肾衰Ⅱ号方颗粒联合恩格列净对慢性肾脏病 2~3期患者蛋白尿和肾功能的影响
Effect of Renal Failure Ⅱ Prescription granule combined with empagliflozin on proteinuria and renal function in patients with CKD at stages 2⁃3
- 上海中医药大学学报 2023年37卷第5期 页码：61-66
- 作者机构：
1.上海中医药大学附属曙光医院肾病科，上海市中医临床重点实验室，肝肾疾病病证教育部重点实验室（上海 201203）
- 作者简介：
顾宇滢，女，在读硕士生，主要从事中医药防治慢性肾脏病的临床研究
王琛，主任医师，博士生导师；E-mail： chenwang42@163.com
- 基金信息：国家自然科学基金资助项目(81973770);上海市进一步加快中医药事业发展三年行动计划项目（ZY〔2018-2020〕-FWTX-7005）
DOI：10.16306/j.1008-861x.2023.05.008
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顾宇滢,钱祎玲,姚东升等.肾衰Ⅱ号方颗粒联合恩格列净对慢性肾脏病 2~3期患者蛋白尿和肾功能的影响[J].上海中医药大学学报,2023,37(05):61-66.
GU Yuying,QIAN Yiling,YAO Dongsheng,et al.Effect of Renal Failure Ⅱ Prescription granule combined with empagliflozin on proteinuria and renal function in patients with CKD at stages 2⁃3[J].Academic Journal of Shanghai University of Traditional Chinese Medicine,2023,37(05):61-66.
顾宇滢,钱祎玲,姚东升等.肾衰Ⅱ号方颗粒联合恩格列净对慢性肾脏病 2~3期患者蛋白尿和肾功能的影响[J].上海中医药大学学报,2023,37(05):61-66. DOI： 10.16306/j.1008-861x.2023.05.008.
GU Yuying,QIAN Yiling,YAO Dongsheng,et al.Effect of Renal Failure Ⅱ Prescription granule combined with empagliflozin on proteinuria and renal function in patients with CKD at stages 2⁃3[J].Academic Journal of Shanghai University of Traditional Chinese Medicine,2023,37(05):61-66. DOI： 10.16306/j.1008-861x.2023.05.008.
摘要
目的,2,观察肾衰Ⅱ号方颗粒联合恩格列净对慢性肾脏病（CKD）2~3期患者蛋白尿和肾功能的影响。,方法,2,纳入脾肾两虚、湿浊瘀阻证CKD 2~3期患者60例，随机分为对照组30例和治疗组30例。两组患者均予西医一体化治疗，在此基础上，对照组患者予安慰剂颗粒联合恩格列净治疗，治疗组患者予肾衰Ⅱ号方颗粒联合恩格列净治疗，疗程为3个月。治疗后，评价并比较两组患者的临床疗效及中医证候疗效；治疗前后，检测并比较两组患者的血肌酐（Scr）、血尿酸（UA）、血尿素氮（BUN）、肾小球滤过率估计值（eGFR）及24 h尿蛋白定量（24 h UPro）水平。,结果,2,①治疗后，对照组的临床疗效总有效率为56.67%，治疗组为86.67%，治疗组的疗效显著优于对照组（,P,<,0.05）。②治疗后，对照组的中医证候疗效总有效率为56.67%，治疗组为83.33%，治疗组的中医证候疗效显著优于对照组（,P,<,0.05）。③治疗后，两组患者的Scr、UA、24 h UPro水平较治疗前均明显降低（,P,<,0.05），eGFR水平明显升高（,P,<,0.05），治疗组患者的BUN水平亦明显降低（,P,<,0.05），且治疗组患者的Scr水平显著低于对照组（,P,<,0.05）、eGFR水平显著高于对照组（,P,<,0.05）。,结论,2,肾衰Ⅱ号方颗粒联合恩格列净可更好地改善脾肾两虚、湿浊瘀阻证CKD 2~3期患者的中医证候和肾功能，提高临床疗效，具有较好的肾脏保护作用。
Abstract
Objective： To observe the effects of Renal Failure Ⅱ Prescription combined with empagliflozin on proteinuria and renal function in patients with chronic kidney disease （CKD） at stages 2-3.,Methods,2,Sixty patients of CKD at stages 2-3 with spleen-kidney deficiency and dampness-turbidity-stasis syndrome were included， and randomly divided into the control group （30 cases） and treatment group （30 cases）. The patients in both groups were treated with conventional western medicine. Based on above， the patients in the control group were treated with placebo granule combined with empagliflozin， and the patients in the treatment group were treated with Renal Failure Ⅱ Prescription granule combined with empagliflozin. The treatment course was 3 months. After treatment， the clinical efficacy and the efficacy of traditional Chinese medical syndrome were evaluated and compared between the two groups. Before and after treatment， the levels of serum creatinine （Scr）， uric acid （UA）， blood urine nitrogen （BUN）， estimated glomerular filtration rate （eGFR） and 24 h urinary protein quantification （24 h UPro） in the two groups were detected and compared.,Results,2,①After treatment， the total clinical effective rate was 56.67% in the control group and 86.67% in the treatment group， and the curative effect of the treatment group was significantly better than that of the control group （,P,<,0.05）. ②After treatment， the total effective rate of traditional Chinese medical syndrome was 56.67% in the control group and 83.33% in the treatment group， and the curative effect of traditional Chinese medical syndrome in the treatment group was significantly better than that in the control group （,P,<,0.05）. ③After treatment， the levels of Scr， UA and 24 h UPro in the two groups were significantly decreased compared with those before treatment （,P,<,0.05）， the level of eGFR was significantly increased （,P,<,0.05）， the level of BUN in the treatment group was also significantly decreased （,P,<,0.05）， and the level of Scr in the treatment group was significantly lower than that in the control group （,P,<,0.05）， the level of eGFR was significantly higher than that in the control group （,P,<,0.05）.,Conclusion,2,Renal Failure Ⅱ Prescription granule combined with empagliflozin can better improve the traditional Chinese medical syndrome and renal function in patients of CKD at stages 2-3 with spleen-kidney deficiency and dampness-turbidity-stasis syndrome， and enhance the clinical efficacy， which has better renal protection effect.
关键词
慢性肾脏病肾衰Ⅱ号方恩格列净蛋白尿肾功能中西医结合
Keywords
chronic kidney diseaseRenal Failure Ⅱ Prescriptionempagliflozinproteinuriarenal functionintegrated traditional Chinese and western medicine
references
余桂珍. G3a/G3b分期能够更好的预测CKD3期IgA肾病患者的预后［D］.郑州： 郑州大学， 2017.
YU G Z. Dividing CKD Stage 3 into G3a and G3b Could Better Predict the Prognosis of IgA Nephropathy［D］. Zhengzhou： Zhengzhou University， 2017.
上海慢性肾脏病早发现及规范化诊治与示范项目专家组. 慢性肾脏病筛查诊断及防治指南［J］. 中国实用内科杂志， 2017， 37（1）： 28-34.
Expert Group on Early Detection， Diagnosis and Treatment System Construction of Chronic Kidney Disease in Shanghai. Guideline for screening， diagnosis， prevention and treatment of chronic kidney disease［J］. Chinese Journal of Practical Internal Medicine， 2017， 37（1）： 28-34.
孙蓓蓓. 中医辨证论治慢性肾脏病1-3期多中心前瞻性随机对照临床研究及机制探讨［D］. 上海： 上海中医药大学， 2019.
SUN B B. A Multicentered， Prospective， Randomized Controlled Clinical Study and Mechanism Study about TCM Syndrome Differentiation Treatment of 1-3 stages of Chronic Kidney Disease［D］. Shanghai： Shanghai University of Traditional Chinese Medicine， 2019.
杨婧， 邹赟， 吴琪琪， 等. 肾衰Ⅱ号方对慢性肾脏病3-4期轻中度蛋白尿患者影响的临床研究［J］. 上海中医药杂志， 2021， 55（2）： 71-75.
YANG J， ZOU Y， WU Q Q， et al. Clinical study on the effect of Shenshuai Ⅱ Decoction on chronic kidney diseases 3-4 stages patients with mild-to-moderate proteinuria［J］. Shanghai Journal of Traditional Chinese Medicine， 2021， 55（2）： 71-75.
徐亚赟， 何峥， 周圆， 等. 肾衰Ⅱ号方联合西药对原发性慢性肾脏病3、4期患者肾功能及肾血流灌注的影响［J］. 中医杂志， 2018， 59（17）： 1480-1484.
XU Y Y， HE Z， ZHOU Y， et al. Effects of the Meliorated Renal Failure Decoction Combined with Western Medicine on Renal Function and Renal Perfusion in Primary Chronic Kidney Disease 3 or 4 Stage Patients［J］. Journal of Traditional Chinese Medicine， 2018， 59（17）： 1480-1484.
周圆， 王琛， 邵命海， 等. 肾衰Ⅱ号方联合西医一体化治疗方案治疗CKD3-4期肾性贫血32例临床研究［J］. 江苏中医药， 2017， 49（2）： 39-41.
ZHOU Y， WANG C， SHAO M H， et al. Clinical Study of 32 Cases of Renal Anemia in CKD 3-4 Stage Treated by Shenshuai Ⅱ Decoction Combined with Western Medicine Integrated Treatment Scheme［J］. Jiangsu Journal of Traditional Chinese Medicine， 2017， 49（2）： 39-41.
WANNER C， LACHIN J M， INZUCCHI S E， et al. Empagliflozin and Clinical Outcomes in Patients With Type 2 Diabetes Mellitus， Established Cardiovascular Disease， and Chronic Kidney Disease［J］. Circulation， 2018， 137（2）： 119-129.
ZANNAD F， FERREIRA J P， POCOCK S J， et al. Cardiac and Kidney Benefits of Empagliflozin in Heart Failure Across the Spectrum of Kidney Function： Insights From EMPEROR-Reduced［J］. Circulation， 2021， 143（4）： 310-321.
FERNANDEZ-FERNANDEZ B， SARAFIDIS P， KANBAY M， et al. SGLT2 inhibitors for non-diabetic kidney disease： drugs to treat CKD that also improve glycaemia［J］. Clin Kidney J， 2020， 13（5）： 728-733.
National Kidney Foundation．K/DOQI clinical practice guidelines for chronic kidney disease： evaluation， classification， and stratification［J］. Am J Kidney Dis， 2002， 39（Suppl 1）： S1-S266.
郑筱萸. 中药新药临床研究指导原则（试行）［M］. 北京： 中国医药科技出版社， 2002： 163-168.
ZHENG X Y. Guiding Principles for Clinical Research of New Drugs of Traditional Chinese Medicine （trial implementation）［M］. Beijing： China Medical Science Press， 2002： 163-168.
李丹， 丁洁. 蛋白尿加速慢性肾脏病进展的分子机制［J］. 北京大学学报（医学版）， 2010， 42（5）： 608-611.
LI D， DING J. Molecular Mechanism of Proteinuria Caused Progression of Chronic Renal Diease［J］. Journal of Peking University （Health Sciences）， 2010， 42（5）： 608-611.
刘俊， 陈香美. 蛋白尿加速肾小管损伤的作用机制［J］. 中华肾病研究电子杂志， 2014， 3（2）： 38-42.
LIU J， CHEN X M. Mechanisms of renal tubular injury acceleration by proteinuria［J］. Chinese Journal of Kidney Disease Investigation （Electronic Edition）， 2014， 3（2）： 38-42.
The EMPA-KIDNEY Collaborative Group； HERRINGTON W G， STAPLIN N， WANNER C， et al. Empagliflozin in Patients with Chronic Kidney Disease［J］. N Engl J Med， 2023， 388（2）： 117-127.
SHARAF EL DIN U A A， SALEM M M， ABDULAZIM D O. Sodium-glucose cotransporter 2 inhibitors as the first universal treatment of chronic kidney disease［J］. Nefrología （Engl Ed）， 2022， 42（4）： 390-403.
ZANNAD F， FERREIRA J P， BUTLER J， et al. Effect of empagliflozin on circulating proteomics in heart failure： mechanistic insights into the EMPEROR programme［J］. Eur Heart J， 2022， 43（48）： 4991-5002.
COWIE M R， FISHER M. SGLT2 inhibitors： mechanisms of cardiovascular benefit beyond glycaemic control［J］. Nat Rev Cardiol， 2020， 17（12）： 761-772.
CHERNEY D， LUND S S， PERKINS B A， et al. The effect of sodium glucose cotransporter 2 inhibition with empagliflozin on microalbuminuria and macroalbuminuria in patients with type 2 diabetes［J］. Diabetologia， 2016， 59（9）： 1860-1870.
POLLOCK C， NEUEN B L. Sodium-Glucose Cotransporter 2 Inhibition： Rationale and Mechanisms for Kidney and Cardiovascular Protection in People With and Without Diabetes［J］. Adv Chronic Kidney Dis， 2021， 28（4）： 298-308.
SANIDAS E A， PAPADOPOULOS D P， HATZIAGELAKI E， et al. Sodium Glucose Cotransporter 2 （SGLT2） Inhibitors Across the Spectrum of Hypertension［J］. Am J Hypertens， 2020， 33（3）： 207-213.
HIDDO J L H， BRUCE A P， DAVID H F， et al. Sodium Glucose Cotransporter 2 Inhibitors in the Treatment of Diabetes Mellitus［J］. Circulation， 2016， 134： 752-772.
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