詹昊冰 林红坤 詹锐文

摘要目的：觀察“早肾方”对糖尿病肾病的临床疗效并探究该汤方部分作用机制。方法：选取2016年1月至2017年1月湛江市第一中医医院收治的糖尿病肾病患者90例，随机分成对照组和观察组，每组45例。2组患者均接受内科常规治疗，观察组在常规治疗基础上加用“早肾方”，均持续治疗8周，疗程结束后比较2组患者中医证候积分、血糖、肾功能、肾段动脉收缩期血流峰值速度（Vmax）、舒张期血流峰值速度（Vmin）、阻力指数（RI）、以及血清抗衰老蛋白水平的变化。结果：治疗后2组患者中医证候积分均有所下降，其中观察组下降的趋势更为明显（P<005）。治疗后2组血肌酐（Scr）、尿素氮（BUN）、24 h蛋白尿、尿微量白蛋白（MA）、基化血红蛋白（HbAlc）、餐后2 h血糖（FPG）均较治疗前有所下降，观察组下降的幅度较对照组明显（P<005）。2组治疗后Vmax、Vmin明显高于治疗前，RI均较治疗前降低，观察组与对照组比较，差异有统计学意义（P<005）。与对照组比较，“早肾方”更可明显上调血清抗衰老蛋白水平，差异均有统计学意义（P<005）。结论：“早肾方”可有效治疗糖尿病肾病，其作用机制可能与上调血清抗衰老蛋白有关。

关键词2型糖尿病；糖尿病肾病；早肾方；肾功能；血糖水平；血流动力学；血清抗衰老蛋白；作用机制

Clinical Observation on Professor Zhan Ruiwen′s Experience Prescription “Zaoshen Decoction” in the Treatment of Diabetic Nephropathy and Part of the Mechanism Discussion

Zhan Haobing， Lin Hongkun， Zhan Ruiwen

（Endocrinology Department of Zhanjiang First Hospital of Traditional Chinese Medicine， Guangdong 524042， China）

AbstractObjective：To observe the clinical curative effects of the Zaoshen decoction on diabetic nephropathy and to explore the mechanism of action.Methods：A total of 90 cases of diabetic nephropathy in our hospital during January 2016 to January 2017 included into the research were randomly divided into the control group and the observation group， with 45 cases in each group.Both groups were treated with conventional medical treatment， and the observation group was added “Zaoshen decoction” on the basis of conventional treatment.The treatment continued for 8 weeks.After treatment， the changes of TCM syndrome integrals， blood glucose， renal function， renal artery peak systolic velocity （Vmax）， peak diastolic velocity （Vmin）， resistance index （RI）， and serum antiaging protein of two groups were compared.Results：1） TCM syndrome integrals of the two groups decreased after treatment， and the downward trend of the observation group was more significant （P<005）.2） Serum creatinine （Scr）， urea nitrogen （BUN）， 24 h proteinuria， urinary microalbuminuria （MA）， hemoglobin （HbAlc）， postprandial 2 hours blood glucose （FPG） were decreased in the two groups after treatment.The decrease of the observation group were more significantly than the control group （P<005）.3） After treatment， Vmax and Vmin of the two groups were significantly higher than before the treatment， and RI was reduced compared before the treatment.There was statistically significant difference between the observation group and control group （P<005）.4） Compared with the control group， the “Zaoshen decoction” increased the serum antiaging protein more significantly， and the differences were with statistical significance （P<005）.Conclusion：“Zaoshen decoction” can effectively treat diabetic nephropathy， whose mechanism may be related to the upregulation of serum antiaging protein.

Key WordsType 2 diabetes； Diabetic nephropathy； Zaoshen decoction； Renal function； Blood glucose level； Hemodynamics； Serum antiaging protein； Mechanism

中图分类号：R2895；R5872文獻标识码：Adoi：10.3969/j.issn.1673-7202.2018.07.017

詹锐文教授是“湛江市名中医”，长期致力于糖尿病及其并发症的治疗研究，詹老认为糖尿病肾病起病缓慢，随着正气损耗，病证多以虚为主，脏腑多由脾病及于肾，脾肾两脏受损，脾虚失于统摄，精微外泄，肾脏封藏固摄失常，终致精微物质漏泄、津液代谢紊乱、水湿内聚而出现蛋白尿、消渴、水肿等临床症状，因此益气健脾、滋肾养阴是治疗本病的主要原则[1]。詹老临床数十年总结出“早肾方”用于治疗糖尿病肾病取得了理想疗效，临床不乏报道，但其作用机制尚未明了。Klotho是目前分子生物学领域研究较为热门的调控衰老的基因，广泛参与机体氧化应激环节，并可通过抑制炎性反应效应发挥保护肾功能的作用。……