徐小君　康俏玲　王玉萍　周向峰　邵邻相

[關键词] 糖尿病肾病;黄葵胶囊;辛伐他汀;细胞因子;肾纤维化

[中图分类号] R587.2          [文献标识码] B          [文章编号] 1673-9701（2021）23-0101-05

Clinical effect of Huangkui capsule combined with simvastatin on diabetic nephropathy and its effect on cytokines and biochemical indexes

XU Xiaojun1   KANG Qiaoling1   WANG Yuping1   ZHOU Xiangfeng2   SHAO Linxiang1， 3

1.Department of Nephrology， Jinhua Guangfu Tumor Hospital， Jinhua   321000， China; 2.Department of Traditional Chinese Medicine， Medical College of Jinhua Polytechnic College， Jinhua   321017， China; 3.School of Chemistry and Life Sciences， Zhejiang Normal University， Jinhua   321004， China

[Abstract] Objective To investigate the clinical effect of huangkui capsule combined with simvastatin in the treatment of type 2 diabetes kidney disease （DKD） and its influence on cytokines. Methods A total of 116 patients with type 2 DKD admitted to Jinhua Guangfu Tumor Hospital and Medical College of Jinhua Polytechnic College from October 2017 to October 2019 were randomly divided into the observation group （58 cases） and the control group （58 cases）. Both groups were given routine treatment. The control group was given 40 mg simvastatin once a day at night. The observation group was administrated orally with 2.5 g huangkui capsule on the basis of the control group， 3 times per day. Both group were treated for 12 weeks as a course of treatment. Blood glucose， blood lipid metabolism， renal function， cytokines and renal fibrosis indexes were observed before and after treatment in the two groups. Results The levels of total cholesterol （TC）， triacylglycerol （TG）， glycosylated hemoglobin （HbA1c） and fasting blood glucose （FPG） were significantly lower in the observation group than those in the control group after treatment （P<0.01）. Tumor necrosis factor （TNF）， transformation growth factor 1 （TGF-1） and interleukin-6 （IL-6） were significantly lower in the observation group than those in the control group after treatment （P<0.01）. The level of matrix metalloproteinase-9 （MMP-9） was significantly higher in the observation group than that in the control group after treatment （P<0.01）， while the levels of blood urea nitrogen （BUN）， creatinine （SCr）， urinary microalbumin excretion rate （UAER） and inhibitor of metalloproteinase-1 （TIMP-1） were significantly lower in the observation group than those in the control group（P<0.01）. Conclusion Huangkui capsule combined with simvastatin can delay renal fibrosis， improve renal function and reduce urinary protein excretion rate of patients with type 2 DKD. Its mechanism may be related to effectively improving lipid metabolism disorder and regulating cytokine imbalance.

[Key words] Diabetes kidney disease; Huangkui capsule; Simvastatin; Cytokines; Renal fibrosis

糖尿病是临床上常见病、多发病，随着人口老龄化的加剧，随着糖尿病患病率的增加，糖尿病肾病（Diabetic kidney disease，DKD）发病率已高达25%～40%[1]。研究显示临床有20%～40%的糖尿病最终发展为终末期肾病（End stage renal disease  ESRD）[2]，DKD已经成为终末肾衰竭的首要病因，也是进行血液透析治疗的第二位原因[3]，严重威胁人类的健康。目前为止，对于该病发病机制仍然不够明确，其复杂的发病机制，可与糖、脂代谢紊乱、血管活性物质增加、非酶糖基化、炎性细胞因子的反应、微循环障碍等多个方面[4] 。有研究[5]发现，内皮功能障碍及肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）及转化生长因子-β1（TGF-β1）等多种炎性因子均与DKD 发病有关，而纠正生化指标及失衡的细胞因子与对 DKD的治疗有重要意义。临床常用降脂药-辛伐他汀为羟甲基戊二酰辅酶A还原酶抑制剂（hydroxy methylglutaryl coenzyme A reductase inhibitor，HMG-CoA），一方面可通过抗氧化、清除细胞因子等作用，另一方面通过调节脂质代谢紊乱改善肾脏结构和功能，具有延缓或减慢肾脏功能损伤甚或进展的临床效果，多数患者仍然呈缓慢进入ESRF。几项研究表明，在多种肾脏疾病包括DKD情况下，辛伐他汀对肾脏仍然有保护作用[6]，DKD的病机多与中医的湿热症相关，因此，清热利湿是治的疗该病的基本法则。黄葵胶囊具有有清利濕热及消肿的独特功效[7]。现代药理认为黄葵胶囊通过抗氧化、抗炎、改善微循环、抑制血小板聚集、修复电荷屏障以减少尿蛋白漏出，对肾功能有一定的保护作用。……