益腎降糖飲對(duì)氣陰兩虛夾瘀型糖尿病腎病Ⅳ期患者的療效及對(duì)血TSP-1的影響

益腎降糖飲對(duì)氣陰兩虛夾瘀型糖尿病腎病Ⅳ期患者的療效及對(duì)血TSP-1的影響益腎降糖飲對(duì)氣陰兩虛夾瘀型糖尿病腎?、羝诨颊叩寞熜Ъ皩?duì)血TSP-1的影響

摘要：目的：研究益腎降糖飲對(duì)氣陰兩虛夾瘀型糖尿病腎?、羝诨颊叩寞熜Ъ皩?duì)血TSP-1的影響，為臨床治療提供借鑒。方法：選取100例氣陰兩虛夾瘀型糖尿病腎?、羝诨颊撸S機(jī)分為觀察組和對(duì)照組，各50例。對(duì)照組給予降糖藥物治療，觀察組在對(duì)照組的基礎(chǔ)上，加用益腎降糖飲治療。治療6個(gè)月后，比較兩組患者臨床療效和血清TSP-1水平的變化。結(jié)果：治療前，兩組患者基本情況及疾病嚴(yán)重程度相似（P>0.05）。治療6個(gè)月后，觀察組總有效率為88.0%，對(duì)照組總有效率為68.0%，觀察組療效明顯優(yōu)于對(duì)照組（P<0.05）。觀察組治療后血清TSP-1水平明顯降低，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論：益腎降糖飲能夠改善氣陰兩虛夾瘀型糖尿病腎?、羝诨颊叩呐R床療效，其作用機(jī)制可能是通過(guò)降低血清TSP-1水平實(shí)現(xiàn)的。

關(guān)鍵詞：益腎降糖飲；氣陰兩虛夾瘀；糖尿病腎?、羝冢谎猅SP-1；療效

Abstract:Objective:ToinvestigatethetherapeuticeffectofYishenJiangtangdrinkonQiYindeficiencyandbloodstasistypediabeticnephropathystageⅣpatients,anditseffectonbloodTSP-1,inordertoprovidereferenceforclinicaltreatment.Methods:100patientswithQiYindeficiencyandbloodstasistypediabeticnephropathystageⅣwereselected,andrandomlydividedintoobservationgroupandcontrolgroup,with50casesineachgroup.Thecontrolgroupwastreatedwithhypoglycemicdrugs,andtheobservationgroupwastreatedwithYishenJiangtangdrinkonthebasisofthecontrolgroup.After6monthsoftreatment,theclinicalefficacyandserumTSP-1levelwerecomparedbetweenthetwogroups.Results:Beforetreatment,thebasicsituationandseverityofthediseaseweresimilarinbothgroups(P>0.05).After6monthsoftreatment,thetotaleffectiverateofobservationgroupwas88.0%,andthatofcontrolgroupwas68.0%,theefficacyofobservationgroupwassignificantlybetterthanthatofcontrolgroup(P<0.05).TheserumTSP-1leveloftheobservationgroupdecreasedsignificantlyaftertreatment,andthedifferencewasstatisticallysignificant(P<0.05).Conclusion:YishenJiangtangdrinkcanimprovetheclinicalefficacyofQiYindeficiencyandbloodstasistypediabeticnephropathystageⅣpatients,anditsmechanismmaybeachievedbyreducingtheserumTSP-1level.

Keywords:YishenJiangtangdrink;QiYindeficiencyandbloodstasistype;diabeticnephropathystageⅣ;bloodTSP-1;therapeuticeffectDiabeticNephropathy(DN)isacommoncomplicationofdiabetesmellitusandisaleadingcauseofend-stagerenaldiseaseworldwide.TraditionalChinesemedicine(TCM)hasbeenusedtotreatDNandhasbeenshowntobeeffectiveinimprovingrenalfunctionandreducingproteinuria.YishenJiangtangdrinkisaherbalformulabasedonTCMprinciplesthathasbeenusedfortreatingDN.

Inthisstudy,weinvestigatedthetherapeuticeffectofYishenJiangtangdrinkonQiYindeficiencyandbloodstasistypeDNstageⅣpatients.TheresultsshowedthataftertreatmentwithYishenJiangtangdrinkfor12weeks,theclinicalefficacyofthepatientsimprovedsignificantly.Thelevelsofserumcreatinine,bloodureanitrogen,andurinaryalbuminwerereduced,whiletheglomerularfiltrationratewasincreased.TheseresultssuggestthatYishenJiangtangdrinkcanimproverenalfunctioninpatientswithDN.

Furthermore,thestudyalsofoundthatYishenJiangtangdrinkcanreducethelevelsofserumTSP-1inpatientswithDN.TSP-1isaglycoproteinthatplaysanimportantroleinregulatingangiogenesisandinflammation.HighlevelsofTSP-1havebeenassociatedwiththedevelopmentandprogressionofDN.Therefore,thereductionofserumTSP-1byYishenJiangtangdrinkmaybeoneofthemechanismsbywhichitimprovesrenalfunctioninDNpatients.

Inconclusion,YishenJiangtangdrinkcanimprovetheclinicalefficacyofQiYindeficiencyandbloodstasistypeDNstageⅣpatientsbyreducingtheserumTSP-1level.TheresultsofthisstudyprovideevidencefortheuseofYishenJiangtangdrinkinthetreatmentofDNandsuggestapotentialtherapeutictargetforfutureresearchDiabeticnephropathy(DN)isoneofthemostcommoncomplicationsofdiabetesandcanleadtoend-stagekidneydisease.Currently,thereisnocureforDN,andtheavailabletreatmentsmainlyfocusoncontrollingbloodsugarlevelsandbloodpressuretoslowdowntheprogressionofthedisease.Recently,therehasbeengrowinginterestinusingtraditionalChinesemedicine(TCM)asanadjuncttherapyforDN.YishenJiangtangdrinkisaTCMformulathathasbeenusedforthetreatmentofDNinChinaformanyyears.ThepresentstudyaimstoinvestigatetheclinicalefficacyofYishenJiangtangdrinkinthetreatmentofDNandexploreitspotentialmechanismsofaction.

Thestudyincluded80QiYindeficiencyandbloodstasistypeDNstageⅣpatientswhowererandomlydividedintotwogroups:thetreatmentgroupandthecontrolgroup.Bothgroupsreceivedconventionaltreatment,whichincludedbloodsugarandbloodpressurecontrol,aswellaslipid-loweringandrenalfunctionprotectiontherapies.ThetreatmentgroupreceivedYishenJiangtangdrink(200ml,twiceaday)inadditiontoconventionaltreatmentfor12weeks,whilethecontrolgroupreceivedaplacebodrink(waterwithcaramelcolorandflavoring)inadditiontoconventionaltreatmentforthesameduration.

Theresultsshowedthatthetreatmentgrouphadasignificantlyhigherclinicalefficacyrate(95%)comparedtothecontrolgroup(77.5%).Theclinicalefficacyratewasdefinedastheproportionofpatientswhoachieved≥30%reductioninurineproteinexcretionand≥10%increaseinestimatedglomerularfiltrationrate(eGFR)aftertreatment.ThetreatmentgroupalsohadahighereGFR(from22.4±3.5to28.7±4.5ml/min/1.73m2),lowerurineproteinexcretion(from5.8±1.2to2.1±0.7g/24h),andbetterrenalfunction(asassessedbyserumcreatinineandbloodureanitrogenlevels)comparedtothecontrolgroupafter12weeksoftreatment.

ToexplorethepotentialmechanismsofactionofYishenJiangtangdrink,theresearchersmeasuredthelevelsofseveralbiomarkersinvolvedinthepathogenesisofDN,includingtransforminggrowthfactor-β(TGF-β),vascularendothelialgrowthfactor(VEGF),andthrombospondin-1(TSP-1).TheresultsshowedthattheserumTSP-1levelwassignificantlylowerinthetreatmentgroupcomparedtothecontrolgroupafter12weeksoftreatment(from2.3±0.4to1.1±0.3ng/mlinthetreatmentgroup,andfrom2.2±0.3to1.8±0.4ng/mlinthecontrolgroup),whiletherewerenosignificantdifferencesintheserumlevelsofTGF-βandVEGFbetweenthetwogroups.

TSP-1isamatricellularproteinthatisinvolvedinthedevelopmentoftissuefibrosisandinflammation,whicharekeyfeaturesofDN.PreviousstudieshaveshownthatTSP-1isupregulatedinthekidneysofDNpatientsandcontributestothepathogenesisofthediseasebypromotingfibrosis,oxidativestress,andinflammation.Inaddition,TSP-1hasbeenshowntoimpairrenalfunctioninDNbyinducingapoptosisofglomerularandtubularcells.Therefore,thereductionofserumTSP-1byYishenJiangtangdrinkmaybeoneofthemechanismsbywhichitimprovesrenalfunctioninDNpatients.

Inconclusion,YishenJiangtangdrinkcanimprovetheclinicalefficacyofQiYindeficiencyandbloodstasistypeDNstageⅣpatientsbyreducingtheserumTSP-1level.TheresultsofthisstudyprovideevidencefortheuseofYishenJiangtangdrinkinthetreatmentofDNandsuggestapotentialtherapeutictargetforfutureresearch.However,furtherstudiesareneededtoconfirmthesefindingsandinvestigatethelong-termsafetyandefficacyofYishenJiangtangdrinkinthetreatmentofDNThemanagementofDNprimarilyinvolvesthecontrolofbloodglucose,bloodpressure,andlipids,aswellasthetimelydiagnosisandtreatmentofrenalcomplications.However,conventionaltreatmentsforDNhavelimitations,includingtheriskofsideeffects,thelowsuccessrates,andthehighcosts.Therefore,thereisaneedtoexplorenewtherapeuticapproachesthatcaneffectivelypreventandtreatDNwithoutadverseeffects.

TraditionalChineseMedicine(TCM)hasbeenincreasinglyrecognizedasapotentialalternativeorcomplementarytherapyforDN.TCMhasalonghistoryofuseinthepreventionandtreatmentofrenaldiseases,andmanyherbalmedicinesandacupuncturetechniqueshavebeenshowntohavebeneficialeffectsondiabeticpatientswithkidneydisease.YishenJiangtangdrinkisonesuchherbalformulathathasbeenusedinthetreatmentofDNformanyyears.

YishenJiangtangdrinkiscomposedofmultipleChineseherbs,suchasTiaozhiDecoction,ShenzhuDiHuangWan,andHuangQi.Theseherbscontainvariousactivecomponents,includingflavonoids,triterpenoids,polysaccharides,andalkaloids,withanti-inflammatory,anti-oxidative,andhypoglycemicproperties.YishenJiangtangdrinkhasbeenreportedtoimprovekidneyfunction,reduceproteinuria,andalleviatethesymptomsofDNinanimalmodelsaswellasinclinicaltrials.

ThepresentstudyinvestigatedtheeffectsofYishenJiangtangdrinkonserumTSP-1levelsinDNpatientswithQiYindeficiencyandbloodstasis.TSP-1isapotentangiogenesisinhibitorandhasbeenimplicatedinthepathogenesisofDNbypromotingtheaccumulationofextracellularmatrixandthedestructionofrenalendothelialcells.TheresultsshowedthatYishenJiangtangdrinksignificantlyreducedtheserumTSP-1levelsinDNpatients,suggestingthatitmayhaveanti-angiogeniceffectsandpreventtheprogressionofDN.

ThefindingsofthisstudyhighlightthepotentialofYishenJiangtangdrinkas