1、世界中西医结合杂志 2023 年第 18 卷第 1 期World Journal of Integrated Traditional and Western Medicine2023，Vol.18，No.1临床研究DOI:10 13935/j cnki sjzx 230119基金项目:河南省中医药科学研究专项课题(2018ZY3060)作者单位:河南省周口市中医院糖尿病肾病科，河南 周口 466000通信作者:朱剑南，Email:1174973261 qq com健脾益肾方加减对早中期糖尿病肾病患者疗效及血清转化生长因子 1、胰岛素样生长因子 1、血管内皮生长因子的影响张英杰王秉新朱剑南闫爱华
2、刘秋艳【摘要】目的探讨健脾益肾方加减对早中期糖尿病肾病(Diabetic nephropathy，DN)患者疗效及血清转化生长因子 1(Transforming growth factor 1，TGF 1)、胰岛素样生长因子 1(Insulin like growth factor 1，IGF1)、血管内皮生长因子(Vascular endothelial growth factor，VEGF)的影响。方法选取2019 年6 月2021 年6 月河南省周口市中医院收治的 DN 患者 90 例，采用随机数字表法分为对照组和治疗组，每组各 45 例。对照组采用常规西医治疗，治疗组在对照组的基础上采
3、用健脾益肾方加减治疗。治疗 3 个月后，观察比较两组患者临床疗效、不良反应发生率，治疗前后血清 TGF 1、IGF 1、VEGF 水平，中医证候积分、肾功能指标尿白蛋白排泄率(Urinary albumin excretion rates，UAE)、血尿素氮(Blood urea nitrogen，BUN)、血清肌酐(Serum creatinine，SCr)、内生肌酐清除率(Endogenous creatinine clearance，CCr)水平。结果治疗后治疗组临床总有效率 84 44%(38/45)与对照组 64 44%(29/45)比较，差异有统计学意义(P 0 05)。治疗后两组
4、患者中医证候积分均较治疗前降低，差异有统计学意义(P 0 05);且治疗组中医证候积分较对照组降低，差异有统计学意义(P 0 05)。治疗后两组患者 UAE、BUN 水平均较治疗前降低，SCr、CCr 水平均较治疗前升高，差异有统计学意义(P 0 05);且治疗组UAE、BUN 水平均较对照组降低，SCr、CCr 水平均较对照组升高，差异有统计学意义(P 0 05)。治疗后两组患者血清 TGF 1、IGF 1、VEGF 水平均较治疗前降低，差异有统计学意义(P 0 05);且治疗组血清 TGF 1、IGF 1、VEGF 水平均较对照组降低，差异有统计学意义(P 0 05)。治疗期间，两组患者不
5、良反应发生率比较，差异无统计学意义(P 0 05)。结论健脾益肾方加减对 DN 的治疗具有积极作用，能明显改善患者临床症状，控制 DN 患者血糖，保护肾功能，降低血清 TGF 1、IGF 1、VEGF 水平。【关键词】健脾益肾方;糖尿病肾病;转化生长因子 1;胰岛素样生长因子 1;血管内皮生长因子【中图分类号】587 2【文献标识码】AEffect of Modified Jianpi Yishen Prescription on Early and Middle stage DiabeticNephropathy and Its Influence on Serum TGF 1，IGF 1，
6、and VEGFZHANG Ying jie，WANG Bing xin，ZHU Jian nan，YAN Ai hua，LIU Qiu yan(Department of Diabetic Nephrology，Zhoukou Hospital of Traditional Chinese Medicine，Zhoukou Henan 466000)【Abstract】ObjectiveTo investigate the effect of the modified Jianpi Yishen Prescription on early and middle stage diabetic
7、nephropathy(DN)and its influence on serum transforming growth factor 1(TGF 1)，insulin like growthfactor 1(IGF 1)，and vascular endothelial growth factor(VEGF)MethodsNinety DN patients admitted to theZhoukou Hospital of Traditional Chinese Medicine(TCM)from June 2019 to June 2021 were included and div
8、ided into acontrol group and an observation group by the random number table，with 45 cases in each group The control group wastreated with conventional western medicine，and the observation group was treated with the modified Jianpi Yishen Prescrip-tion based on the treatment of the control group Aft
9、er three months of treatment，the clinical efficacy and incidence of ad-verse reactions of the two groups were observed and compared The levels of serum TGF 1，IGF 1，and VEGF，the TCMsyndrome scores，and renal function indexes urine albumin excretion rate(UAE)，blood urea nitrogen(BUN)，serum cre-atinine(
10、SCr)，and endogenous creatinine clearance rate(CCr)before and after treatment of the two groups were com-pared esultsThe total effective rate of the observation group 84 44%(38/45)was significantly higher than that ofthe control group 64 44%(29/45)(P 0 05)After treatment，the TCM syndrome scores in th
11、e two groups were signif-811世界中西医结合杂志 2023 年第 18 卷第 1 期World Journal of Integrated Traditional and Western Medicine2023，Vol.18，No.1icantly lower than those before treatment(P 0 05)，and the TCM syndrome score in the observation group was lower thanthat in the control group(P 0 05)After treatment，the
12、levels of UAE and BUN in the two groups were lower and thelevels of SCr and CCr were higher as compared with the control group(P 0 05)As compared with the control group，thelevels of UAE and BUN in the observation group were decreased，and the levels of SCr and CCr were increased(P 0 05)After treatmen
13、t，the levels of serum TGF 1，IGF 1，and VEGF were lower than those before treatment(P 0 05)As compared with the control group，the levels of serum TGF 1，IGF 1，and VEGF were decreased(P 0 05)The comparison of the incidence of adverse reactions in the two groups had no statistical significance(P 0 05)Con
14、clu-sionThe modified Jianpi Yishen Prescription has a positive effect on DN，which can significantly improve the clinicalsyndromes of patients with DN，control blood glucose，protect renal function，and reduce the levels of serum TGF 1，IGF1，and VEGF【Keywords】Jianpi Yishen Prescription;Diabetic Nephropat
15、hy;Transformation Growth Factor 1;Insulin likeGrowth Factor 1;Vascular Endothelial Growth Factor随着人们饮食及作息习惯的改变，糖尿病发病率呈逐年上升的趋势，作为糖尿病最常见微血管并发症，糖尿病肾病(Diabetic nephropathy，DN)可引起患者蛋白尿、水肿等1，部分症状严重者可出现肾衰竭，对患者生命健康构成威胁。可见早中期及时有效的治疗对 DN 患者而言极其重要。目前关于DN 的发病机制尚未有明确定论，有研究指出2，3，DN 患者机体长期维持高葡萄糖状态，会改变肾脏微血管形态及功能，通过
16、血清转化生长因子 1(Transforming growth factor 1，TGF 1)、胰岛素样生长因子 1(Insulin like growth factor 1，IGF 1)、血管内皮生长因子(Vascular endothelial growth factor，VEGF)水平检测，能反映肾损伤程度。西药在治疗糖尿病肾病方面缺乏有效的治疗手段，中医学在糖尿病肾病治疗方面具有一定优势，中药因其大复方多靶点效应，在多种疾病治疗中发挥重要作用4。基于此，本研究给予 DN 患者健脾益肾方加减治疗，旨在探讨其对患者血清 TGF 1、IGF 1、VEGF 的影响。1资料与方法1 1临床资料1 1 1一般资料选取 2019 年 6 月2021 年 6 月期间我院收治的 DN 患者 90 例，采用随机数字表法分为对照组和治疗组，每组各 45 例。对照组患者年龄 45 68 岁，平均(62 8 2 4)岁;男女比例为 24 21;病程 6 个月 7 年，平均(5 3 1 5)年;DN 分期:早期 27 例，中期18 例。治疗组患者年龄 44 67 岁，平均(624 2 2)岁;男女比例为 2
