| 摘要: |
| ［摘要］ 目的 观察加味消痛安肾方辅助治疗痛风性肾病的效果，并探讨其相关治疗机制。方法 招募2021年4月至2024年3月沧州中西医结合医院收治的痛风性肾病患者106例，慢性肾脏病分期为3～4期。采用随机数字表法将其分为观察组和对照组，各53例。对照组采用西医常规治疗，观察组辅以加味消痛安肾方治疗，疗程均为3周。比较两组临床疗效，以及治疗前后中医证候积分、肾功能指标［尿素氮、血肌酐、24 h尿蛋白定量（24 h UTP）、β2-微球蛋白（β2-MG）］、血尿酸、血沉和磷脂酰肌醇3-激酶（PI3K）/苏氨酸激酶（AKT）/核因子-κB（NF-κB）信号通路相关蛋白水平。记录患者治疗期间不良反应发生情况。结果 观察组临床总有效率显著高于对照组（94.34% vs 77.36%， χ2=6.290，P=0.012）。两组治疗后关节红肿、关节灼热、关节疼痛、颜面或下肢浮肿以及四肢沉重的中医证候积分均较治疗前降低，且观察组中医证候积分较对照组更低，差异有统计学意义（P<0.05）。两组治疗后尿素氮、血肌酐、24 h UTP、β2-MG、血尿酸以及血沉水平较治疗前降低，且观察组水平较对照组更低，差异有统计学意义（P<0.05）。两组治疗后磷酸化PI3K（p-PI3K）、磷酸化AKT（p-AKT）、磷酸化NF-κB（p-NF-κB）蛋白水平均较治疗前降低，且观察组水平较对照组更低，差异有统计学意义（P<0.05）。观察组治疗期间发生腹泻1例，对照组发生恶心、便秘各2例，两组不良反应总发生率比较差异无统计学意义（P>0.05）。结论 加味消痛安肾方结合西医治疗痛风性肾病的效果确切且安全性好，其可能通过抑制PI3K/AKT/NF-κB信号通路发挥治疗作用。 |
| 关键词: 痛风性肾病 加味消痛安肾方 肾功能 磷脂酰肌醇3-激酶 苏氨酸激酶 核因子-κB |
| DOI：10.3969/j.issn.1674-3806.2025.11.13 |
| 分类号:R 227.5 |
| 基金项目:河北省中医药管理局项目（编号：2022265） |
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| Observation on therapeutic effect of modified Xiaotong Anshen prescription in adjuvant treatment of gouty nephropathy and exploration on the related mechanisms |
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LI Li, MA Jinrong, ZHAO Li, PAN Hongmei, ZHANG Linyan, YAO Shuoshuo, LI Yuelin
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Department of Nephrology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cangzhou 061001, China
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| Abstract: |
| ［Abstract］ Objective To observe the therapeutic effect of modified Xiaotong Anshen prescription in adjuvant treatment of gouty nephropathy(GN) and to explore the related mechanisms. Methods A total of 106 patients with GN who were admitted to Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from April 2021 to March 2024 were recruited. The stages of chronic kidney disease of these patients were stages 3 to 4. The GN patients were divided into observation group and control group by using random number table method, with 53 patients in each group. The control group was treated with conventional Western medicine, while the observation group was treated with conventional Western medicine plus modified Xiaotong Anshen prescription. The treatment course for both groups was 3 weeks. The clinical efficacy, as well as the scores of traditional Chinese medicine(TCM) symptoms, renal function indicators［blood urea nitrogen(BUN), serum creatinine(Scr), 24-hour urine total protein(24 h UTP), β2-microglobulin(β2-MG)］, serum uric acid, erythrocyte sedimentation rate(ESR), and the levels of proteins related to the phosphoinositide 3-kinase(PI3K)/threonine kinase(AKT)/nuclear factor-κB(NF-κB) signaling pathway were compared between the two groups before and after treatment. The occurrence of adverse reactions during the patients′ treatment period was recorded. Results The total clinical effective rate of the observation group was significantly higher than that of the control group(94.34% vs 77.36%, χ2=6.290, P=0.012). After treatment, the TCM syndrome scores of joint skin redness and swelling, joint burning, joint pain, facial or lower limb edema, and heavy limbs in both groups were lower than those before treatment, and the TCM syndrome scores of the observation group were lower than those of the control group after treatment, with statistically significant differences(P<0.05). After treatment, the levels of BUN, Scr, 24 h UTP, β2-MG, serum uric acid and ESR in both groups were lower than those before treatment, and the levels in the observation group were lower than those in the control group after treatment, with statistically significant differences(P<0.05). After treatment, the levels of phosphorylated PI3K(p-PI3K), phosphorylated AKT(p-AKT), and phosphorylated NF-κB(p-NF-κB) proteins in both groups were lower than those before treatment, and the levels in the observation group were lower than those in the control group after treatment, with statistically significant differences(P<0.05). During the treatment period, 1 case of diarrhea occurred in the observation group, and 2 cases of nausea and 2 cases of constipation occurred in the control group. There was no statistically significant difference in the total incidence of adverse reactions between the two groups(P>0.05). Conclusion The modified Xiaotong Anshen prescription combined with Western medicine has definite effect and good safety in treatment of GN. It may play a therapeutic role through the PI3K/AKT/NF-κB signaling pathway. |
| Key words: Gouty nephropathy(GN) Modified Xiaotong Anshen prescription Renal function Phosphoinositide 3-kinase(PI3K) Threonine kinase(AKT) Nuclear factor-κB(NF-κB) |
