2020 年第 8 期 第 15 卷

参芎葡萄糖注射液对慢性肾功能不全患者估算肾小球滤过率的长期影响

Long-term effect of salivae miltiorrhizae liguspyragine hydrochloride and glucose injection on estimated glomerular filtration rate in patients with chronic renal failure

作者：冉孟萍1 唐海容2 栾军军1 周华1

英文作者：Ran Mengping1 Tang Hairong2 Luan Junjun1 Zhou Hua1 

单位：1中国医科大学附属盛京医院肾脏内科，沈阳110004；2中山大学附属第八医院肾脏内科，广东省深圳市518033

英文单位：1Department of Nephrology the Affiliated Shengjing Hospital of China Medical University Shenyang 110004 China; 2Department of Nephrology the Eighth Affiliated Hospital of Sun Yat-sen University Guangdong Province Shenzhen 518033 China 

关键词：慢性肾功能不全；参芎葡萄糖注射液；估算肾小球滤过率

英文关键词：Chronicrenalfailure；Salivaemiltiorrhizaeliguspyraginehydrochlorideandglucoseinjection；Estimatedglomerularfiltrationrate

• 摘要：

• 目的 观察参芎葡萄糖注射液对慢性肾功能不全（CRF）患者估算肾小球滤过率（eGFR)的长期影响，并分析可能相关机制。方法 选取2012年6月至2014年11月于中国医科大学附属盛京医院住院的CRF单次应用参芎葡萄糖注射液患者193例，收集患者治疗前后和随访1、3、6、12个月的肾功能等相关指标。分析治疗前后及随访期间相关指标变化，比较疗程1周和2周患者治疗前后肾功能相关指标差值、慢性肾脏病（CKD）不同分期患者用药前后肾功能相关指标差值、肾小球疾病（GN）和小管间质性肾病（TIN）患者治疗前后肾功能相关指标差值。比较重复应用（7例）与单次应用参芎葡萄糖注射液患者（7例）随访12个月治疗前后肾功能相关指标差值。结果 单次参芎葡萄糖注射液疗程结束后,eGFR较治疗前升高［（34±25）ml/(min·1.73 m2)比（25±19）ml/(min·1.73 m2)］，血肌酐、血尿素氮、纤维蛋白原、血尿酸、低密度脂蛋白、血磷、血钾等指标均较治疗前下降，碳酸氢根离子水平较治疗前升高(均P＜0.05)。eGFR、血清白蛋白在随访期间的各时点均较治疗前升高，24 h尿蛋白定量随访12个月时明显低于治疗前(均P＜0.05)。应用参芎葡萄糖注射液2周疗程较1周疗程血肌酐下降更为明显［（-106±121）μmol/L比（-49±90）μmol/L］(P＜0.001)。CKD G5期患者血肌酐下降幅度最大，但CKD G2期与G3a期患者eGFR的升高更为明显(均P＜0.05)。参芎葡萄糖注射液用于GN及TIN导致的CRF患者，治疗前后肾功能差值比较，差异均无统计学意义(均P＞0.05)。随访12个月，重复应用与单次应用参芎葡萄糖注射液CRF患者血肌酐、eGFR、血尿素氮差值比较，差异均无统计学意义(均P＞0.05)。结论 给予CRF患者参芎葡萄糖注射液治疗可显著改善eGFR，影响可见于疗程结束时及12个月随访后。CKD早期（G2与G3a期）应用参芎葡萄糖注射液对eGFR改善更为明显。参芎葡萄糖注射液对CRF患者eGFR的改善作用可能与降低蛋白尿排泄，提高血清白蛋白及改善肾小球凝血纤溶亢进相关。目的 观察参芎葡萄糖注射液对慢性肾功能不全（CRF）患者估算肾小球滤过率（eGFR)的长期影响，并分析可能相关机制。方法 选取2012年6月至2014年11月于中国医科大学附属盛京医院住院的CRF单次应用参芎葡萄糖注射液患者193例，收集患者治疗前后和随访1、3、6、12个月的肾功能等相关指标。分析治疗前后及随访期间相关指标变化，比较疗程1周和2周患者治疗前后肾功能相关指标差值、慢性肾脏病（CKD）不同分期患者用药前后肾功能相关指标差值、肾小球疾病（GN）和小管间质性肾病（TIN）患者治疗前后肾功能相关指标差值。比较重复应用（7例）与单次应用参芎葡萄糖注射液患者（7例）随访12个月治疗前后肾功能相关指标差值。结果 单次参芎葡萄糖注射液疗程结束后,eGFR较治疗前升高［（34±25）ml/(min·1.73 m2)比（25±19）ml/(min·1.73 m2)］，血肌酐、血尿素氮、纤维蛋白原、血尿酸、低密度脂蛋白、血磷、血钾等指标均较治疗前下降，碳酸氢根离子水平较治疗前升高(均P＜0.05)。eGFR、血清白蛋白在随访期间的各时点均较治疗前升高，24 h尿蛋白定量随访12个月时明显低于治疗前(均P＜0.05)。应用参芎葡萄糖注射液2周疗程较1周疗程血肌酐下降更为明显［（-106±121）μmol/L比（-49±90）μmol/L］(P＜0.001)。CKD G5期患者血肌酐下降幅度最大，但CKD G2期与G3a期患者eGFR的升高更为明显(均P＜0.05)。参芎葡萄糖注射液用于GN及TIN导致的CRF患者，治疗前后肾功能差值比较，差异均无统计学意义(均P＞0.05)。随访12个月，重复应用与单次应用参芎葡萄糖注射液CRF患者血肌酐、eGFR、血尿素氮差值比较，差异均无统计学意义(均P＞0.05)。结论 给予CRF患者参芎葡萄糖注射液治疗可显著改善eGFR，影响可见于疗程结束时及12个月随访后。CKD早期（G2与G3a期）应用参芎葡萄糖注射液对eGFR改善更为明显。参芎葡萄糖注射液对CRF患者eGFR的改善作用可能与降低蛋白尿排泄，提高血清白蛋白及改善肾小球凝血纤溶亢进相关。

• Objective To investigate the effect of salivae miltiorrhizae liguspyragine hydrochloride（SMLH)  and glucose injection on estimated glomerular filtration rate (eGFR) in chronic renal failure (CRF). Methods From June 2012 to November 2014, 193 CRF patients at the Affiliated Shengjing Hospital of China Medical University were selected for single application of SMLH  and glucose injection . The changes of related indexes before and after the treatment, the difference of related indexes before and after the treatment, the difference of related indexes before and after the treatment of different stages of Chronic kidney disease （CKD）, the difference of indexes before and after the treatment of glomerular disease (GN) and tubulointerstitial nephropathy (TIN) were analyzed.Results At the end of a single course of SMLH  and glucose injection , eGFR increased［（34±25）ml/(min·1.73 m2) vs （25±19）ml/(min·1.73 m2)］; serum creatinine, blood urea nitrogen, fibrinogen, uric acid, low-density lipoprotein, blood phosphorus, blood potassium and other indicators decreased; bicarbonate ion level increased (all P＜0.05). The eGFR and serum albumin increased at all time points during the follow-up period; the 24-hour quantitative follow-up of urine protein was significantly lower than that before treatment (P＜0.05). The serum creatinine of SMLH  and glucose injection decreased more significantly in two weeks than in one week［（-106±121）μmol/L vs （-49±90）μmol/L］(P＜0.001). The decrease of serum creatinine was the highest in patients with CKD-G5 but the increase of eGFR was more obvious in patients with CKD-G2 and G3a(P＜0.05). Comparison of renal function difference between before and after treatment of SMLH  and glucose injection in CRF patients caused by GN and TIN， there were no significant differences in renal function before and after treatment (P＞0.05). After 12 months follow-up, there were no significant differences in serum creatinine, eGFR and blood urea nitrogen between patients with CRF treated by multiple application and single application of SMLH  and glucose injection (P＞0.05). Conclusions SMLH  and glucose injection can significantly improve the eGFR in CRF patients. SMLH  and glucose injection can significantly improve eGFR when CKD patients are treated with SMLH in the early stage (G2 and G3a). The effect of SMLH  and glucose injection on improving eGFR of CRF patients may be related to proteinuria excretion, serum albumin and hyperfibrinolysis in glomeruli.