| 摘要: |
| 【】目的 ?探讨固本祛湿化瘀方联合非布司他治疗痛风性肾病(GN)的临床疗效,并分析该治疗方案对患者氧化应激的影响。方法 ? 前瞻性随机对照研究。选取2022年1月~2025年1月上海市光华中西医结合医院收治的GN患者106例,均为湿浊瘀阻型,据随机数字表法分为对照组(非布司他治疗,53例)与观察组(固本祛湿化瘀方联合非布司他,53例),疗程均为3个月。观察两组患者临床疗效、不良反应。对比两组治疗前后中医证候积分、肾功能指标[肾小球滤过率(eGFR)、肌酐(Scr)、尿素氮(BUN)、尿酸(UA)]、尿蛋白指标[尿β2微球蛋白(Uβ2-MG)、尿白蛋白肌酐比(UACR)、24 h尿蛋白定量(24 h UTP)]、氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH- Px)]。结果:治疗后,观察组主证(关节疼痛、肿胀,肌肤麻木不仁,屈伸不利)证候积分分别为(0.94±0.26)分、(1.03±0.28)分、(1.08±0.31)分、(0.92±0.25)分,均低于对照组的(1.86±0.50)分、(1.54±0.41)分、(1.63±0.43)分、(1.49±0.40)分(P＜0.05)。观察组治疗后血清Scr、BUN、UA、MDA水平分别为(92.49±11.13)μmol/L、(7.36±2.04)mmol/L、(362.18±18.17)μmol/L、(4.65±1.22)nmol/mL,均低于对照组的(103.54±10.02)μmol/L、(10.28±2.19)mmol/L、(405.79±20.41)μmol/L、(6.37±1.18)nmol/mL；eGFR、SOD、GSH- Px水平分别为(68.50±4.32)mL/min/1.73m2、(93.49±8.17)U/mL、(178.32±19.40)U/L,均高于对照组的(61.17±4.22)mL/min/1.73m2、(85.75±8.06)U/mL、(151.12±16.43)U/L(P＜0.05)。治疗后两组Uβ2-MG、UACR、24 h UTP水平均降低,且观察组均低于对照组[(1.21±0.31)vs(2.28±0.54)mg/L,(470.82±28.93)vs(628.51±30.19)mg/g,(1.01±0.29)vs (1.42±0.33)g/24h](P＜0.05)。观察组临床疗效总有效率为94.34%,高于对照组的81.13%(P＜0.05)。两组不良反应总发生率比较差异无统计学意义(15.09% vs 11.32%,P＞0.05)。结论:固本祛湿化瘀方联合非布司他治疗湿浊瘀阻型GN,在改善患者临床症状、肾功能和减轻氧化应激方面可能优于单用非布司他,且安全性良好。 |
| 关键词: 痛风性肾病 固本祛湿化瘀方 非布司他 疗效 氧化应激 肾功能 |
| DOI： |
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| 基金项目:“十四五”中医特色专科和中医急诊能力提升（第一批）项目（编号：ZYJZNLTS1-5） |
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| Curative effect of Guben Qushi Huayu Formula combined with febuxostat and its influences on oxidative stress in patients with gouty nephropathy |
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Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine
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| Abstract: |
| Objective To explore clinical curative effect of Guben Qushi Huayu Formula combined with febuxostat and analyze its influences on oxidative stress in patients with gouty nephropathy (GN). Methods In the prospective and randomized controlled study, 106 patients with GN of dampness-turbidity stasis obstruction type in Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine were enrolled between January 2022 and January 2025. According to random number table method, they were divided into control group (febuxostat, 53 cases) and observation group (Guben Qushi Huayu Formula combined with febuxostat, 53 cases). All patients were treated for 3 months. The clinical curative effect and adverse reactions in the two groups were observed. The scores of TCM syndromes, renal function indexes [estimated glomerular filtration rate (eGFR), serum creatinine (Scr), blood urea nitrogen (BUN), uric acid (UA)], urinary protein indexes [urinary β2-microglobulin (Uβ2-MG), urinary albumin creatinine ratio (UACR), 24h urine protein quantification (24hUTP)] and oxidative stress indexes [superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase (GSH-Px)] were compared between the two groups before and after treatment. Results: After treatment, scores of main syndromes (joint pain, swelling, skin numbness, difficulty in flexion and extension) in observation group were (0.94±0.26) points, (1.03±0.28) points, (1.08±0.31) points and (0.92±0.25) points, lower than those in control group [(1.86±0.50) points, (1.54±0.41) points, (1.63±0.43) points, (1.49±0.40) points; P<0.05]. After treatment, levels of serum Scr, BUN, UA and MDA in observation group were (92.49±11.13) μmol/L, (7.36±2.04) mmol/L, (362.18±18.17) μmol/L and (4.65±1.22) nmol/mL, lower than those in control group [(103.54±10.02) μmol/L, (10.28±2.19) mmol/L, (405.79±20.41) μmol/L, (6.37±1.18) nmol/mL], while levels of eGFR, SOD and GSH-Px were (68.50±4.32) mL/min/1.73m2, (93.49±8.17) U/mL and (178.32±19.40) U/L, higher than those in control group [(61.17±4.22) mL/min/1.73m2, (85.75±8.06) U/mL, (151.12±16.43) U/L; P<0.05]. After treatment, levels of Uβ2-MG, UACR and 24hUTP were decreased in both groups, which were lower in observation group than control group [(1.21±0.31) vs (2.28±0.54) mg/L, (470.82±28.93) vs (628.51±30.19) mg/g, (1.01±0.29) vs (1.42±0.33) g/24h; P<0.05]. The total response rate of clinical treatment in observation group was higher than that in control group (94.34% vs 81.13%, P<0.05). There was no significant difference in total incidence of adverse reactions between the two groups (15.09% vs 11.32%, P>0.05). Conclusion:? Compared with with febuxostat alone, Guben Qushi Huayu Formula combined with febuxostat may be better in terms of improving clinical syndromes and renal function, and alleviate oxidative stress in patients with GN of dampness-turbidity stasis obstruction type, which has good safety. |
| Key words: Gouty nephropathy Guben Qushi Huayu Formula Febuxostat Curative effect Oxidative stress Renal function |
