摘要
目的 观察艾灸联合保真汤加减治疗糖尿病肾病气阴两虚证的临床疗效及对CT灌注参数、Rho/ROCK信号通路蛋白的影响。方法 将146例糖尿病肾病气阴两虚证患者随机分为观察组(74例)和对照组(72例)。在对症治疗的基础上,对照组给予厄贝沙坦片,观察组给予艾灸联合保真汤加减。观察两组中医主症积分、CT灌注参数[血尿素氮(blood urea nitrogen, BUN)、血肌酐(serum creatinine, SCr)、尿白蛋白排泄率(urinary albumin excretion rate, UAER)和24 h尿蛋白定量(24-hour urinary protein quantification, 24 h Upro)]、肾血流指标[舒张末期血流速度(end-diastolic velocity, EDV)、肾段动脉的收缩期峰值流速(peak-systolic velocity, PSV)、搏动指数(pulsatility index, PI)和阻力指数(resistive index, RI)]、血清炎性因子[肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)、白细胞介素-1β(interleukin-1β, IL-1β)、白细胞介素-6(interleukin-6, IL-6)和C反应蛋白(C-reactive protein, CRP)]水平及Rho/ROCK信号通路[Ras同源基因家族成员A(Ras homolog gene family member A, RhoA)、Rho关联含卷曲螺旋蛋白激酶Ⅰ(Rho-associated coiled-coil containing protein kinaseⅠ, ROCKI)、α-平滑肌肌动蛋白(α-smooth muscle actin, α-SMA)和钙黏附蛋白-E(E-cadherin, E-Cad)]蛋白水平,并比较两组临床疗效及不良反应。结果 观察组总有效率为97.3%(72/74),明显高于对照组的81.9%(59/72)(P<0.05)。观察组治疗后中医主症积分低于治疗前和对照组(P<0.05)。两组治疗后CT灌注参数降低(P<0.05),且观察组低于对照组(P<0.05)。观察组治疗后PSV、EDV较治疗前和对照组加快(P<0.05),RI、PI较治疗前和对照组降低(P<0.05)。观察组治疗后血清炎性因子水平较治疗前和对照组降低(P<0.05)。观察组治疗后Rho A、ROCKI、α-SMA蛋白水平较治疗前和对照组降低(P<0.05),E-Cad蛋白水平较治疗前和对照组升高(P<0.05)。观察组不良反应发生率为1.4%(1/74),低于对照组的19.4%(14/72)(P<0.05)。结论 在对症治疗的基础上,艾灸联合保真汤加减可明显提高糖尿病肾病气阴两虚证患者的治疗效果,其机制可能与改善CT灌注参数,调节血清Rho/ROCK信号通路蛋白相关。
Objective To observe the clinical efficacy of moxibustion plus modified Bao Zhen Tang in treating diabetic nephropathy due to dual deficiency of Qi and Yin and its effects on CT perfusion parameters and Pho/ROCK signaling pathway proteins.Method A total of 146 patients with diabetic nephropathy due to dual deficiency of Qi and Yin were randomly allocated to an observation group(74 cases)and a control group(72 cases).In addition to symptomatic treatment, the control group was given Irbesartan tablets, and the observation group received moxibustion combined with modified Bao Zhen Tang. The following items were observed for the two groups: the primary symptom score of traditional Chinese medicine (TCM), CT perfusion parameters [blood urea nitrogen (BUN), serum creatinine (SCr), urinary albumin excretion rate (UAER), and 24-hour urinary protein quantification (24 h Upro)], renal blood flow indicators [end-diastolic velocity (EDV), peak-systolic velocity (PSV), pulsatility index (PI), resistive index (RI)], serum inflammatory factor levels [tumor necrosis factor-a (TNF-a), interleukin-1b (IL-1b), interleukin-6 (IL-6), and C-reactive protein (CRP)], and Rho//ROCK signaling pathway protein levels [Ras homolog gene family member A (RhoA), Rho-associated coiled-coil containing protein kinase Ⅰ (ROCKI), a-smooth muscle actin (a-SMA), and E-cadherin (E-Cad)]. The clinical efficacy and adverse reactions were compared between the two groups. Result The total effective rate was 97.3% (72/74) in the observation group, significantly higher than 81.9% (59/72) in the control group (P<0.05). After the intervention, the TCM primary symptom score dropped in the observation group and was lower than that in the control group (P<0.05). The CT perfusion parameters decreased in both groups after the treatment (P<0.05) and were lower in the observation group than in the control group (P<0.05). After the treatment, the PSV and EDV accelerated in the observation group and were higher than those in the control group (P<0.05);the RI and PI dropped in the observation group and were lower than those in the control group (P<0.05). The serum inflammatory factor levels dropped after the treatment in the observation group and were lower than those in the control group (P<0.05). The RhoA, ROCKI, and a-SMA protein levels decreased after the treatment in the observation group and were lower than those in the control group (P<0.05), and the E-Cad protein level increased in the observation group and was higher than that in the control group (P<0.05). The adverse reaction rate was 1.4% (1/74) in the observation group, lower than 19.4% (14/72) in the control group (P<0.05). Conclusion In addition to symptomatic treatment, moxibustion plus modified Bao Zhen Tang can enhance the efficacy in treating patients with diabetic nephropathy due to dual deficiency of Qi and Yin. The mechanism may be related to improving CT perfusion parameters and regulating serum Rho/ROCK signaling pathway proteins.
作者
赵小艳
王俊杰
ZHAO Xiaoyan;WANG Junjie(Henan Province Hospital of Traditional Chinese Medicine,Zhengzhou 450002,China)
出处
《上海针灸杂志》
CSCD
2024年第1期17-23,共7页
Shanghai Journal of Acupuncture and Moxibustion
基金
河南省中医药科学研究专项课题(2022ZY1071)。
关键词
灸法
糖尿病并发症
糖尿病肾病
气阴两虚
Rho/ROCK信号通路蛋白
Moxibustion
Diabetes complications
Diabetic nephropathies
Dual deficiency of Qi and Yin
Rho/ROCK signaling pathway proteins
