健脾补肾化瘀汤辅助血液灌流治疗糖尿病肾病对肾功能及胰岛素抵抗的影响
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Effect of Jianpi Bushen Huayu Tang Assisting Hemoperfusion on Kidney Function and Insulin Resistance of Patients with Diabetic Nephropathy
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    摘要:

    目的:探讨健脾补肾化瘀汤辅助血液灌流治疗糖尿病肾病对改善患者肾功能和胰岛素抵抗情况的价值。方法:将糖尿病肾病患者108 例,根据治疗方法不同分为对照组(血液灌流治疗) 和观察组(健脾补肾化瘀汤辅助血液灌流治疗),观察2 组患者治疗后的临床疗效。结果:治疗前,2组肾功能和胰岛素抵抗情况比较,差异无统计学意义(P>0.05)。治疗后,2组与治疗前比较,肾功能及胰岛素抵抗指标改善(P<0.05),观察组血肌酐(SCr)、尿素氮(BUN)、尿蛋白排泄率(UAER)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR) 水平低于对照组(P<0.05)。治疗前,2组双肾主动脉血流动力学指标水平比较,差异无统计学意义(P>0.05)。治疗后,2组与治疗前比较,双肾主动脉血流动力学指标改善(P<0.05),观察组收缩期最大血流速度(Vsmax)、舒张期最低血流速度(Vdmin) 水平高于对照组,阻力指数(RI)、搏动指数(PI) 水平低于对照组(P<0.05)。治疗前,2 组核因子-κB(NF-κB)、血管紧张素Ⅱ(AngⅡ) 水平比较,差异无统计学意义(P>0.05)。治疗后,2组与治疗前比较,NF-κB、AngⅡ改善(P<0.05),观察组NF-κB、AngⅡ水平低于对照组(P<0.05)。治疗前,2组炎症因子水平比较,差异无统计学意义(P>0.05)。治疗后,2组与治疗前比较,单核细胞趋化蛋白(MCP-1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α) 改善(P<0.05),观察组MCP-1、IL-6、TNF-α水平低于对照组(P<0.05)。结论:健脾补肾化瘀汤辅助血液灌流治疗糖尿病肾病可改善患者肾功能和胰岛素抵抗情况,其作用机制可能与改善肾血流动力学,降低NF-κB、AngⅡ、炎症因子水平有关。

    Abstract:

    Abstract:Objective:To discuss the value of Jianpi Bushen Huayu tang assisting hemoperfusion in improving the kidney function and insulin resistance of patients with diabetic nephropathy. Methods:A total of 108 cases of patients with diabetic nephropathy were divided into the control group and the observation group according to different treatment methods. The control group was given hemoperfusion,and the observation group was additionally treated with Jianpi Bushen Huayu tang.The clinical effect in the two groups was analyzed. Results:Before treatment,compared the kidney function and the insulin resistance between the two groups, there was no significance in the difference(P>0.05). After treatment, the kidney function and the indexes of insulin resistance in the two groups were improved when compared with those before treatment (P<0.05); the levels of serum creatinine(SCr), blood urea nitrogen(BUN), urinary albumin excretion rate(UAER), fasting insulin(FINS), hemoglobin A1c(HbA1c), and homeostatic model assessment of insulin resistance(HOMA- IR) in the observation group were lower than those in the control group(P<0.05). Before treatment, compared the levels of hemodynamic indexes of aorta in both kidneys between the two groups,there was no significance in the difference(P>0.05).After treatment,the hemodynamic indexes of aorta in both kidneys in the two groups were improved when compared with those before treatment(P<0.05); the maximum systolic velocity(Vsmax) and the minimum diastolic velocity(Vdmin) in the observation group were higher than those in the control group,and the levels of resistance index(RI) and pulsatility index(PI) were lower than those in the control group(P<0.05). Before treatment,compared the levels of nuclear factor-κB(NF-κB) and angiotensinⅡ (AngⅡ) between the two groups,there was no significance in the difference(P>0.05). After treatment,the levels of NF-κB and AngⅡ in the two groups were improved when compared with those before treatment(P<0.05),and the above two levels in the observation group were lower than those in the control group(P<0.05). Before treatment,there was no significant difference being found in the comparison of the levels of inflammatory factors between the two groups(P>0.05). After treatment, compared with those before treatment, the levels of monocyte chemoattractant protein(MCP- 1),interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) in the two groups were improved(P<0.05);the above three levels in the observation group were lower than those in the control group(P<0.05). Conclusion: The application of Jianpi Bushen Huayu tang assisting hemoperfusion in the treatment of diabetic nephropathy can improve the kidney function and insulin resistance, whose mechanism may be related to its improvement of hemodynamics and the reduction of the levels of NF-κB,AngⅡ and inflammatory factors.

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鲁阳侠,周云蕾,杨芳,孟帆.健脾补肾化瘀汤辅助血液灌流治疗糖尿病肾病对肾功能及胰岛素抵抗的影响[J].新中医,2020,52(11):46-50

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  • 在线发布日期: 2020-06-04
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