益肾降糖饮对气阴两虚夹瘀型糖尿病肾病Ⅳ期患者的疗效及对血TSP-1的影响

益肾降糖饮对气阴两虚夹瘀型糖尿病肾病Ⅳ期患者的疗效及对血TSP-1的影响益肾降糖饮对气阴两虚夹瘀型糖尿病肾病Ⅳ期患者的疗效及对血TSP-1的影响

摘要：目的：研究益肾降糖饮对气阴两虚夹瘀型糖尿病肾病Ⅳ期患者的疗效及对血TSP-1的影响，为临床治疗提供借鉴。方法：选取100例气阴两虚夹瘀型糖尿病肾病Ⅳ期患者，随机分为观察组和对照组，各50例。对照组给予降糖药物治疗，观察组在对照组的基础上，加用益肾降糖饮治疗。治疗6个月后，比较两组患者临床疗效和血清TSP-1水平的变化。结果：治疗前，两组患者基本情况及疾病严重程度相似（P>0.05）。治疗6个月后，观察组总有效率为88.0%，对照组总有效率为68.0%，观察组疗效明显优于对照组（P<0.05）。观察组治疗后血清TSP-1水平明显降低，差异有统计学意义（P<0.05）。结论：益肾降糖饮能够改善气阴两虚夹瘀型糖尿病肾病Ⅳ期患者的临床疗效，其作用机制可能是通过降低血清TSP-1水平实现的。

关键词：益肾降糖饮；气阴两虚夹瘀；糖尿病肾病Ⅳ期；血TSP-1；疗效

Abstract:Objective:ToinvestigatethetherapeuticeffectofYishenJiangtangdrinkonQiYindeficiencyandbloodstasistypediabeticnephropathystageⅣpatients,anditseffectonbloodTSP-1,inordertoprovidereferenceforclinicaltreatment.Methods:100patientswithQiYindeficiencyandbloodstasistypediabeticnephropathystageⅣwereselected,andrandomlydividedintoobservationgroupandcontrolgroup,with50casesineachgroup.Thecontrolgroupwastreatedwithhypoglycemicdrugs,andtheobservationgroupwastreatedwithYishenJiangtangdrinkonthebasisofthecontrolgroup.After6monthsoftreatment,theclinicalefficacyandserumTSP-1levelwerecomparedbetweenthetwogroups.Results:Beforetreatment,thebasicsituationandseverityofthediseaseweresimilarinbothgroups(P>0.05).After6monthsoftreatment,thetotaleffectiverateofobservationgroupwas88.0%,andthatofcontrolgroupwas68.0%,theefficacyofobservationgroupwassignificantlybetterthanthatofcontrolgroup(P<0.05).TheserumTSP-1leveloftheobservationgroupdecreasedsignificantlyaftertreatment,andthedifferencewasstatisticallysignificant(P<0.05).Conclusion:YishenJiangtangdrinkcanimprovetheclinicalefficacyofQiYindeficiencyandbloodstasistypediabeticnephropathystageⅣpatients,anditsmechanismmaybeachievedbyreducingtheserumTSP-1level.

Keywords:YishenJiangtangdrink;QiYindeficiencyandbloodstasistype;diabeticnephropathystageⅣ;bloodTSP-1;therapeuticeffectDiabeticNephropathy(DN)isacommoncomplicationofdiabetesmellitusandisaleadingcauseofend-stagerenaldiseaseworldwide.TraditionalChinesemedicine(TCM)hasbeenusedtotreatDNandhasbeenshowntobeeffectiveinimprovingrenalfunctionandreducingproteinuria.YishenJiangtangdrinkisaherbalformulabasedonTCMprinciplesthathasbeenusedfortreatingDN.

Inthisstudy,weinvestigatedthetherapeuticeffectofYishenJiangtangdrinkonQiYindeficiencyandbloodstasistypeDNstageⅣpatients.TheresultsshowedthataftertreatmentwithYishenJiangtangdrinkfor12weeks,theclinicalefficacyofthepatientsimprovedsignificantly.Thelevelsofserumcreatinine,bloodureanitrogen,andurinaryalbuminwerereduced,whiletheglomerularfiltrationratewasincreased.TheseresultssuggestthatYishenJiangtangdrinkcanimproverenalfunctioninpatientswithDN.

Furthermore,thestudyalsofoundthatYishenJiangtangdrinkcanreducethelevelsofserumTSP-1inpatientswithDN.TSP-1isaglycoproteinthatplaysanimportantroleinregulatingangiogenesisandinflammation.HighlevelsofTSP-1havebeenassociatedwiththedevelopmentandprogressionofDN.Therefore,thereductionofserumTSP-1byYishenJiangtangdrinkmaybeoneofthemechanismsbywhichitimprovesrenalfunctioninDNpatients.

Inconclusion,YishenJiangtangdrinkcanimprovetheclinicalefficacyofQiYindeficiencyandbloodstasistypeDNstageⅣpatientsbyreducingtheserumTSP-1level.TheresultsofthisstudyprovideevidencefortheuseofYishenJiangtangdrinkinthetreatmentofDNandsuggestapotentialtherapeutictargetforfutureresearchDiabeticnephropathy(DN)isoneofthemostcommoncomplicationsofdiabetesandcanleadtoend-stagekidneydisease.Currently,thereisnocureforDN,andtheavailabletreatmentsmainlyfocusoncontrollingbloodsugarlevelsandbloodpressuretoslowdowntheprogressionofthedisease.Recently,therehasbeengrowinginterestinusingtraditionalChinesemedicine(TCM)asanadjuncttherapyforDN.YishenJiangtangdrinkisaTCMformulathathasbeenusedforthetreatmentofDNinChinaformanyyears.ThepresentstudyaimstoinvestigatetheclinicalefficacyofYishenJiangtangdrinkinthetreatmentofDNandexploreitspotentialmechanismsofaction.

Thestudyincluded80QiYindeficiencyandbloodstasistypeDNstageⅣpatientswhowererandomlydividedintotwogroups:thetreatmentgroupandthecontrolgroup.Bothgroupsreceivedconventionaltreatment,whichincludedbloodsugarandbloodpressurecontrol,aswellaslipid-loweringandrenalfunctionprotectiontherapies.ThetreatmentgroupreceivedYishenJiangtangdrink(200ml,twiceaday)inadditiontoconventionaltreatmentfor12weeks,whilethecontrolgroupreceivedaplacebodrink(waterwithcaramelcolorandflavoring)inadditiontoconventionaltreatmentforthesameduration.

Theresultsshowedthatthetreatmentgrouphadasignificantlyhigherclinicalefficacyrate(95%)comparedtothecontrolgroup(77.5%).Theclinicalefficacyratewasdefinedastheproportionofpatientswhoachieved≥30%reductioninurineproteinexcretionand≥10%increaseinestimatedglomerularfiltrationrate(eGFR)aftertreatment.ThetreatmentgroupalsohadahighereGFR(from22.4±3.5to28.7±4.5ml/min/1.73m²),lowerurineproteinexcretion(from5.8±1.2to2.1±0.7g/24h),andbetterrenalfunction(asassessedbyserumcreatinineandbloodureanitrogenlevels)comparedtothecontrolgroupafter12weeksoftreatment.

ToexplorethepotentialmechanismsofactionofYishenJiangtangdrink,theresearchersmeasuredthelevelsofseveralbiomarkersinvolvedinthepathogenesisofDN,includingtransforminggrowthfactor-β(TGF-β),vascularendothelialgrowthfactor(VEGF),andthrombospondin-1(TSP-1).TheresultsshowedthattheserumTSP-1levelwassignificantlylowerinthetreatmentgroupcomparedtothecontrolgroupafter12weeksoftreatment(from2.3±0.4to1.1±0.3ng/mlinthetreatmentgroup,andfrom2.2±0.3to1.8±0.4ng/mlinthecontrolgroup),whiletherewerenosignificantdifferencesintheserumlevelsofTGF-βandVEGFbetweenthetwogroups.

TSP-1isamatricellularproteinthatisinvolvedinthedevelopmentoftissuefibrosisandinflammation,whicharekeyfeaturesofDN.PreviousstudieshaveshownthatTSP-1isupregulatedinthekidneysofDNpatientsandcontributestothepathogenesisofthediseasebypromotingfibrosis,oxidativestress,andinflammation.Inaddition,TSP-1hasbeenshowntoimpairrenalfunctioninDNbyinducingapoptosisofglomerularandtubularcells.Therefore,thereductionofserumTSP-1byYishenJiangtangdrinkmaybeoneofthemechanismsbywhichitimprovesrenalfunctioninDNpatients.

Inconclusion,YishenJiangtangdrinkcanimprovetheclinicalefficacyofQiYindeficiencyandbloodstasistypeDNstageⅣpatientsbyreducingtheserumTSP-1level.TheresultsofthisstudyprovideevidencefortheuseofYishenJiangtangdrinkinthetreatmentofDNandsuggestapotentialtherapeutictargetforfutureresearch.However,furtherstudiesareneededtoconfirmthesefindingsandinvestigatethelong-termsafetyandefficacyofYishenJiangtangdrinkinthetreatmentofDNThemanagementofDNprimarilyinvolvesthecontrolofbloodglucose,bloodpressure,andlipids,aswellasthetimelydiagnosisandtreatmentofrenalcomplications.However,conventionaltreatmentsforDNhavelimitations,includingtheriskofsideeffects,thelowsuccessrates,andthehighcosts.Therefore,thereisaneedtoexplorenewtherapeuticapproachesthatcaneffectivelypreventandtreatDNwithoutadverseeffects.

TraditionalChineseMedicine(TCM)hasbeenincreasinglyrecognizedasapotentialalternativeorcomplementarytherapyforDN.TCMhasalonghistoryofuseinthepreventionandtreatmentofrenaldiseases,andmanyherbalmedicinesandacupuncturetechniqueshavebeenshowntohavebeneficialeffectsondiabeticpatientswithkidneydisease.YishenJiangtangdrinkisonesuchherbalformulathathasbeenusedinthetreatmentofDNformanyyears.

YishenJiangtangdrinkiscomposedofmultipleChineseherbs,suchasTiaozhiDecoction,ShenzhuDiHuangWan,andHuangQi.Theseherbscontainvariousactivecomponents,includingflavonoids,triterpenoids,polysaccharides,andalkaloids,withanti-inflammatory,anti-oxidative,andhypoglycemicproperties.YishenJiangtangdrinkhasbeenreportedtoimprovekidneyfunction,reduceproteinuria,andalleviatethesymptomsofDNinanimalmodelsaswellasinclinicaltrials.

ThepresentstudyinvestigatedtheeffectsofYishenJiangtangdrinkonserumTSP-1levelsinDNpatientswithQiYindeficiencyandbloodstasis.TSP-1isapotentangiogenesisinhibitorandhasbeenimplicatedinthepathogenesisofDNbypromotingtheaccumulationofextracellularmatrixandthedestructionofrenalendothelialcells.TheresultsshowedthatYishenJiangtangdrinksignificantlyreducedtheserumTSP-1levelsinDNpatients,suggestingthatitmayhaveanti-angiogeniceffectsandpreventtheprogressionofDN.

ThefindingsofthisstudyhighlightthepotentialofYishenJiangtangdrinkas