Clinical，endothelial，hemorheological and immune responses in patients with early diabetic nephropathy to the treatment with Compound Xiancao Granules（a Zhuang Medicine）

doi:10.12114/j.issn.1007-9572.2020.00.243

Abstract

Abstract: Background　At present，the application of Western medicine treatment alone is not very effective in patients with early diabetic nephropathy（DN），especially in microcirculation disturbance，abnormal endothelial function，hemorheology and immune function.Moreover，after such treatment，the disease is easily recur.Therefore，it is particularly important to find a more effective treatment for early DN.Objective　To explore the clinical，endothelial，hemorheological and immune responses in patients with early DN to the treatment with Compound Xiancao Granules，a Zhuang Medicine.Methods　From July 2018 to April 2019，60 patients with early DN were selected from Department of Nephrology，Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine and were randomly and equally divided into control group and observation group.Both groups were treated with routine treatment combined with intravenous administration of alprostadil injection，the observation group additionally orally administered Compound Xiancao Granules.The treatment course lasted for 4 weeks.Clinical response，renal function parameters〔24 h urinary albumin excretion rate（UAER），serum creatinine（Scr） and cystatin C（Cys C）〕，microcirculation and endothelial function parameters 〔thromboxane-B2（TX-B2），nitric oxide（NO），endothelin-1（ET-1），von Willebrand factor（vWF） and thrombomodulin（TM）〕，whole blood viscosity at high shear rates（ηbH），whole blood viscosity at medium shear rates（ηbM），whole blood viscosity at low shear rates（ηbL），plasma viscosity（ηp），fibrinogen（FIB），and erythrocyte aggregation index（AI），and immune parameters〔CD4+ helper T cells，CD8+ T suppressor cells，and CD4+/CD8+ 〕 were compared between the two groups before and after treatment.Results　The overall clinical response of the observation group was better than that of the control group（P< 0.05）.After treatment，the mean levels of UAER，Scr，Cys C and TX-B2 of the observation group were significantly lower than those of the control group（P<0.05）.The observation group showed higher NO but lower mean ET-1，vWF and TM compared with the control group（P<0.05）.Moreover，mean post-treatment ηbH，ηbM，ηbL，ηp，FIB and erythrocyte AI of the observation group were significantly lower than those of the control group（P<0.05）.Furthermore，the observation group showed higher mean CD4+ and CD4+/CD8+ but lower mean CD8+ after treatment（P<0.05）.Conclusion　Compound Xiancao Granules in combination with Western medicine achieves good response in treating deficiency of spleen and kidney，and damp-heat and blood stasis syndrome in early DN patients，mainly manifesting as alleviating the microcirculation disturbance，improving renal，endothelial，hemorheological and immune functions.

Key words: Diabetic nephropathy, Microcirculatory disturbance, Zhuang drugs, Compound Xiancao Granules, Endothelial function, Hemorheology, Immune function, Treatment outcome

摘要： 背景　目前单纯应用西药治疗早期糖尿病肾病（DN）特别是对微循环障碍及内皮功能、血液流变学、免疫功能异常的临床治疗效果不够理想，且容易复发，因此寻找一种更为有效的治疗早期DN的方法显得尤为重要。目的　探讨壮药复方仙草颗粒治疗早期DN的临床疗效及对患者内皮功能、血液流变学、免疫功能的影响。方法　选取2018年7月—2019年4月在广西中医药大学附属瑞康医院肾内科就诊的早期DN患者60例，采用随机数字表法分为对照组和观察组，各30例。在常规治疗基础上，对照组给予前列地尔注射液静脉注射治疗，观察组在对照组的基础上口服壮药复方仙草颗粒治疗，两组患者疗程均为4周。比较两组患者临床疗效及治疗前后24 h尿微量白蛋白排泄率（UAER）、血肌酐（Scr）、胱抑素C（Cys C）、血栓素-B2（TX-B2）、一氧化氮（NO）、内皮素-1（ET-1）、血管性血友病因子（vWF）、凝血酶调节蛋白（TM）、全血高切黏度（ηbH）、全血中切黏度（ηbM）、全血低切黏度（ηbL）、血浆黏度（ηp）、纤维蛋白原（FIB）、红细胞聚集指数（AI）、辅助T淋巴细胞（CD4+）、抑制T淋巴细胞（CD8+）、辅助T淋巴细胞/抑制T淋巴细胞（CD4+/CD8+）。结果　观察组患者临床疗效优于对照组（P<0.05）；治疗后观察组患者UAER、Scr、Cys C、TX-B2低于对照组（P<0.05）。治疗后观察组患者NO高于对照组，ET-1、vWF、TM低于对照组（P<0.05）。治疗后观察组患者ηbH、ηbM、ηbL、ηp、FIB、红细胞AI低于对照组（P<0.05）。治疗后观察组患者CD4+、CD4+/CD8+高于对照组，CD8+低于对照组（P<0.05）。结论　壮药复方仙草颗粒治疗早期DN脾肾亏虚、湿热瘀血证的临床疗效确切，能够减轻早期DN患者的微循环障碍，改善早期DN患者的肾功能、内皮功能、血液流变学及免疫功能。

关键词: 糖尿病肾病, 微循环障碍, 壮药, 复方仙草颗粒, 内皮功能, 血液流变学, 免疫功能, 治疗结果

HUANG Yalan1,HUANG Guodong2*,CAI Linkun1, et al. Clinical，endothelial，hemorheological and immune responses in patients with early diabetic nephropathy to the treatment with Compound Xiancao Granules（a Zhuang Medicine）[J]. Chinese General Practice, 2020, 23(24): 3086-3093. DOI: 10.12114/j.issn.1007-9572.2020.00.243.
黄雅兰1,黄国东2*,蔡林坤1等. 壮药复方仙草颗粒治疗早期糖尿病肾病的临床疗效及对患者内皮功能、血液流变学、免疫功能的影响[J]. 中国全科医学, 2020, 23(24): 3086-3093. DOI: 10.12114/j.issn.1007-9572.2020.00.243.

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