当归补血汤合六味地黄汤对高血压肝肾阴虚证早期肾损害的防治

发布时间：2019-03-15 10:42

【摘要】：目的:观察当归补血汤合六味地黄汤治疗早期高血压肾损害的临床疗效及对转化生长因子-β_1(TGF-β_1),纤溶酶原激活物抑制剂-1(PAI-1),白细胞介素-1β(IL-1β)和肿瘤坏死因子-α(TNF-α)水平的影响。方法:240例患者采用区组分层随机,以SAS软件生成的数字表法,按1∶1分为观察组和对照组各120例。基础治疗口服缬沙坦胶囊,80 mg/次,1次/d;血压未达标加用硝苯地平控释片,1片/次,1次/d。对照组采用六味地黄汤,1剂/d,分早晚2次内服;观察组采用当归补血汤合六味地黄汤,1剂/d,分早晚2次内服。两组疗程均为12周。检测尿血清β_2微球蛋白(β_2-MG),尿N-乙酰-β-氨基葡萄糖苷酶(NAG),胱抑素C(CysC)水平,微量白蛋白(mALB),血肌酐(SCr),并计算尿微量白蛋白/肌酐(UACR)和肾小球滤过率(e GFR),包括eGFR_(MDRD)和eGFR_(CKD-EPI);进行治疗前后肝肾阴虚证评分;检测治疗前后血清TGF-β_1,PAI-1,IL-1β和TNF-α水平,进行安全性评价。结果:观察组中医证候疗效总有效率为89.09%,优于对照组的77.27%,组间差异有统计学意义(χ~2=5.491,P0.05);治疗后观察组β_2-MG,CysC,NAG,m ALB和SCr水平均低于对照组(P0.01);治疗后观察组UACR低于对照组,eGFR_(MDRD)和eGFR_(CKD-EPI)均高于对照组(P0.01);治疗后观察组患者血清TGF-β_1,PAI-1,IL-1β和TNF-α水平均低于对照组(P0.01);两组患者均未发现与中药相关不良反应。结论:当归补血汤合六味地黄汤治疗早期高血压肾损害,能减临床症状,减轻早期肾损伤,延缓肾损害进展,并能调节TGF-β_1,PAI-1,IL-1β和TNF-α等因子,起到保护肾损伤的作用。
[Abstract]:Objective: To observe the clinical effect of Danggui Buxue Decoction and Liuwei Dihuang Decoction in the treatment of early hypertensive renal injury and its effect on the transformation growth factor-1 (TGF-1), plasminogen activator inhibitor-1 (PAI-1), The effect of interleukin-1 (IL-1) and tumor necrosis factor-1 (TNF-1) on the level of tumor necrosis factor-1 (TNF-1). Methods:240 patients were divided into two groups: observation group and control group. On the basis of the treatment of oral and losartan capsules,80 mg/ day and 1 time/ day, nifedipine controlled-release tablets,1 tablet/ time and 1 time/ day were used for the non-compliance of the blood pressure, and the control group adopted Liuwei Dihuang Decoction,1 agent/ d, and the control group was taken orally in the morning and the second time; the observation group adopted the Chinese angelica and the blood-tonifying decoction, the six-flavor dihuang decoction and the 1-agent/ d, It is taken orally 2 times in the morning and evening. The course of treatment was 12 weeks. urine serum level 2 microglobulin (HCO3 _ 2-MG), urine N-B-1-amino-grape-glycanase (NAG), cystatin C (CysC) level, microalbumin (mALB), and blood myoglobin (SCr) were detected, and the urinary micro-albumin/ myoglobin (UACR) and the glomerular filtration rate (e GFR) were calculated, Including eGFR _ (MDRD) and eGFR _ (CKD-EPI); liver and kidney yin deficiency syndrome scores before and after treatment; serum TGF-1, PAI-1, IL-1 and TNF-1 levels before and after treatment, and safety evaluation. Results: The total effective rate was 89.09% in the observation group and 77.27% in the control group, and the difference between the groups was statistically significant (P ~ 2 = 5.491, P <0.05), and the level of the group of the observation group was lower than that of the control group (P 0.01) after the treatment, and the UACR of the observation group after treatment was lower than that of the control group. EGFR _ (MDRD) and eGFR _ (CKD-EPI) were higher than those in the control group (P0.01). The levels of serum TGF-1, PAI-1, IL-1, and TNF-1 in the treated group were lower than that in the control group (P0.01), and no adverse reactions with the traditional Chinese medicine were found in both groups. Conclusion: Danggui Buxue Decoction and Liuwei Dihuang Decoction can reduce the clinical symptoms, reduce the early renal injury, delay the progression of renal damage, and can adjust the factors such as TGF-1, PAI-1, IL-1, and TNF-1 to play a role in protecting the kidney.
【作者单位】：河南中医药大学第二临床医学院;河南省中医院;
【基金】：河南省中医药科学研究专项(2014ZY02021)
【分类号】：R259

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