加味参芪地黄汤干预内质网应激辅助治疗糖尿病肾病的疗效及对肾功能、糖脂代谢的影响

Efficacy of Modified Shenqi Dihuang Decoction as an adjuvant therapy for diabetic nephropathy via modulating endoplasmic reticulum stress and its effect on renal function and glucose and lipid metabolism

摘要:

目的 探究加味参芪地黄汤干预内质网应激辅助治疗糖尿病肾病的疗效及对肾功能、糖脂代谢的影响。方法 选取2016年6月—2021年10月黑龙江中医药大学附属第二医院肾内科收治的糖尿病肾病患者126例为研究对象，根据患者对治疗方案的选择分为研究组（79例）和对照组（47例）。对照组接受常规西药治疗，研究组在对照组基础上增加加味参芪地黄汤辅助治疗。比较两组疗效、血糖指标［空腹血糖、餐后2小时血糖、糖化血红蛋白、空腹胰岛素、稳态胰岛素评价指数］、血脂指标［甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇］、肾功能［血清肌酐、血尿素氮、白蛋白、24 h尿蛋白定量］、内质网应激指标［人内质网应激相关蛋白、活化转录因子6、分子伴侣葡萄糖调节蛋白78 mRNA，以及血管紧张素、血清Caspase-12］、不良反应等。结果 研究组治疗前后血糖、血脂、肾功能及内质网应激各指标的差值大于对照组（P <0.05）。研究组总有效率为87.34%，高于对照组的68.09%（P <0.05）。研究组总不良反应发生率为7.59%，低于对照组的27.66%（P <0.05）。结论 联合加味参芪地黄汤对糖尿病肾病患者的临床症状、糖脂代谢改善及肾功能恢复效果更优，更有利于降低西药治疗带来的不良反应，值得临床推广应用。

Abstract:

Objective To explore the curative effect of Modified Shenqi Dihuang Decoction as an adjuvant therapy for diabetic nephropathy via modulating endoplasmic reticulum stress and its effect on renal function and glucose and lipid metabolism.Methods A total of 126 patients with diabetic nephropathy who were admitted to the Department of Nephrology of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from June 2016 to October 2021 were selected, and they were divided into the study group (79 cases) and the control group (47 cases). The control group received conventional Western medicine treatment, and the study group was additionally treated with Modified Shenqi Dihuang Decoction on the basis of the control group. The curative effect, blood glucose-related indicators [fasting blood glucose (FBG), 2-hour postprandial blood glucose (2 hPBG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS), and insulin resistance index (HOMA-IR) ], blood lipid-related indicators [triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) ], renal function [serum creatinine (Scr), blood urea nitrogen (BUN), albumin (Alb), and 24-hour urine protein], endoplasmic reticulum stress-related indicators [mRNA expressions of C/EBP homologous protein (CHOP), activating transcription factor 6 (ATF6), and glucose-regulated protein 78 (GRP78), and levels of angiotensin Ⅱ (Ang Ⅱ) and serum caspase-12], and adverse reactions were compared between the two groups.Results The differences in blood glucose-related indicators, blood lipid-related indicators, renal function, and endoplasmic reticulum stress-related indicators before and after the treatments were greater in the study group than those in the control group (P < 0.05). The overall effective rate in the study group was 87.34%, which was higher than 68.09% in the control group (P < 0.05). The incidence of adverse reactions in the study group was 7.59%, which was lower than 27.66% in the control group (P < 0.05).Conclusions The combination of Modified Shenqi Dihuang Decoction better improves clinical symptoms, glucose and lipid metabolism, and renal function in patients with diabetic nephropathy. Besides, it reduces the incidence of adverse reactions caused by Western medicine treatment. Thus, Modified Shenqi Dihuang Decoction as an adjuvant therapy for diabetic nephropathy is worthy of being more widely adopted in the clinical practice.