黄芪联合缬沙坦治疗糖尿病肾病及对尿亮氨酸氨基肽酶、足细胞标志蛋白水平的影响

Effect of Astragalus injection combined with Valsartan on urine LAP and PCX in treating diabetic nephropathy

摘要:

目的  探讨黄芪联合缬沙坦治疗糖尿病肾病（DN）的临床疗效及对尿亮氨酸氨基肽酶（LAP）和足细胞标志蛋白（PCX）水平的影响。方法  选取2014年5月-2015年5月该院收治的74例DN患者为研究对象，随机分为对照组37例和黄芪治疗组37例，对照组接受糖尿病的常规治疗，并口服缬沙坦，黄芪治疗组在对照组的基础上应用中药黄芪注射液，比较两组的临床治疗效果及尿LAP、PCX水平。结果  黄芪治疗组的总有效率为86.5%，高于对照组的总有效率64.9%（χ2 =4.702，P <0.05），黄芪治疗组的疗效优于对照组（u =2.913，P <
0.01）。与对照组比较，黄芪治疗组的24 h尿蛋白、尿微量白蛋白和血肌酐水平均降低，差异有统计学意义（t =
3.744、12.752和2.949，P <0.01）。治疗后对照组患者与治疗前比较，LAP水平下降（t =3.812，P <0.05），而PCX水平略有下降，但与治疗前比较差异无统计学意义（t =2.591，P >0.05）；黄芪治疗组患者接受黄芪注射液与缬沙坦联合治疗后LAP和PCX水平较治疗前均下降（t =7.694和9.312，P <0.01）。接受不同治疗后两组患者LAP和PCX水平比较，差异有统计学意义（t =7.803和5.693，P <0.01）。结论  黄芪联合缬沙坦治疗糖尿病肾病效果较好，可有效降低患者尿LAP和PCX水平，明显改善患者临床症状，值得临床推广应用。

Abstract:

Objective To explore the effect of Astragalus injection combined with Valsartan on urine leucine arylamidase (LAP) and podocalyxin (PCX) in treating diabetic nephropathy. Methods The 74 diabetic nephropathy patients in our hospital from May 2014 to May 2015 were randomly divided into control group (37 cases) and Astragalus-treated group (37 cases). The control group received conventional diabetes treatment with Valsartan. Astragalus-treated group was treated with Chinese herbal medicine Astragalus injection in addition to the treatment for the control group. The clinical results and urine LAP and PCX levels were compared. Results The total effective rate of the Astragalus-treated group (86.5%) was significantly higher than that of the control group (64.9%; χ2 = 4.702, P < 0.05). The efficacy of the Astragalus-treated group was better than that of the control group (u = 2.913, P < 0.01). The 24-h urinary protein, urine albumin and serum creatinine levels of the Astragalus-treated group were significantly reduced compared to those of the control group (t = 3.744, 12.752 and 2.949; P < 0.01). In the control group, the LAP level significantly decreased after treatment (t = 3.812, P < 0.05), but the PCX level only slightly decreased after treatment without significant difference (t = 2.591, P > 0.05). In the Astragalus-treated group, the LAP and PCX levels after treatment significantly decreased compared with pre-treatment ones (t = 7.694 and 9.312; P < 0.01). LAP and PCX levels after treatment had significant differences between the two groups (t = 7.803 and 5.693; P < 0.01). Conclusions Astragalus combined with Valsartan has better clinical efficacy than Valsartan alone for the treatment of diabetic nephropathy. It can effectively reduce urinary levels of LAP and PCX and improve the clinical symptoms. It has considerable value in the clinical application.