Effect of Dahuang Xiezhuo Prescription on Renal Tubular Function in Patients with IgA Nephropathy Complicated with Hyperuricemia

ZHANG Qian; YANG Fengwen; SHI Meng; LIU Jinchang; WANG Gang; REN Meifang; ZHAO Meijiao; MAO Jingyu; TAN Jinchuan

doi:10.13422/j.cnki.syfjx.20221090

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Effect of Dahuang Xiezhuo Prescription on Renal Tubular Function in Patients with IgA Nephropathy Complicated with Hyperuricemia

更新时间：2023-05-16

- Effect of Dahuang Xiezhuo Prescription on Renal Tubular Function in Patients with IgA Nephropathy Complicated with Hyperuricemia
- Chinese Journal of Experimental Traditional Medical Formulae Vol. 29, Issue 12, Pages: 135-141(2023)
- 作者机构：
  
  1.河北省中医院，石家庄 050011
  2.易县中医医院，河北保定 074200
  3.雄县中医医院，河北保定 071800
  4.河北中医学院，石家庄050200
- 作者简介：
- 基金信息：
- DOI：10.13422/j.cnki.syfjx.20221090
  CLC： R242;R2-031;R442.2;R692;
- Published：20 June 2023，
  
  Published Online：23 April 2023，
  
  Received：08 October 2022，
- 稿件说明：
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张倩,杨凤文,石蒙等.大黄泄浊方对IgA肾病合并高尿酸血症患者肾小管功能的影响[J].中国实验方剂学杂志,2023,29(12):135-141.

ZHANG Qian,YANG Fengwen,SHI Meng,et al.Effect of Dahuang Xiezhuo Prescription on Renal Tubular Function in Patients with IgA Nephropathy Complicated with Hyperuricemia[J].Chinese Journal of Experimental Traditional Medical Formulae,2023,29(12):135-141.
张倩,杨凤文,石蒙等.大黄泄浊方对IgA肾病合并高尿酸血症患者肾小管功能的影响[J].中国实验方剂学杂志,2023,29(12):135-141. DOI： 10.13422/j.cnki.syfjx.20221090.

ZHANG Qian,YANG Fengwen,SHI Meng,et al.Effect of Dahuang Xiezhuo Prescription on Renal Tubular Function in Patients with IgA Nephropathy Complicated with Hyperuricemia[J].Chinese Journal of Experimental Traditional Medical Formulae,2023,29(12):135-141. DOI： 10.13422/j.cnki.syfjx.20221090.

摘要

目的

观察大黄泄浊方对慢性肾脏病（CKD）1~2期免疫球蛋白A（IgA）肾病合并高尿酸血症（HUA）患者的临床症状、血尿酸及肾小管功能的影响。

方法

将中医辨证为脾肾两虚浊瘀互结证的60例CKD1~2期IgA肾病合并HUA患者随机分为观察组和对照组各30例。对照组予基础治疗，氯沙坦钾片50~100 mg/次，1次/d及碳酸氢钠片0.5 g/次，3次/d口服，配合低盐低脂饮食、低嘌呤饮食；观察组在基础治疗基础上予以大黄泄浊方，每日1剂，分早晚2次温水冲服，2组患者均治疗2个月。分别于治疗前及治疗后2个月记录观察组和对照组患者的中医证候总积分、血压和24 h尿蛋白定量（UTP）、尿素氮（BUN）、血肌酐（SCr）［按慢性肾病流行病学合作研究（CKD-EPI）公式计算肾小球滤过率（eGFR）］、血尿酸（SUA）、肾小管功能指标［尿

-微球蛋白（

-MG）、尿

-微球蛋白（

-MG）、尿液中的肾损伤分子-1（KIM-1）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）］，并于治疗2个月评定2组患者的临床疗效。

结果

治疗2个月后，观察组总有效率为81.48%（22/27），对照组的总有效率为50.00%（14/28），观察组明显高于对照组，差异具有统计学意义（

=6.661，

0.05）。与本组治疗前比较，观察组和对照组患者的中医证候总积分、UTP、SUA均明显降低（

0.05）；与对照组治疗后比较，观察组降低更明显（

0.05）。与本组治疗前比较，观察组和对照组患者的血压均明显降低（

0.05）；与对照组治疗后比较，治疗后2组患者血压差异无统计学意义。与本组治疗前比较，2组患者尿

-MG、

-MG、KIM-1和NGAL水平均明显降低（

0.05）；与对照组治疗后比较，观察组患者降低更明显（

0.05）。2组患者BUN、SCr、eGFR水平治疗前后组内和组间比较差异均无统计学意义。2组患者治疗前后血常规、肝功能、电解质均无明显异常，未出现过敏等不良反应。

结论

大黄泄浊方可有效改善脾肾两虚浊瘀互结证IgA肾病合并HUA（CKD1~2期）患者的临床症状，降低血尿酸水平，缓解肾小管损伤，进而保护肾脏，疗效优于基础治疗。

Abstract

Objective

To observe the effect of Dahuang Xiezhuo prescription on the clinical symptoms， blood uric acid， and renal tubular function of patients with immunoglobulin A （IgA） nephropathy in stages 1-2 of chronic kidney disease （CKD） complicated with hyperuricemia （HUA）.

Method

Sixty patients with IgA nephropathy in stages 1-2 of CKD complicated with HUA of spleen and kidney deficiency and combined turbidity and blood stasis syndromes were randomly divided into an observation group and a control group， with 30 cases in each group. The patients in the control group received basic treatment，

i.e

.， losartan potassium tablets 50-100 mg/time， once per day， and sodium bicarbonate tablets 0.5 g/time， three times per day by oral administration， combined with low-salt， low-fat， and low-purine diet. The patients in the observation group received Dahuang Xiezhuo prescription on the basis of basic treatment， one dose per day， twice a day in the morning and evening with warm water. Both groups were treated for two months. The total scores of traditional Chinese medicine（TCM）syndrome， blood pressure， 24 h urinary protein （24 h UTP）， blood urea nitrogen （BUN）， serum creatinine （SCr）［glomerular filtration rate （eGFR） was calculated by CKD-epidemiology collaboration （CKD-EPI） formula］， serum uric acid （SUA）， and renal tubular function indexes ［urinary

-microglobulin （

-MG）， urinary

-microglobulin （

-MG）， urinary kidney injury molecule-1 （KIM-1）， and neutrophil gelatinase-associated lipocalin （NGAL）］ of the two groups before treatment and two months after treatment were recorded. The clinical efficacy of the two groups was evaluated two months after treatment.

Result

After 2 months of treatment，the total effective rate in the observation group was 81.48%（22/27），higher than 50.00%（14/28） in the control group（

=6.661，

0.05）. The total scores of TCM syndrome， 24 h UTP， and SUA in the observation group and the observation group were lower than those before treatment （

0.05）， and compared with the control group after treatment， the observation group decreased more significantly （

0.05）. After treatment， the blood pressure in the observation group and the observation group was lower than that before treatment （

0.05）， and there was no significant difference in blood pressure between the two groups after treatment. After treatment， the levels of urinary

-MG，

-MG， KIM-1， and NGAL in the two groups were lower than those before treatment （

0.05）， and the observation group was lower than the control group after treatment （

0.05）. There were no significant inter-group and intra-group differences in BUN， SCr， and eGFR levels before and after treatment. There were no obvious abnormalities in blood routine， liver function， and electrolytes before and after treatment in the two groups， and no adverse reactions such as allergies occurred.

Conclusion

Dahuang Xiezhuo prescription can effectively improve the clinical symptoms of IgA nephropathy with HUA （CKD1-2） patients with spleen and kidney deficiency and combined turbidity and blood stasis syndromes， reduce blood uric acid level， alleviate renal tubular injury， and protect the kidney. The curative effect is better than that of basic treatment.

关键词

IgA肾病高尿酸血症脾肾两虚浊瘀互结大黄泄浊方肾小管功能

Keywords

immunoglobulin A （IgA） nephropathyhyperuricemiaspleen and kidney deficiencycombined turbidity and blood stasisDahuang Xiezhuo prescriptionrenal tubular function

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