陈玲玲,左扬,冯源,程锦国

• 1:浙江中医药大学附属温州市中医院
• 2:温州医科大学

摘要(Abstract)：

目的观察益气活血化瘀汤对膜性肾病大鼠肾脏组织Podocin蛋白表达的影响,为临床治疗膜性肾病(MN)提供依据。方法 SD大鼠随机分为正常对照组和造模组,其中造模组采用抗Fx1A血清一次性尾静脉注射诱导被动型Heymann肾炎模型,造模成功后将造模组随机分为模型组、洛丁新(盐酸贝那普利)组、益气活血化瘀汤低、中、高剂量组。各组按相应剂量灌胃4周,每周留取大鼠24 h尿量,检测24 h尿蛋白定量(UTP)。于4周末处死大鼠,心脏取血,检测血肌酐(Scr)、尿素氮(BUN)、血清总蛋白(TP)、血清白蛋白(ALB)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TAG),取肾脏组织行Masson、PASM染色观察肾脏组织病理改变,免疫荧光观察肾脏组织IgG、C3改变,免疫组化观察Podocin蛋白在肾脏组织的阳性表达情况。结果与正常组相比,其余5组UTP均升高(P <0.05);与模型组相比,各给药组UTP均减少(P<0.05),肾脏组织Podocin蛋白表达增加(P <0.01),TP、ALB有所升高但差异无统计学意义(P> 0.05),Scr、BUN、TC、HDL-C、TAG差异无统计学意义(P> 0.05);与洛丁新组相比,益气活血化瘀汤低、中、高剂量组UTP减少,但差异无统计学意义(P> 0.05),各生化指标差异无统计学意义(P> 0.05),益气活血化瘀汤低、中、高剂量组肾脏组织Podocin蛋白表达增加(P <0.01);益气活血化瘀汤各组之间各指标差异无统计学意义(P>0.05)。结论益气活血化瘀汤可以明显降低膜性肾病大鼠的尿蛋白水平,减少肾脏病理损伤,能够上调肾脏组织Podocin蛋白的表达,延缓膜性肾病的进展。

关键词(KeyWords)： 益气活血化瘀汤;膜性肾病;Podocin;中药治疗

Abstract:

Keywords:

基金项目(Foundation): 2018年浙江省中医药重大研究项目(2018ZY011)

作者(Author): 陈玲玲,左扬,冯源,程锦国

参考文献(References)：

• [1]Kronbichler A,Oh J,Meijers B,et al.Recent Progress in Deciphering the Etiopathogenesis of Primary Membranous Nephropathy[J].Biomed Res Int,2017:14.
• [2]周飞,李春国,商明,等.肾脏疾病患者262例肾活检病理类型及流行病学特点[J].中国社区医师,2018,34(2):127-128.
• [3]Pan X,Xu J,Ren H,et a1.Changing spectrum of biopsyproven primary glomerular diseases over the past 15 years:a single-center study in China[J].Contributions to Nephrology,2013,181:22-30.
• [4]Obana M,Nakanishi K,Sako M,et al.Segmental membranous glomerulonephritis in children:Comparison with global membranous glomerulonephritis[J].Clin J Am Soc Nephrol,2006,1:723-729.
• [5]Wang PR,Kitamura H,Shimizu A,et al.Glomerular damage in experimental proliferative glomerulonephritis under glomerular capillary hypertension[J].Kidney Blood Press Res,2015,40:188-199.
• [6]丁磊,汪宏.特发性膜性肾病的诊治进展[J].家庭医药,2017,16(10):228-229.
• [7]Ren S,Wang Y,Xian L,et al.Comparative effectiveness and tolerance of immunosuppressive treatments for idiopathic membranous nephropathy:A network meta-analysis[J].PLoSOne,2017,12(9):e0184398.
• [8]Cunningham PN,Hack BK,Ren G,et al.Glomerular complement regulation is overwhelmed in passive Heymann nephritis[J].Kidney Int,2001,60(3):900-909.
• [9]张英,白香妮.肾功能相关检测指标在慢性肾病临床筛查中的作用分析[J].医学临床研究,2017,34(11):2243-2244.
• [10]Tian X,Kim JJ,Monkley SM,et al.Podocyte-associated talin1 is critical for glomerular filtration barrier maintenance[J].JClin Invest,2015,125(2):882.
• [11]Fukusumi Y,Miyauchi N,Hashimoto T,et al.Therapeutic target for nephrotic syndrome:Identification of novel slit diaphragm associated molecules[J].World J Nephrol,2014,3(3):77-84.
• [12]Lin Ting,Li Zhang,Liu Shuangxin,et al.WWC1 promotes podocyte survival via stabilizing slit diaphragm protein dendrin[J].Molecular Medicine Reports,2017,16(6):8685-8690.
• [13]程鹏,曹灵.足细胞与膜性肾病[J].实用医学杂志,2010,26(6):1063-1064.
• [14]G觟del M,Ostendorf BN,Baumer J,et al.A novel domain regulating degradation of the glomerular slit diaphragm protein podocin in cell culture systems[J].PLoS One,2013,8(2):e57078.
• [15]Nakatsue T,Koike H,Han GD,et al.Nephrin and podocin dissociate at the onset of proteinuria in experimental membranous nephropathy[J].Kidney Int,2005,67(6):2239-2253.
• [16]达展云,范亚平,沈良兰,等.Nephrin和Podocin在3种膜性肾病表达中的差异及其意义[J].中国现代医学,2009,19(15):2381-2385.
• [17]刘学永,何聪芹,王聪舟,等.膜性肾病的中医诊治进展[J].临床医药文献杂志,2017,4(76):15039-15041.
• [18]张晓丹,邓跃毅.中医医家辨治膜性肾病经验探析[J].现代中西医结合杂志,2017,26(1):112-114.
• [19]武亚丹,程锦国.程锦国运用中满分消丸治疗膜性肾病经验介绍[J].新中医,2018,50(1):188-190.