery Disease[J].N Engl J Med,1995,332:481-487.
    [41]屠伯言,俞中康,郑敬宇,等.糖尿病肾病补肾活血法治疗的临床和实验研究[J].上海中医药杂志,1991,1:1-4.
    [42]肖敏,樊均明.黄芪在肾脏疾病治疗中的作用机制[J].西部医学,2009,21(3):474-475.
    [43]刘志强,李全志,秦贵军,等.黄芪注射液对早期糖尿病肾病患者血小板功能和血浆内皮素的影响[J].中国中西医结合杂志,2001,21(4):274.
    [44]陈莉芬,李荣亨,曹文富,等.黄芪对慢性肾炎患者血清TNF-α、IL-6及细胞免疫功能的影响[L].重庆医科大学学报.2002,27(2):174.
    [45]钱东生,罗琳,何敏,等.山茱萸乙醇提取液对Ⅱ型糖尿病大鼠的治疗效应[J].南 通医学院学报,2000,20(4):337-339.
    [46]许惠琴,郝海平,皮文霞,等.山茱萸环烯醚萜总苷对糖尿病大鼠肾皮质糖化终产物及其受体mRNA表达的影响[J].中药药理与临床.2003,19(4):9-11.
    [47]梁恒,邢建宇,刘希成,等.山茱萸作用鼠IgA肾病的肾组织差异蛋白质谱[J].西安交通大学学报.2005,39(6):650-654.
    [48]黄黎明,梁恒,邢建宇,等.山茱萸提取物对慢性肾炎小鼠的药理作用及蛋白质组学效应的实验研究[J].中国药理学通报.2004,20(10):1144-1150.
    [49]雷载权.中华临床中药学[M].第1版.北京:人民卫生出版社.1998.1615.
    [50]吕圭源,李万里.白术抗衰老作用研究[J].现代应用药学,1996,13(5):26-29.
    [51]田代华.实用中药辞典[M].第1版.北京:人民卫生出版社,2002.9,531.
    [52]关晓辉,曲娴,杨志萍,等.白术挥发油对小鼠免疫功能的影响[J].北华大学学报(自然科学版),2001,2(2):122-123.
    [53]钟先阳,罗任,魏连波,等.丹参酮ⅡA对大鼠出血性休克--再灌注肾损伤的防治作用[J].中国中西医结合肾病杂志,2002,3(1):13-15.
    [54]宋怀方,林金华.复方丹参片对糖尿患者超氧化物歧化酶活力及血液流变学的影响[J].药学进展,2004,24(30):170-172.
    [55]孙锡铭,蔡海江,宋素云,等.丹参素的新药理作用[J].中草药,1991,22(1):20.
    [56]李中和,张建明,霍飞蛟.丹参对糖尿病早期肾病患者血浆内皮素和Ⅳ型胶原的影响[J].中国综合临床,2002,18(7):621-622.
    [57]杨新波,黄正明,曹文彬,等.泽泻水提取物对正常小鼠及高血糖小鼠血糖的影响[J].中药药理与临床,1998,14(6):29.
    [58]陶晋舆,吕环,张秋菊,等.泽泻抗动脉粥样硬化作用系列研究(二)[J].北京中医学院学报,1991,14(6):51.
    [59]刘志红,李颖健,张精,等.转化生长因子及大黄酸对肾小球系膜细胞葡萄糖转运蛋白功能影响[J].中华医学杂志,1999;79(10):78.
    [60]顾刘宝,万毅刚,万铭.大黄治疗糖尿病肾病的分子细胞机制研究进展[J].中国中药杂志,2003,28(8):703-705.
    [61]张永和,宋祖军,郭学刚.大黄对危重病患者血清TNF-α、IL-1及IL-6的影响[J].陕西医学杂志,2003,32(12):1066-1067.
    [62]黄华,邹志森.大黄对急性胰腺炎炎症反应的影响[J].海南医学,2003,14(1):67-68.
    [63]李真.生地黄连液对四氧嘧啶小鼠影响的研究[J].辽宁中医杂志,2000,27(12):574.
    [64]刘长山,王秀军.黄连素对醛糖还原酶活性的抑制及防治糖尿病神经病变的临床意义[J].中国中药杂志,2002,27(12):950-952.
    [65]国家中医药管理局科技教育司.中药药理学[M].第1版.北京:中国中药出版社,1997,15.
    [66]付晓春,王敏伟.黄连解毒汤的抗血栓作用研究[J].沈阳药科大学学报,2001,18(6):425-427.
    [67]周江.川芎有效成分及其药理作用研究概况[J].浙江中医杂志.2007,42(10):615-616.
    [68]胡国芬,王建平.川芎嗪的药理作用及临床应用进展[J].中国药物与临床.2006,6(10):773-774.
    [1]李秀钧,邬云红.糖尿病是一种炎症性疾病?[J].中华内分泌代谢杂志,2003,19:251-253.
    [2]Katherine R Tuttle. Linking Metabolism and Immunology:Diabetic Nephr-opthy Is an Inflammatory Disease. J Am Soc Nephrol,2005,16(6):1537-1538.
    [3]Stehouwer CD,Gall MA, Twisk JW, et al. Increased urinary albumin excretion,endothelial dysfunction, and chronic low-grade inflammation in type 2 diabetes:Progressive, interrelated, and independently associated with risk of death[J]. Diabetes,2002,51(4):1157-1165.
    [4]Navarro JF, Mora C, Macia M, et al. Inflammatory parameters are independently associated with urinary albumin in type 2 diabetes mellitus[J].Am J Kidney Dis,2003,42(1):53-61.
    [5]李静,李荣山.巨噬细胞在大鼠糖尿病肾病发病机制中的作用[J].中国中西医结 合肾病杂志,2005,6:79-82.
    [6]Chow F, Ozols E, Nikolic Paterson DJ, etal Macrophages in mouse type 2 diabetic nephropathy correlation with diabetic state and progression renal injury. Kidney Int,2004,65:116-128.
    [7]Young BA, Johnson RJ,Alpers CE, et al, Kid Int,1995;47:934-944.
    [8]Cortes P, Zhao X, Riser BL, et al, Kid Int,1997;51:57-68.
    [9]Giunti S, Tesch GH, Pinach S, et a.l Monocyte chemoattractant protein-1 has prosclerotic effects both in amouse model of experimental diabetes and in vitro in humanmesangial cells[J].Diabetologia,2008,51(1): 198-207.
    [10]Kyouichi Tashiro, lchiro koyanagi, Akemi Saitoh, et al. Urinary Levels of monocy-techemoatractant protein-1(MCP-1) and interleukin-8(IL-8), and renal injuriesin patients with type 2 diabetic nephropathy.J clin lab. Anal,2002,16(1):1-4.
    [11]Viedt C, Dechend R, Fei J,et al.MCP-1 induces imflammatory activation of Human tubular epithelial cells:involvement of the transcription factors, nuclear factor kappaB and activating protein-1[J].J Am Soe Nephrol,2002,13(6):1534-1547.
    [12]Sun Y, Zhang JK, Lu L, etal Tissue angiotensin Ⅱ in the regulation of inflammation and fibrogenic components of repair in the rat heart. J Lab Clin Med,2004,143:41-51.
    [13]Mezzano S, DroguettA, BurgosME, et al. Renin-angiotensin system activation and interstitial inflammation in human diabetic nephropathy. Kidney Int,2003,86:64-70.
    [14]Mezzano S, DroguettA, BurgosM E, etal Renin-angiotensin system activation and interstitial inflammation in human diabetic nephropathy. Kidney Internationa, J 2003:64-70.
    [15]Sassy-Prigent C, Heudes D, Mandet C, etal Early glomerular macrophage recruitment in streptozotocin-induced diabetic rats. Diabetes,2000,49: 466-475.
    [16]DallaVestraM, MussapM, Gallina P, eta.l Acute-phasemarkers of inflammation and glomerular structure in patientswith type 2 diabetes [J]. J Am SocNephro,1 2005,16 (Suppl1):78-82.
    [17]Navarro JF, Mora C, GomezM, et a.1 Influence of renal involvement on peripheral blood mononuclear cell expression behavior of tumor necrosis factor-{alpha} and interleukin-6 in type 2 diabetic patients[J]. NephrolDialTransplant,2008,23(3):919-926.
    [18]MoriwakiY, InokuchiT, YamamotoA, eta.l EffectofTNF-alpha inhibition on urinary albumin excretion in experimentaldiabetic rats[J]. Acta Diabeto,1 2007,44(4):215-218.
    [19]查冬青,吴小燕,徐联芳,等.神经生长因子在2型糖尿病大鼠肾组织中的表达及意义[J].临床肾脏病杂志,2005,10(5):213-215.
    [20]刘明媛,袁伟杰.NF-κB在肾脏疾病中作用的研究进展[J].国外医学泌尿系统分册,2002,6(22):399-402.
    [21]Auwardt R, Mudge SJ, Chen CG, et al. Regulation of nuclear factor κB by corticosteroids in rat mesangial cells. J Am Soc Nephrol 1998;9(9): 1620-1628.
    [22]Sugimoto H, Shikata K, Hirata K, et al. Increased expression of intercellular adhesion molecule-1 (ICAM-1) in diabetic rat glomeruli. Diabetes,1997,46(12):2075-2081.
    [23]Mezzano S, ArosC, DroguettA, etal. NF-κB activation and overexpression of regulated genes in human diabetic nephropathy. Nephrol Dial Transplant,2004,19(10):2505-2512.
    [24]VidtDG. Inflammation in renal disease[J]. Am J Cardio,1 2006,97(2): 20-27.
    [25]刘东,伦立德,郑晓勇,等.炎症在2型糖尿病患者肾功能损害中的作用[J].临床内科杂志,2005,22(2):98-100.
    [26]陶谦,周宣岩,刘淑会,等.炎症相关因子水平联检在2型糖尿病肾病患者中 的临床意义[J].发射免疫学杂志,2007,20(6):533-544.
    [27]钱浩,吴永贵,林辉,等.霉酚酸酯对糖尿病大鼠肾组织单核细胞趋化蛋白-1与细胞间粘附分子-1表达的影响[J].中华肾脏病杂志,2004,5:375-376.
    [28]余堂宏,贾汝汉,陈健,等.霉酚酸酯对2型糖尿病大鼠肾脏单核细胞趋化蛋白-1表达的影响[J].中国中西医结合肾病杂志,2005,6:192-196.
    [29]Wang SN, LaPage J, Hirschberg R. Role of glomerular ultrafiltration of growth factors in progressive interstitial fibrosis in diabetic nephropathy. Kidney Int,2000,57(3):1002-1014.
    [30]Kato S,Luyckx VA, Ots M, etal.Kid Int,1999; 56 (3):1037-1048.
    [31]高苹,贾汝汉,宋恩峰,等.阿伐他汀、缬沙坦及两药合用对DM大鼠肾小管间质病变的保护作用[J].中华肾脏病杂志,2004,20:218-219.
    [32]熊燕,贾汝汉,邱昌健,等.辛伐他汀对糖尿病大鼠肾组织中核因子-κB活性的影响[J].临床肾脏病杂志,2005,1:18-21.
    [33]叶子枫.HMG-COA还原酶抑制剂降脂以外作用研究进展[J].西北国防医学杂志,2002,23:456-460.
    [34]白云.辛伐他汀对糖尿病肾病相关炎症因子的影响分析[J].山西医药杂志,2008,37(10):931-932.
    [35]Li JJ, Lee SH, Kim DK, et al.Colchicine Attenuates Inflammatory Cells Infiltration and Extracellular Matrix Accumulation in Diabetic Nephropathy. Am J Physiol Renal Physiol,2009,297(1):F200-F209.
    [36]Okada S, Shikata K, Matsuda M, et al. Intercellular adhesion molecule-1-deficient mice are resistant against renal injury after induction of diabetes. Diabetes,2003,52:2586-2593.
    [37]陆付耳,王智民,郭爱群.DM从“毒”论治探讨[J].中国中医基础医学杂志,2002,8(5):315-317.
    [38]陈路燕,高彦彬,赵东英,等.益气养阴补肾活血方剂治疗早期糖尿病肾病的临床研究[J].中国中医基础医学杂志,2005,11(10):767-769.
    [39]朴春丽,南红梅,南征,等.从炎症发病机制探讨中医治疗糖尿病肾病的思路与方法[J].中国中西医结合杂志,2005,25(4):365-367.
    [40]赵贤俊,李才,邓悦,等.解毒通络保肾胶囊对糖尿病大鼠肾脏的保护作用[J].中国中医基础医学杂志2003;9(8):586-591.
    [41]杨爱成,魏连波,肖炜,等.肾康丸对早期糖尿病肾病患者胰岛素敏感性及炎症因子的影响[J].新中医,2009,41(4):37-39.
NGLC 2004-2010.National Geological Library of China All Rights Reserved.
Add:29 Xueyuan Rd,Haidian District,Beijing,PRC. Mail Add: 8324 mailbox 100083
For exchange or info please contact us via email.