尿毒清颗粒对老年糖尿病肾病患者微炎性反应状态和血管内皮生长因子的影响

摘要

目的：观察尿毒清颗粒对老年糖尿病肾病（ DN）患者微炎性反应状态和血管内皮生长因子（ VEGF）的影响。方法将老年临床期DN患者102例随机分为2组，常规治疗组50例，常规治疗加尿毒清治疗组52例，2组疗程均12周，另纳入30例同期健康体检老年人为健康对照组。比较3组间血清微炎性反应标志物白细胞介素1β（IL-1β）、白细胞介素6（IL-6）、C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）水平，并将这些促炎因子与VEGF和尿白蛋白排泄率（ UAER）进行相关分析。观察2组患者治疗前、后IL-1β、IL-6、CRP、TNF-α、VEGF和UAER水平的变化。结果（1）2组老年临床期DN患者IL-1β、IL-6、CRP、TNF-α、VEGF、UAER水平均显著高于健康对照组，差异有统计学意义（ P ＜0．05）；2组间差异无统计学意义（ P ＞0．05）。（2）治疗12周，常规治疗组IL-1β、VEGF、UAER显著下降（ P ＜0．05），而IL-6、CRP、TNF-α无明显变化（ P ＞0．05）；尿毒清治疗组IL-1β、IL-6、CRP、TNF-α、VEGF、UAER均明显下降，差异均有统计学意义（ P ＜0．05）。且尿毒清治疗组各项指标下降均优于常规治疗组（ P ＜0．05）。（3）相关性分析结果表明，VEGF与IL-1β（ r ＝0．41， P ＜0．01）、IL-6（ r ＝0．28， P ＜0．01）、CRP（ r ＝0．33， P ＜0．01）、TNF-α（ r ＝0．36， P ＜0．01）呈正相关；UAER与IL-1β（ r ＝0．39， P ＜0．01）、IL-6（ r ＝0．32， P ＜0．01）、CRP（ r ＝0．29， P ＜0．01）、TNF-α（ r ＝0．37， P ＜0．01）呈正相关；VEGF与UAER呈正相关（ r ＝0．55， P ＜0．01）。结论老年DN患者存在不同程度的微炎性反应状态和VEGF增高，尿毒清颗粒治疗能有效改善微炎性反应状态。%Objective To observe the effect of Niaoduqing granules on micro-inflammatory state and vascular endo-thelial growth factor ( VEGF) in aged patients with diabetic nephropathy ( DN) .Methods Elderly patients with clinical stage DN 102 cases were randomly divided into 2 groups, 50 cases in conventional treatment group , 52 cases in the treatment group received the routine treatment plus Niaoduqing granules, two groups of patients were treated for 12 weeks, another 30 cases of healthy elderly people were enrolled as healthy controls .Compared of serum micro inflammatory markers interleukin-1β( IL-1β), interleukin-6 (IL-6), C reactive protein (CRP), tumor necrosis factor alpha (TNF-α) levels among the 3 groups, and these proinflammatory cytokines and VEGF and urinary albumin excretion rate ( UAER) were analyzed .Observe the change of IL-1 β, IL-6, CRP, TNF-α,VEGF and UAER levels in the 2 groups of patients before and after treatment .Results (1) 2 groups of elderly patients with clinical stage DN IL-1 β, IL-6, CRP, TNF-α, VEGF, UAER levels were significantly higher than that of the control group , the difference was statistically significant ( P <0.05);there was no significant difference be-tween the 2 groups ( P >0.05).(2)For 12 weeks, the conventional treatment group's IL-1β, VEGF, UAER decreased sig-nificantly ( P <0.05), while IL-6, CRP, TNF-αhad no significant changes ( P >0.05);Niaoduqing granules treatment group's IL-1 β, IL-6, CRP, TNF-α, VEGF, UAER decreased significantly , the difference was statistically significant ( P <0.05).All of the indexes in the Niaoduqing granules treatment group decreased obviously than routine treatment group ( P <0.05).(3) The result of correlation analysis showed that , VEGF and IL-1β( r =0.41, P <0.01), IL-6 ( r =0.28, P <0.01), CRP ( r =0.33, P <0.01), TNF-α( r =0.36, P <0.01) was positively correlated with UAER and IL-1β( r =0.39, P <0.01), IL-6 ( r =0.32, P <0.01), CRP ( r =0.29, P <0.01), TNF-α( r =0.37, P <0.01) were posi-tively correlated;VEGF was positively correlated with UAER ( r =0.55, P <0.01).Conclusion The aged patients with DN have suffered different degree of micro-inflammatory state and increased VEGF , Niaoduqing granules could effectively im-prove the micro inflammatory state .