加味升降散对早期糖尿病肾病患者肾小管功能的影响

目的：观察加味升降散对早期糖尿病肾病（DN）患者肾小管功能的影响及其作用机制。方法：选取2018年3月至2019年10月河北省中医院肾内科门诊及住院部收治的早期DN患者92例作为研究对象，中医辨证属气阴两虚、浊毒郁热证。用简单随机化法分为对照组和观察组，每组46例。对照组给予基础治疗；观察组在基础治疗上加服加味升降散，疗程均为2个月。记录2组患者治疗前后中医证候积分；临床指标：糖化血红蛋白（HbA1c），低密度脂蛋白（LDL），总胆固醇（TC），尿微量白蛋白排泄率（UAER），肾小球滤过率（GFR）；肾小管功能标志物：β2-微球蛋白（β2-MG），肝型脂肪酸结合蛋白（L-FABP），α1-微球蛋白（α1-MG）；氧化应激指标：NADPH氧化酶4（NOX4），超氧化物歧化酶（SOD），总抗氧化能力（T-AOC）。结果：治疗后，观察组总有效率为92.68%，对照组为81.40%，差异有统计学意义（P<0.05）；2组患者中医证候积分、HbA1c、TC、LDL、UAER均较前下降，且观察组下降更为显著（均P<0.05）；2组患者治疗前后GFR变化不明显，α1-MG、β2-MG、L-FABP水平均较前降低，且观察组下降更显著（均P<0.05）；2组患者NOX4表达受到抑制，T-AOC、SOD水平回升（均P<0.05），观察组患者NOX4表达的下降以及T-AOC、SOD水平的回升更显著（P<0.05）；2组患者均未出现不良反应。结论：加味升降散能够改善早期DN患者临床症状，调节氧化-抗氧化失衡，减轻氧化应激，缓解肾小管损伤。

Effect of Jiawei Shengjiang Powder on Renal Tubule Function of Patients with Early Diabetic Nephropathy

To observe the effect and mechanism of Jiawei Shengjiang Powder on renal tubule function in patients with early diabetic nephropathy(DN).Methods:Ninety-two inpatients and outpatients with early DN，diagnosed with deficiency of both qi and yin and retention of turbid toxin and heat syndrome，were selected from the Nephropathy Department of Hebei Provincial Hospital of Traditional Chinese Medicine between March 2018 and October 2019.They were randomly divided into a control group and an observation group by simple randomization，with 46 patients in each group.The control group received standard treatment，while the observation group received Jiawei Shengjiang Powder in addition to standard treatment.The treatment period for both groups was two months.Traditional Chinese medicine(TCM) syndrome scores，clinical indicators [hemoglobin A1C(HbA1c)，low density lipoprotein(LDL)，total cholesterol(TC)，urinary albumin excretion rate(UAER)，glomerular filtration rate(GFR)]，renal tubule function markers [α1-microglobulin(α1-MG)，β2-microglobulin(β2-MG)，liver fatty acid-binding protein(L-FABP)]，and oxidative stress indicators [NADPH oxidase 4(NOX4)，superoxide dismutase(SOD)，total antioxidant capacity(T-AOC)] were recorded before and after treatment in both groups.Results:After treatment，the overall efficacy rate was 92.68% in the observation group and 81.40% in the control group，showing a statistically significant difference(P<0.05).TCM syndrome scores，HbA1c，TC，LDL，and UAER decreased in both groups，with more significant reductions in the observation group(all P<0.05).There was no significant change in GFR in either group.Levels of α1-MG，β2-MG，and L-FABP decreased in both groups，with more significant reductions in the observation group(all P<0.05).NOX4 expression was suppressed，and T-AOC and SOD levels increased in both groups(all P<0.05)，with more significant changes in the observation group(P<0.05).No adverse reactions were observed in either group.Conclusion:Jiawei Shengjiang Powder can improve clinical symptoms in patients with early DN，regulate the imbalance between oxidation and antioxidation，reduce oxidative stress，and alleviate renal tubule damage.