摘要
目的:观察扶元散加减联合耳穴压豆治疗Ⅱ,Ⅲ期糖尿病肾病的疗效及对血清酪氨酸激酶/信号转导子及转录激活因子(JAK/STAT)信号通路的影响。方法:180例患者随机分为对照组和观察组,各90例。两组分别给予氯沙坦钾,扶元散加减联合耳穴压豆,疗程均为12周。治疗前后分别观察两组肾功能指标血尿素氮(BUN),肌酐(SCr),尿白蛋白排泄率(UAER),24 h尿蛋白定量(24 h Upor);肠道菌群(疣微菌门菌、硬壁菌门菌、脱铁杆菌门菌、变形菌门菌)相对丰度;氧化应激指标晚期蛋白氧化产物(AOPPs),活性氧(ROS),谷胱甘肽过氧化物酶(GSH-Px),总超氧化物歧化酶(TSOD);肾血流指标舒张末期的血流速度(EDV),肾段动脉的收缩期峰值(PSV),搏动指数(PI),血流阻力指数(RI);JAK/STAT信号通路JAK,磷酸化JAK(p-JAK),STAT,磷酸化STAT(p-STAT)水平。观察两组安全性,治疗后及随访1年,2年临床疗效。结果:治疗后及随访1年,2年,观察组总有效率分别为97.8%(87/89),81.6%(71/87),59.8%(49/82),明显高于同期对照组的79.3%(69/87),57.8%(48/83),37.2%(29/78)(χ^(2)=4.016,χ^(2)=4.503,χ^(2)=4.769,P<0.05)。治疗后与对照组比较,观察组BUN,SCr,UAER,24 h Upor,硬壁菌门菌,脱铁杆菌门菌,变形菌门菌,AOPPs,ROS,PI,RI,p-JAK,p-STAT3明显降低(P<0.05,P<0.01),疣微菌门菌,GSH-Px,TSOD,JAK,STAT3明显升高(P<0.05,P<0.01),EDV,PSV明显加快(P<0.05,P<0.01)。观察组不良反应发生率1.1%(1/89),低于对照组的13.8%(12/87)(χ^(2)=5.127,P<0.05)。结论:扶元散加减联合耳穴压豆可明显改善Ⅱ,Ⅲ期糖尿病肾病的临床疗效,其作用机制可能与调节血清JAK/STAT信号通路有关。
Objective: To observe the therapeutic effect of modified Fuyuanwan combined with auricular acupressure bean on stage Ⅱ,Ⅲ diabetic nephropathy and its effect on serum janus kinase(JAK)/signal transducer and activator of tranions(STAT)signaling pathway. Method: A total of 180 cases were randomly divided into control group and observation group,90 cases in each group. Losartan potassium,modified Fuyuanwan combined with auricular acupressure bean were given respectively for 12 weeks. Renal function indexes [blood urea nitrogen(BUN), serum creatinine(SCr), urinary albumin excretion rate(UAER),24 h urinary protein quantitative(24 h Upor)],relative abundance of intestinal flora(verruca microflora,scleriobacteriae,deferribacter,proteobacteria),oxidative stress indicators [advanced oxidation protein products(AOPPs), reactive oxygen species(ROS), glutathione peroxidase(GSH-Px), total superoxide dismutase(TSOD)],renal blood flow index [end-diastolic blood flow velocity(EDV),peak systolic value(PSV),pulse index(PI),blood flow resistance index(RI)],JAK/STAT signaling pathway[JAK,phosphorylated JAK(p-JAK),STAT,phosphorylated STAT(p-STAT)were observed before and after treatment. The safety indexes of two groups were evaluated after treatment. The efficacy was observed after treatment and followed up for 1 years and 2 years. Result: After treatment and follow-up for 1,2 years,the total effective rates of patients in observation group were 97.8%(87/89),81.6%(71/87),59.8%(49/82),respectively,observation group which were significantly higher than those in control group of 79.3%(69/87),57.8%(48/83),37.2%(29/78)(χ^(2)=4.016,χ^(2)=4.503,χ^(2)=4.769,P<0.05). Compared with control group after treatment,UAER,BUN,SCr,24 h Upor,firmicutes,actinobacillus,proteobacteria,AOPPs,ROS,PI,RI,p-JAK,p-STAT3 in observation group were significantly decreased(P<0.05,P<0.01),microflora verruca,GSH-PX, TSOD, JAK, STAT3 were significantly increased(P<0.05,P<0.01), EDV and PSV were significantly accelerated(P<0.05,P<0.01). The incidence of adverse reactions was 1.1%(1/89)in observation group,lower than 13.8%(12/87)in control group(χ^(2)=5.127,P<0.05). Conclusion: Modified Fuyuanwan combined with auricular acupressure bean can significantly improve the curative effect of stage Ⅱ,Ⅲ diabetic nephropathy,and its mechanism of action may be related to the serum JAK/STAT signaling pathway.
作者
姚玉红
张华
李健
张君普
孙新宇
YAO Yu-hong;ZHANG Hua;LI Jian;ZHANG Jun-pu;SUN Xin-yu(Henan Province Hospital of Traditional Chinese Medicine,Zhengzhou 450002,China;The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450008,China;The Third Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450003,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2021年第18期80-87,共8页
Chinese Journal of Experimental Traditional Medical Formulae
基金
河南省中医药科学研究专项(2019JDZY090)。
