世界中医药

目的：探究消渴方治疗糖尿病肾病（DN）患者的疗效，对其沉默信息调节因子2相关酶I（SIRT1）/腺苷酸活化蛋白激酶（AMPK）通路作用机制进行研究。方法：选取2017年1月至2018年1月中山市小榄人民医院收治的糖尿病肾病患者122例作为研究对象，按照就诊顺序编号随机分为对照组和观察组，每组61例。对照组予常规治疗，观察组加用消渴方加减治疗，均治疗8周。观察2组治疗前、治疗后在糖化血红蛋白（HbA1c）、24 h尿蛋白定量（Upro）、血清肌酐（Scr）、尿素氮（BUN）、总胆固醇（TC）、载脂蛋白A（ApoA）、载脂蛋白B（ApoB）、三酰甘油（TG）水平变化并比较；观察2组治疗前、治疗后SIRT1、AMPK、丙二醇（MDA）、超氧化物歧化酶（SOD）水平变化并比较；观察治疗前、治疗后白细胞介素-6（IL-6）、IL-8、肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）水平变化并比较；观察2组治疗前、治疗后症状积分倦怠乏力、心悸气短、头晕耳鸣、自汗变化并比较；治疗结束后进行安全性评定。结果：治疗前2组BUN、Scr、HbA1c、Upro、TC、ApoA、ApoB、TG比较，差异无统计学意义（P>0.05），治疗后2组BUN、Scr、HbA1c、Upro、TC、ApoB、TG较治疗前均显著下降，ApoA较治疗前显著升高，差异有统计学意义（P<0.05），治疗后观察组ApoA显著高于对照组，余均显著低于对照组，差异有统计学意义（P<0.05）。治疗前2组SIRT1/AMPK、MDA、SOD比较，差异无统计学意义（P>0.05），治疗后2组MDA较治疗前均显著下降，SOD较治疗前均显著升高，而观察组在SIRT1、AMPK水平上显著高于对照组，差异有统计学意义（P<0.05），而对照组SIRT1/AMPK治疗前、治疗后比较，差异无统计学意义（P>0.05），治疗后观察组SIRT1、AMPK、SOD显著高于对照组、MDA显著低于对照组，差异有统计学意义（P<0.05）。治疗前2组IL-6、IL-8、TNF-α、CRP比较，差异无统计学意义（P>0.05），治疗后2组IL-6、IL-8、TNF-α、CRP较治疗前均显著下降，差异有统计学意义（P<0.05），治疗后观察组以上指标均显著低于对照组，差异有统计学意义（P<0.05）。治疗前2组倦怠乏力、心悸气短、头晕耳鸣、自汗比较，差异无统计学意义（P>0.05），治疗后2组以上指标较治疗前均显著下降，差异有统计学意义（P<0.05），治疗后观察组各指标均显著低于对照组，差异有统计学意义（P<0.05）。2组安全性比较，差异无统计学意义（P>0.05）。结论：消渴方能通过抑制DN患者氧化应激反应，降低DN氧自由基释放，改善SIRT1/AMPK通路，从而实现多环节治疗提高疗效。

English Summary:

To explore the efficacy of Xiaoke Formula in diabetic nephropathy(DN),and to study the mechanism of SIRT1/AMPK pathway in order to improve the efficacy.Methods：A total of 122 patients with DN admitted in the ZhongShan Xiaolan People's Hospital from January 2017 to January 2018 were selected as research subjects.They were randomly divided into control group(61 cases）and observation group(61 cases）according to the order of treatment.The control group was given routine treatment,while the observation group was treated with Xiaoke Formula,both for 8 weeks.Content changes of glycosylated hemoglobin(HbA1c),24-hour urinary protein(Upro),serum creatinine(Scr),urea nitrogen(BUN),total cholesterol(CHOL),apolipoprotein A(ApoA),apolipoprotein B(ApoB）and triglyceride(TG）in the 2 groups before and after the treatment were observed and compared.Content changes of SIRT1,AMPK,MDA and SOD in the 2 groups before and after the treatment were observed and compared.Content changes of interleukin-6(IL-6),IL-8,TNF-α,C-reactive protein(CRP）before and after the treatment were observed and compared.Changes on symptom scores of fatigue,palpitation and shortness of breath,dizziness and tinnitus,and spontaneous sweating in the 2 groups before and after the treatment were observed and compared.And safety was evaluated after the treatment.Results：1）Before the treatment,the BUN,Scr,HbA1c,Upro,CHOL,ApoA,ApoB and TG in the 2 groups were comparable(P>0.05).After the treatment,the BUN,Scr,HbA1c,Upro,CHOL,ApoB and TG in the 2 groups were significantly lower than those before the treatment,the ApoA was significantly higher than that before the treatment(P<0.05).After the treatment,the ApoA in the observation group was significantly higher than that in the control group,while the rest were significantly lower than those in the control group(P<0.05). 2）The SIRT1/AMPK,MDA and SOD between the 2 groups before the treatment were comparable(P>0.05).After the treatment in both groups,the MDA was decreased significantly and the SOD was increased significantly,while the SIRT1 and AMPK in the observation group were significantly higher than those in the control group(P<0.05).However,the difference of the SIRT1/AMPK in the control group was not significant before and after the treatment(P>0.05).After the treatment,the SIRT1,AMPK and SOD in the observation group were significantly higher than those in the control group,and the MDA was significantly lower than that in the control group(P<0.05). 3）There were comparable differences in IL-6,IL-8,TNF-α and CRP between the 2 groups before the treatment(P>0.05).After the treatment,the levels of IL-6,IL-8,TNF-α and CRP in the 2 groups were significantly lower than those before the treatment(P<0.05),and the above indexes in the observation group after the treatment were significantly lower than those in the control group(P<0.05). 4）Before the treatment,there were comparable differences in fatigue,palpitation and shortness of breath,dizziness and tinnitus and spontaneous sweating between the 2 groups(P>0.05).After the treatment,the above indexes of the 2 groups were significantly lower than those before the treatment(P<0.05).After the treatment,the above indexes of the observation group were significantly lower than those of the control group(P<0.05). 5）There was no significant difference in the safety ratio between the 2 groups(P>0.05).Conclusion：Xiaoke Formula can improve the SIRT1/AMPK pathway by inhibiting oxidative stress reaction and reducing the release of DN oxygen free radicals,thus to achieve multi-stage treatment and improve the efficacy.

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