凉血散瘀汤联合替米沙坦治疗肾虚血瘀型IgA肾病疗效及对肾脏纤维化的影响
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摘要
目的观察凉血散瘀汤联合替米沙坦治疗肾虚血瘀型IgA肾病患者的疗效及对肾脏纤维化相关细胞因子和纤维化指标的影响。方法将64例肾虚血瘀型IgA肾病患者按抽签法分为2组,对照组32例在基础治疗同时给予替米沙坦片口服,实验组32例在对照组治疗基础上给予凉血散瘀汤口服,2组均以2周为1个疗程,连续治疗4个疗程。观察2组治疗前后24 h尿蛋白定量、尿红细胞计数、内生肌酐清除率(Ccr)和血清细胞因子指标[转化生长因子-β1(TGF-β1)、单核细胞趋化蛋白-1(MCP-1)、血管内皮生长因子(VEGF)、巨噬细胞移动抑制因子(MIF)]、肾脏纤维化指标[Ⅳ型胶原(C-Ⅳ)、层黏连蛋白(LN)、基质金属蛋白酶组织抑制剂-1(TIMP-1)]变化情况,记录2组不良反应发生情况。结果治疗后,2组24 h尿蛋白定量、尿红细胞计数均明显降低(P均<0. 05),且实验组明显低于对照组(P均<0. 05); 2组Ccr均无明显变化(P均> 0. 05)。治疗后,2组血清TGF-β1、MCP-1、MIF、C-Ⅳ、LN、TIMP-1水平均明显降低(P均<0. 05),且实验组各指标水平均明显低于对照组(P均<0. 05); 2组血清VEGF水平均明显升高(P均<0. 05),且实验组明显高于对照组(P <0. 05)。2组不良反应发生率比较差异无统计学意义(P>0. 05)。结论凉血散瘀汤联合替米沙坦治疗肾虚血瘀型IgA肾病可有效降低患者24 h尿蛋白定量和尿红细胞计数,可延缓肾脏纤维化,且临床安全性高。
Objective It is to observe the curative effect of Liangxueshuyu decoction combined with telmisartan on IgA nephropathy of type of renal deficiency and blood stasis and its effect on cytokines and fibrosis indexes of renal fibrosis.Methods 64 patients with IgA nephropathy of type of renal deficiency and blood stasis were divided into experimental group( n = 32) and control group( n = 32). The control group was treated with basic therapy plus telmisartan tablets. The experimental group was treated with Liangxue Sanyu decoction the basis of control group. 2 weeks as one treatment course,both groups were treated for 2 courses. The changes of levels of 24 h urinary protein( 24 h U-pro),erythrocyte( RBC),endogenous creatinine clearance( Ccr),serological cytokines [transforming growth factor-β1( TGF-β1),monocyte chemotaxis( MCP-1),vascular endothelial growth factor( VEGF),macrophage migration inhibitory factor( MIF) ],renal fibrosis indexes [collagen Ⅳ( Col-Ⅳ),laminin( LN),matrix metal( TIMP-1) ] before and after treatment were observed,and the adverse reactions were recorded in the two groups. Results After treatment,the 24 h U-pro and RBC of the two groups were significantly lower than those before treatment( P < 0. 05),and the decrease was more significant in the experiment group,there was no significant difference in Ccr between the two groups( P > 0. 05). After treatment,the levels of TGF-β1,MCP-1,MIF,Col-Ⅳ,LN and TIMP-1 in the two groups were significantly lower( P < 0. 05),while the level of VEGF was significantly higher than those before treatment( P < 0. 05),and the improvements of these indicators in the experiment group were significantly better than those in the control group( P < 0. 05). There was no significant difference in the incidence of adverse reactions between the two groups( P > 0. 05). Conclusion The application of Liangxueshuyu decoction combined with telmisartan can effectively reduce 24 h U-pro and RBC,delay the development of renal fibrosis with high safety in the treatment of IgA nephropathy with renal deficiency and blood stasis.
Objective It is to observe the curative effect of Liangxueshuyu decoction combined with telmisartan on IgA nephropathy of type of renal deficiency and blood stasis and its effect on cytokines and fibrosis indexes of renal fibrosis.Methods 64 patients with IgA nephropathy of type of renal deficiency and blood stasis were divided into experimental group( n = 32) and control group( n = 32). The control group was treated with basic therapy plus telmisartan tablets. The experimental group was treated with Liangxue Sanyu decoction the basis of control group. 2 weeks as one treatment course,both groups were treated for 2 courses. The changes of levels of 24 h urinary protein( 24 h U-pro),erythrocyte( RBC),endogenous creatinine clearance( Ccr),serological cytokines [transforming growth factor-β1( TGF-β1),monocyte chemotaxis( MCP-1),vascular endothelial growth factor( VEGF),macrophage migration inhibitory factor( MIF) ],renal fibrosis indexes [collagen Ⅳ( Col-Ⅳ),laminin( LN),matrix metal( TIMP-1) ] before and after treatment were observed,and the adverse reactions were recorded in the two groups. Results After treatment,the 24 h U-pro and RBC of the two groups were significantly lower than those before treatment( P < 0. 05),and the decrease was more significant in the experiment group,there was no significant difference in Ccr between the two groups( P > 0. 05). After treatment,the levels of TGF-β1,MCP-1,MIF,Col-Ⅳ,LN and TIMP-1 in the two groups were significantly lower( P < 0. 05),while the level of VEGF was significantly higher than those before treatment( P < 0. 05),and the improvements of these indicators in the experiment group were significantly better than those in the control group( P < 0. 05). There was no significant difference in the incidence of adverse reactions between the two groups( P > 0. 05). Conclusion The application of Liangxueshuyu decoction combined with telmisartan can effectively reduce 24 h U-pro and RBC,delay the development of renal fibrosis with high safety in the treatment of IgA nephropathy with renal deficiency and blood stasis.
引文
[1]闵璐琳,张敏芳,车霞静,等.来氟米特联合中小剂量激素治疗Ig A肾病的疗效观察[J].中华肾脏病杂志,2016,32(10):721-727
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[9]段玉蕊,杨素霞,陈宝平.冬虫夏草胶囊联合替米沙坦片对糖尿病肾病大鼠肾小管上皮细胞转分化的调节作用[J].中国临床药理学杂志,2016,32(23):2170-2173; 2177
[10]柏琳.替米沙坦对Ig A肾病中肾小管间质损害及PPARγ途径作用的实验研究[D].哈尔滨:哈尔滨医科大学,2008
[11]陈淑娟,罗仁.益气养阴凉血法联合替米沙坦治疗原发性Ig A肾病的效果[J].广东医学,2014,35(10):1612-1615
[12]王琳.陈以平教授诊治中重症Ig A肾病学术思想研究[J].中国中西医结合肾病杂志,2010,11(12):1043-1045
[13]刘永芳,陈帮明,胡修全,等.通络保肾方治疗Ig A肾病的临床研究[J].中国中西医结合肾病杂志,2016,17(11):991-993
[14]吕高虹,许惠琴,吕兴.生地对高糖致人肾小球系膜细胞增殖、氧化应激及细胞外基质的影响[J].南京中医药大学学报,2015,31(6):551-554
[15]舒贝.青蒿琥酯对UUO模型大鼠肾间质纤维化抑制作用及其机制研究[D].成都:四川大学,2006
[2]钟燕斌,周永恒,刘仕欣,等.三黄益肾胶囊联合糖皮质激素治疗Ig A肾病的疗效观察及其对VEGF水平的影响[J].中国中医药科技,2016,23(5):523-525
[3]魏明刚,熊佩华,孙伟,等.加味当归补血汤调节Ig A肾病肾虚血瘀证患者细胞因子的临床研究[J].北京中医药大学学报,2015,38(8):573-576
[4]国家中医药管理局.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:315-319
[5]王卫军,石娟,张涛,等.泼尼松联合CTX对Ig A肾病患者疗效及肾功能指标的影响[J].检验医学与临床,2016,13(21):3043-3045
[6]张娜,赵凌霞,郑国平,等.肾脏纤维化相关细胞因子和信号通路[J].中国药物与临床,2016,16(6):835-837
[7]涂金花.足细胞异常与Ig A肾病[J].医学综述,2011,17(23):3552-3555
[8]许艳芳,万建新. TGF-β1与BMP-7在肾间质纤维化中的作用[J].华夏医学,2007,20(3):623-626
[9]段玉蕊,杨素霞,陈宝平.冬虫夏草胶囊联合替米沙坦片对糖尿病肾病大鼠肾小管上皮细胞转分化的调节作用[J].中国临床药理学杂志,2016,32(23):2170-2173; 2177
[10]柏琳.替米沙坦对Ig A肾病中肾小管间质损害及PPARγ途径作用的实验研究[D].哈尔滨:哈尔滨医科大学,2008
[11]陈淑娟,罗仁.益气养阴凉血法联合替米沙坦治疗原发性Ig A肾病的效果[J].广东医学,2014,35(10):1612-1615
[12]王琳.陈以平教授诊治中重症Ig A肾病学术思想研究[J].中国中西医结合肾病杂志,2010,11(12):1043-1045
[13]刘永芳,陈帮明,胡修全,等.通络保肾方治疗Ig A肾病的临床研究[J].中国中西医结合肾病杂志,2016,17(11):991-993
[14]吕高虹,许惠琴,吕兴.生地对高糖致人肾小球系膜细胞增殖、氧化应激及细胞外基质的影响[J].南京中医药大学学报,2015,31(6):551-554
[15]舒贝.青蒿琥酯对UUO模型大鼠肾间质纤维化抑制作用及其机制研究[D].成都:四川大学,2006