Effects of Shenmai Dihuang Decoction Combined with Valsartan on Oxidative Stress, Vascular Endothelial Function and Serum miR-133b, miR-135b in Patients with Diabetic Nephropathy
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摘要:
目的 探究参麦地黄汤联合缬沙坦对糖尿病肾病患者氧化应激、血管内皮功能及血清miR-133b、miR-135b的影响。 方法 选取2017年1月至2020年10月于江阴市中医院门诊就诊的90例糖尿病肾病患者为研究对象, 依据随机数字表法将其分为对照组、观察组各45例。对照组采用缬沙坦分散片口服治疗, 观察组在对照组治疗基础上加服参麦地黄汤。2组疗程均为3个月, 治疗前后评估2组患者中医证候积分变化, 检测2组患者空腹血糖(FPG)和血清肌酐(SCr)、尿素氮(BUN)、尿微量白蛋白/肌酐比值(UACR)、氧化应激指标[超氧化物歧化酶(SOD)及丙二醛(MDA)]、血管内皮功能指标[可溶性细胞间黏附分子-1(sICAM-1)及内皮素-1(ET-1)]及miR-133b、miR-135b变化。 结果 治疗后, 2组患者中医症候积分、FPG、SCr、BUN、UACR及MDA、sICAM-1、ET-1、miR-133b、miR-135b表达水平均显著下降, SOD活性明显升高(P<0.01), 观察组优于对照组(P<0.01)。观察组治疗总有效率高于对照组(P<0.01)。 结论 参麦地黄汤联合缬沙坦可有效改善糖尿病肾病临床症状，可能与其调控机体氧化应激、血管内皮功能、血清miR-133b、miR-135b水平有关。 Abstract:OBJECTIVE To explore the effect of Shenmai Dihuang Decoction combined with valsartan on oxidative stress, vascular endothelial function and serum miR-133b, miR-135b in patients with diabetic nephropathy. METHODS A total of 90 patients with diabetic nephropathy who were treated in the outpatient department of Jiangyin Hospital of Traditional Chinese Medicine from January 2017 to October 2020 were selected as the research objects, and they were divided into the control group and the observation group, with 45 cases in each group according to the random number table method. The control group was treated with valsartan dispersible tablets orally, and the observation group was additionally given Shenmai Dihuang Decoction on the basis of the treatment of the control group. The course of treatment for both groups was 3 months. Before and after treatment, TCM syndrome scores were evaluated; fasting blood glucose (FPG), serum creatinine (SCr), blood urea nitrogen (BUN), urine albumin/creatinine ratio (UACR), the changes of oxidative stress indexes [superoxide dismutase (SOD) and malondialdehyde (MDA)], vascular endothelial function indicators [soluble intercellular adhesion molecule-1 (sICAM-1) and endothelin-1 (ET-1)] and miR-133b, miR-135b were assessed. RESULTS After treatment, the TCM syndrome scores, FPG, SCr, BUN, UACR, and the expression levels of MDA, sICAM-1, ET-1, miR-133b, and miR-135b were significantly decreased, and the SOD activity was significantly increased in the two groups (P<0.01). The observation group showed better therapeutic efficacy than the control group (P<0.01), with the total effective rate higher than the control group (P<0.01). CONCLUSION Shenmai Dihuang Decoction combined with valsartan can effectively improve the clinical symptoms of diabetic nephropathy, which may be related to the regulation of oxidative stress, vascular endothelial function, and serum miR-133b and miR-135b levels. -
Key words:
- Shenmai Dihuang Decoction /
- valsartan /
- diabetic nephropathy /
- oxidative stress /
- vascular endothelial function /
- miR-133b /
- miR-135b
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表 1 2组患者一般资料比较(x±s, n=45)
Table 1. Comparison of general information of patients in the two groups (x±s, n=45)
组别 性别 年龄/岁 糖尿病病程/月 糖尿病肾病病程/月 男 女 观察组 23 22 57.24±5.58 13.13±2.17 6.29±2.33 对照组 25 20 56.67±5.96 13.20±2.23 6.44±2.02 
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表 2 2组患者临床疗效比较(n=45)
Table 2. Comparison of clinical curative effects of the two groups of patients (n=45)
组别 显效 有效 无效 总有效/% 观察组 20 24 1 97.78## 对照组 12 25 8 82.22 注: 与对照组比较, χ2=6.049, ##P<0.01。
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表 3 2组患者治疗前后中医证候积分比较(x±s, n=45)
Table 3. Comparison of TCM syndrome scores before and after treatment in the two groups (x±s, n=45)
组别 时间 水肿 尿浊 神疲乏力 咽干口燥 五心烦热 观察组 治疗前 4.01±0.21 4.13±0.56 4.01±0.52 4.21±0.91 3.85±0.51 治疗后 2.01±0.34**## 2.11±0.51**## 2.21±0.65**## 2.01±0.57**## 1.65±0.52**## 对照组 治疗前 4.07±0.20 4.15±0.57 4.05±0.58 4.15±0.99 3.89±0.59 治疗后 3.14±0.39** 3.21±0.54** 3.12±0.60** 3.14±0.65** 2.57±0.50** 组别 时间 潮热盗汗 纳差 大便干燥 形瘦多食 总积分 观察组 治疗前 2.13±0.51 2.20±0.50 2.14±0.49 2.06±0.51 28.74±3.54 治疗后 1.01±0.52**## 1.11±0.51**## 1.12±0.50**## 1.01±0.43**## 14.24±2.32**## 对照组 治疗前 2.14±0.50 2.16±0.47 2.18±0.45 2.20±0.43 28.99±3.23 治疗后 1.52±0.50** 1.65±0.43** 1.67±0.40** 1.59±0.51** 21.61±2.51** 注: 组内比较, **P<0.01;组间比较, ##P<0.01。
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表 4 2组患者治疗前后血糖及肾功能比较(x±s, n=45)
Table 4. Comparison of blood glucose and renal function before and after treatment in the two groups (x±s, n=45)
组别 时间 FPG/(nmol·L-1) SCr/(μmol·L-1) BUN/(mmol·L-1) UACR/(mg·g-1) 观察组 治疗前 9.41±1.01 105.61±15.45 8.46±1.71 69.44±6.12 治疗后 6.34±0.45**## 72.41±8.12**## 5.62±1.34**## 35.14±3.70**## 对照组 治疗前 9.20±1.12 105.42±15.99 8.51±1.70 68.44±6.87 治疗后 7.45±0.51** 87.12±9.64** 6.97±1.53** 43.40±5.21** 注: 组内比较, **P<0.01;组间比较, ##P<0.01。
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表 5 2组患者治疗前后氧化应激指标比较(x±s，U·mL-1, n=45)
Table 5. Comparison of oxidative stress indicators before and after treatment in the two groups (x±s, U·mL-1, n=45)
组别 时间 SOD MDA 观察组 治疗前 172.45±16.73 62.45±5.71 治疗后 220.41±20.56**## 51.21±4.016**## 对照组 治疗前 173.44±15.98 61.72±5.68 治疗后 202.46±16.45** 55.62±4.12** 注: 组内比较, **P<0.01;组间比较, ##P<0.01。
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表 6 2组患者治疗前后血管内皮功能指标比较(x±s, n=45)
Table 6. Comparison of vascular endothelial function indicators before and after treatment in the two groups(x±s, n=45)
组别 时间 sICAM-1/(μg·L-1) ET-1/(ng·L-1) 观察组 治疗前 525.45±52.45 261.44±32.16 治疗后 450.13±20.71**## 160.45±10.87**## 对照组 治疗前 529.62±54.15 259.74±30.61 治疗后 487.62±23.12** 191.62±12.14** 注: 组内比较, **P<0.01;组间比较, ##P<0.01。
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表 7 2组患者治疗前后血清miR-133b、miR-135b水平比较(x±s, n=45)
Table 7. Comparison of serum miR-133b and miR-135b levels before and after treatment in the two groups(x±s, n=45)
组别 时间 miR-133b miR-135b 观察组 治疗前 5.01±1.24 3.85±0.79 治疗后 2.01±0.57**## 1.01±0.21**## 对照组 治疗前 5.09±1.27 3.80±0.82 治疗后 2.65±0.60** 1.31±0.24** 注: 组内比较, **P<0.01;组间比较, ##P<0.01。
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