健脾固肾化瘀方治疗脾肾两虚夹瘀型糖尿病肾脏病的疗效及对相关生物标志物的影响

Curative effect of Jianpi Gushen Huayu Decoction in the treatment of spleen and kidney deficiency and blood stasis syndrome diabetic kidney disease and its effect on related biomarkers

关键词:  健脾固肾化瘀方  糖尿病肾脏病  脾肾两虚夹瘀型  基质金属蛋白酶-9  单核细胞趋化因子-1  血管内皮生长因子

Key words:  Jianpi Gushen Huayu Decoction  diabetic kidney disease  spleen and kidney deficiency with blood stasis syndrome  matrix metalloproteinase-9  monocyte chemoattractant factor-1  vascular endothelial growth factor

摘要:

[目的] 探讨健脾固肾化瘀方联合氯沙坦钾片治疗脾肾两虚夹瘀型糖尿病肾脏病（DKD）的临床疗效以及其对患者血清基质金属蛋白酶-9（MMP-9）、单核细胞趋化因子-1（MCP-1）和血管内皮生长因子（VEGF）水平的影响。[方法] 选择沧州中西医结合医院 2019 年 1 月—2021 年 5 月纳入 80 例脾肾两虚夹瘀型 DKD 患者作为研究对象，采用随机数字表法分成观察组与对照组各 40 例。观察组给予健脾固肾化瘀方联合氯沙坦钾片治疗，对照组单用氯沙坦钾片治疗，连续治疗 12 周后观察两组临床疗效。治疗前后检测受试者血糖[空腹血糖（FPG）、餐后 2h 血糖（2h PG）和糖化血红蛋白（HbA1c）]、血脂[总胆固醇（TC）、三酰甘油（TG）和低密度脂蛋白胆固醇（LDL-C）]及肾功能指标[尿微量白蛋白/尿肌酐比值（UACR）、肌酐（SCr）和尿素氮（BUN）]。选用酶联免疫吸附法测定血清 MMP-9、MCP-1 和 VEGF 水平。并统计两组不良反应情况。[结果] 观察组总有效率为 92.50%（37/40），较对照组 72.50%（29/40）有所提高（P＜0.05）。两组治疗后 FPG、2h PG 和 HbA1c 均较治疗前降低（P＜0.05），且均以观察组的改善更显著（P＜0.01）。两组治疗后血清 TC、TG 和 LDL-C 浓度均较治疗前下降（P＜0.05），且均以观察组的改善更显著（P＜0.01）。两组治疗后 UAER 和血清 SCr、BUN 水平均较治疗前降低（P＜0.05），且均以观察组的改善更显著（P＜0.01）。两组治疗后血清 MMP-9 水平均较治疗前升高（P＜0.05），血清 MCP-1、VEGF 浓度均较治疗前下降（P＜0.05）；且治疗后，观察组对血清 MMP-9 水平的升高作用及对血清 MCP-1、VEGF 水平的降低作用较对照组更显著（P＜0.01）。所有患者均无明显不良反应发生。[结论] 应用健脾固肾化瘀方联合氯沙坦钾片治疗脾肾两虚夹瘀型 DKD 能安全有效地上调患者 MMP-9 表达水平，下调MCP-1、VEGF 表达水平，改善肾功能，整体疗效确切。

Abstract:

[Objective] To investigate the clinical efficacy of Jianpi Gushen Huayu Decoction combined with losartan potassium tablets in the treatment of spleen and kidney deficiency and blood stasis syndrome diabetic kidney disease and its effect on serum matrix metalloproteinase-9 （MMP-9），monocyte chemoattractant protein-1 （MCP-1） and vascular endothelial growth factor （VEGF） levels. [Methods] From January 2019 to May 2021，80 patients with DKD of spleen and kidney deficiency and blood stasis type admitted to our hospital were selected as the research objects. They were divided into observation group and control group by random number table method，with 40 cases in each group. The observation group was treated with Jianpi Gushen Huayu Decoction combined with losartan potassium tablets，and the control group was treated with losartan potassium tablets alone. The clinical efficacy of the two groups was observed after 12 weeks of continuous treatment. Blood glucose [fasting plasma glucose（FPG），2 h postprandial blood glucose（2 h PG） and glycosylated hemoglobin （HbA1c）]，blood lipids [total cholesterol （TC），triglyceride （TG） and low density lipoprotein cholesterol （LDL-C）] and renal function indexes [urinary albumin excretion rate（UACR），creatinine（SCr） and urea nitrogen（BUN）] were detected before and after treatment. Serum MMP-9，MCP-1 and VEGF levels were measured by enzyme-linked immunosorbent assay. The side effects of the two groups were counted. [Results] The total effective rate of the observation group was 92.50% （37/40），which was significantly higher than that of the control group [72.50%（29/40）]（P＜0.05）. After treatment，FPG，2h PG and HbA1c in the two groups were significantly lower than those before treatment（P＜0.05），and the improvement in the observation group was more significant（P＜0.01）. After treatment，the serum TC，TG and LDL-C concentrations in the two groups were significantly lower than those before treatment （P＜0.05），and the improvement in the observation group was more significant（P＜0.01）. After treatment，UAER and serum SCr and BUN levels in the two groups were significantly lower than those before treatment （P＜0.05），and the improvement in the observation group was more significant（P＜0.01）. After treatment，serum MMP-9 levels in both groups were significantly higher than those before treatment（P＜0.05），and serum MCP-1 and VEGF concentrations were significantly lower than those before treatment（P＜0.05）. After treatment，the increase of serum MMP-9 level and the decrease of serum MCP-1 and VEGF levels in the observation group were more significant than those in the control group（P＜0.01）. No obvious side effects occurred in all subjects. [Conclusion] The application of Jianpi Gushen Huayu Decoction combined with losartan potassium tablets in the treatment of spleen and kidney deficiency and blood stasis syndrome diabetic kidney disease can safely and effectively up-regulate the expression level of MMP-9 in the blood of patients，down-regulate the expression levels of MCP-1 and VEGF in the blood，and improve renal function. The overall effect is definite.