自拟益肾汤对早期糖尿病肾病患者尿白蛋白的影响及部分机制探讨

摘要

目的：观察自拟益肾汤对早期糖尿病肾病尿白蛋白的临床疗效及部分作用机制。方法：将本院收治的60例2型糖尿病肾病患者根据随机方法分为对照组（30例）和观察组（30例），2组患者均接受健康教育、合理饮食指导，内科降糖治疗，常规口服缬沙坦，80 mg／d；合并高脂血症者加服辛伐他汀，20 mg／d。观察组在上述常规治疗基础上加用自拟益肾汤，水煎药方200 mL，1剂／d（早晚分服），连用12周，1个疗程结束后观察2组患者治疗前后24 h尿微量白蛋白定量、糖化血红蛋白（HbAlc）、空腹血糖（FGC）、餐后2 h血糖（2 h BG）的变化；以及血清中 PI3K、Akt、p-Akt、bad、p-bad、Bcl-2，Bax、Caspase-3蛋白表达水平的变化。结果：1）2组治疗后24 h尿微量白蛋白定量、FPG、OGTT均较治疗前降低，与对照组比较，观察组降低的程度较为明显（P＜0.05）；2）2组治疗后血清中PI3K、p-Akt、p-bad、Bcl-2的蛋白表达均较治疗前升高， Bax、Caspase-3蛋白表达较治疗前降低，与对照组比较，观察组改变的幅度比较明显（P＜0.05）。结论：自拟益肾汤具有明显地降低糖尿病肾病蛋白尿作用，其机制可能与PI3 K／Akt信号转导通路有关。%Objective:To observe clinical effects of self-made kidney tonifying decoction on urinary albumin in patients with early Diabetic Nephropathy and to explore its partial mechanism.Methods:Sixty patients with type 2 diabetic nephropathy admitted at our hospital were randomly divided into control group (n=30)and observation group (n=30),and patients in both groups were given health education,diet instruction,internal medicine hypoglycemic therapy,80 mg/day of conventional oral valsartan.Those who also had hyperlipidemia were given extra treatment of simvastatin,20 mg/day.Observation group also applied the self-made kidney tonifying decoction based on the conventional treatment,200 ml water tisanes,1 agent daily in the morning and evening,for 1 2 continuous weeks.After a period of treatment,24h microal buminuria quantitative determination,glycosylated hemoglobin (HbAlc),fasting blood-glucose (FGC),2 h postprandial blood glucose (2 HBG)changes of patients of the two groups before and after treatment were recorded;and protein expression level changes of serum PI3K,Akt,p - Akt,bad,p - bad,Bcl 2,Bax and Caspase 3 were measured.Results:1 )The levels of 24h microalbuminuria quantitative determination,FPG,OGTT after treatment were reduced compared to those before treatment in both groups,and the reduction extent of observation group were more obvious compared with those of the control group (P<0.05);2)the levels of serum PI3K,p-Akt,p-bad,the Bcl-2 protein expression in the two groups after treatment were increased compared to those before treatment,and the Bax,Caspase 3 protein expression was re-duced,the change magnitude of observation group were more obvious compared with those of the control group (P<0.05 ).Con-clusion:Self-made kidney tonifying decoction has obvious effect to reduce proteinuria of diabetic nephropathy,and its mechanism may be associated with PI3K/Akt signal transduction pathway.