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Article(id=1322925251239215594, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923490592043032, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.05.045, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339558658, onlineDateStr=2026-10-30, pubDate=1746806400000, pubDateStr=2025-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339558658, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339558658, creator=13701087609, updateTime=1793339558658, updator=13701087609, issue=Issue{id=1322923490592043032, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='5', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1746806400000', pubDateStr='2025-05-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339138887, creator='13701087609', updateTime=1793340572227, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929502539612595, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923490592043032, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929502539612596, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923490592043032, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=238, endPage=242, ext={EN=ArticleExt(id=1322925252891771371, articleId=1322925251239215594, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effect of Qufeng Tongluo Jianshen Prescription（祛风通络健肾方）on Expression Levels of p38MAPK, ICAM-1 and MCP-1 in Patients with Chronic Glomerulonephritis, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To observe the effects of Qufeng Tongluo Jianshen Prescription（祛风通络健肾方）on the expression levels of p38 mitogen-activated protein kinase（p38MAPK），intercellular adhesion molecule-1（ICAM-1）and monocyte chemotactic protein-1（MCP-1）in patients with chronic glomerulonephritis（CGN）.

Methods

A total of 108 CGNpatients treated in the hospital from August 2020 to February 2023 were divided into two groups by simple random method. The conventional group was given conventional symptomatic treatment with Western medicine，while the observation group was given Qufeng Tongluo Jianshen Prescription on the basis of symptomatic treatment，all of which were treated continuously for 8 weeks. The levels of renal function related indexes，renal fibrosis related factors，p38MAPK，ICAM-1，urine red blood cell count（RBC），MCP-1 and high sensitivity C-reactive protein（hs-CRP）were compared between the two groups before and after treatment，and the efficacy，adverse reactions and TCM syndrome scores were recorded between the two groups.

Results

There was no statistical significance in renal function or renal fibrosis before treatment between the two groups（P>0.05）. The levels of serum creatinine（SCr），transforming growth factor-β1（TGF-β1），urea nitrogen（BUN），fibronectin（FN），24 h urinary protein quantity（24 h Upro），cystatin C（CysC），tissue inhibitor of metalloproteinase-（TIMP-1）were lower in two groups after treatment than those before treatment（P<0.05）. The renal function indexes and factors related to renal fibrosis in the observation group were lower than those in the conventional group（P<0.05）. There was no statistical significance in the relative expression levels of p38MAPK，ICAM-1，MCP-1，urinary RBC and hs-CRPbetween the two groups before treatment（P>0.05）. The relative expression levels of p38MAPK，ICAM-1，MCP-1，urinary RBC and hs-CRP in the two groups after treatment were lower than those before treatment，while the levels of the observation group were lower than those of the conventional group after treatment（P<0.05）. There was no statistical significance in the scores of 4 major and 5 secondary symptoms before treatment between the two groups（P>0.05）. After treatment，the scores of four major symptoms（edema of limbs，sore waist and knees，fatigue，abdominal distension），and 5 secondary symptoms（cold appearance and cold limbs，thirst and unwilling to drink，pale complexion，loose stools，frequent urination or nocturia）in the two groups were lower than those before treatment，while the scores of the observation group were lower than those of the conventional group after treatment（P<0.05）. The total effective rate of the observation group was 94.44%（51/54），which was higher than that（81.48%，44/54）of the conventional group，with statistical significance（P<0.05）. The cumulative adverse reaction rate of diarrhea，nausea and abnormal liver function in the observation group was not statistically significant compared with that in the conventional group（P>0.05）.

Conclusion

Qufeng Tongluo Jianshen Prescription can improve the renal function，inhibit renal fibrosis，regulate ICAM-1，MCP-1 and other factors in the treatment of CGN，and improve the curative effect.

, authors=Junhong ZHEN, Bing ZHOU, Xiaona SHI, authorsList=Junhong ZHEN, Bing ZHOU, Xiaona SHI, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322925257664889338, articleId=1322925251239215594, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=祛风通络健肾方治疗慢性肾小球肾炎对p38MAPK、ICAM-1、MCP-1表达水平的影响, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

观察祛风通络健肾方治疗慢性肾小肾球炎（Chronic glomerulonephritis，CGN）对患者p38丝裂原活化蛋白激酶（p38 mitogen-activated protein kinase，p38MAPK）、细胞间黏附分子-1（Intercellularadhesionmolecule-1，ICAM-1）、单核细胞趋化蛋白-1（Monocytechemotacticprotein1，MCP-1）表达水平的影响。

方法

将2020年8月—2023年2月在医院接受治疗的108例CGN患者采用简单随机法分为两组，常规组给予常规西药对症治疗，观察组在对症基础上给予祛风通络健肾方治疗，均连续治疗8周。比较两组治疗前和治疗后肾功能相关指标、肾纤维化相关因子及p38MAPK、ICAM-1、尿红细胞计数（Red blood cell count，RBC）、MCP-1、高敏-C反应蛋白（Hypersensitive C-reactive protein，hs-CRP）水平，记录两组疗效、不良反应和中医证候评分。

结果

两组患者治疗前肾功能及肾纤维化指标比较，差异无统计学意义（P>0.05）。两组治疗后血肌酐（Serum creatinine，SCr）、转化生长因子-β1（Transforming growth factor-β1，TGF-β1）、尿素氮（Urea nitrogen，BUN）、纤维连接蛋白（Fibronectin，FN）、24 h尿蛋白定量（24 h urine protein quantification，24 h Upro）、胱抑素C（Cystatin C，CysC）、金属蛋白酶组织抑制因子-1（Metalloproteinase tissue inhibitory factor-1，TIMP-1）等低于治疗前（P<0.05）。观察组治疗后肾功能指标、肾纤维化相关因子均低于常规组治疗后（P<0.05）。两组患者治疗前p38MAPK相对表达量、ICAM-1、MCP-1、尿RBC、hs-CRP等因子比较，差异无统计学意义（P>0.05）。两组治疗后p38MAPK相对表达量、ICAM-1、MCP-1、尿RBC、hs-CRP等低于治疗前，同时观察组治疗后低于常规组（P<0.05）。两组患者治疗前4项主症和5项次症评分比较，差异无统计学意义（P>0.05）。两组治疗后肢体浮肿，腰膝酸软，神疲乏力，腹胀纳呆4项主症和形寒肢冷，口渴不欲饮，面色萎黄，大便稀溏，尿频或夜尿多5项次症评分低于治疗前，同时观察组治疗后低于常规组（P<0.05）。观察组总有效率94.44%（51/54）高于常规组的81.48%（44/54），差异有统计学意义（P<0.05）。观察组出现腹泻、恶心及肝功能异常等累计不良反应率与常规组比较，差异无统计学意义（P>0.05）。

结论

祛风通络健肾方治疗CGN可改善肾功能，抑制肾纤维化，调节ICAM-1、MCP-1等因子水平，提高疗效。

, authors=甄俊红, 周冰, 史晓娜, authorsList=甄俊红, 周冰, 史晓娜, authorCompany=null, correspAuthors=null, authorNote=

甄俊红（1979-），男，山西太原人，主管技师，硕士，研究方向：生物化学和分子生物学、质谱技术蛋白质组学。

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甄俊红（1979-），男，山西太原人，主管技师，硕士，研究方向：生物化学和分子生物学、质谱技术蛋白质组学。

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甄俊红（1979-），男，山西太原人，主管技师，硕士，研究方向：生物化学和分子生物学、质谱技术蛋白质组学。

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Clin Hemorheol Microcirc，2022，82（2）：141-148., articleTitle=Thrombodynamics as a tool for monitoring hemostatic disorders in patients with chronic glomerulonephritis complicated by nephrotic syndrome, refAbstract=null)], funds=[Fund(id=1322925271011164721, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925251239215594, awardId=20210302123300, language=CN, fundingSource=山西省基础研究计划项目(20210302123300), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322925258327589373, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925251239215594, xref=null, ext=[AuthorCompanyExt(id=1322925258344366590, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925251239215594, companyId=1322925258327589373, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=The Second Hospital of Shanxi Medical University，Taiyuan 030001，Shanxi，China), AuthorCompanyExt(id=1322925258352755199, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925251239215594, companyId=1322925258327589373, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=山西医科大学第二医院，山西 太原 030001)])], figs=[ArticleFig(id=1322925266007360030, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925251239215594, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间SCr/（μmol/L）BUN/（mmol/L）24 h Upro/（g）CysC/（mg/L）
常规组54治疗前189.54±25.8511.23±2.122.41±0.723.52±0.51
治疗后130.58±21.93*7.48±1.64*1.66±0.51*2.69±0.39*
观察组54治疗前193.36±24.1411.15±2.2520.46±0.693.47±0.48
治疗后101.12±19.47*#5.53±1.97*#1.12±0.42*#2.01±0.31*#
), ArticleFig(id=1322925266326127135, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925251239215594, language=CN, label=表1, caption=

两组肾小肾球炎患者肾功能相关指标比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间SCr/（μmol/L）BUN/（mmol/L）24 h Upro/（g）CysC/（mg/L）
常规组54治疗前189.54±25.8511.23±2.122.41±0.723.52±0.51
治疗后130.58±21.93*7.48±1.64*1.66±0.51*2.69±0.39*
观察组54治疗前193.36±24.1411.15±2.2520.46±0.693.47±0.48
治疗后101.12±19.47*#5.53±1.97*#1.12±0.42*#2.01±0.31*#
), ArticleFig(id=1322925266691031584, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925251239215594, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间p38MAPK相对表达量ICAM-1/（ng/mL）MCP-1/（ng/mL）尿RBC/（个/μL）hs-CRP/（mg/L）
常规组54治疗前0.51±0.11361.25±28.59269.98±15.4222.14±11.158.56±1.47
治疗后0.46±0.09*224.85±25.04*248.12±13.36*15.26±8.89*4.08±1.01*
观察组54治疗前0.50±0.13358.21±31.47271.14±14.7722.23±10.478.49±1.52
治疗后0.41±0.08*#187.52±21.51*#230.12±11.74*#12.05±7.14*#2.34±0.87*#
), ArticleFig(id=1322925266804277793, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925251239215594, language=CN, label=表2, caption=

两组肾小肾球炎患者p38MAPK、ICAM-1、MCP-1、尿RBC、hs-CRP比较（±s）

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组别例数时间p38MAPK相对表达量ICAM-1/（ng/mL）MCP-1/（ng/mL）尿RBC/（个/μL）hs-CRP/（mg/L）
常规组54治疗前0.51±0.11361.25±28.59269.98±15.4222.14±11.158.56±1.47
治疗后0.46±0.09*224.85±25.04*248.12±13.36*15.26±8.89*4.08±1.01*
观察组54治疗前0.50±0.13358.21±31.47271.14±14.7722.23±10.478.49±1.52
治疗后0.41±0.08*#187.52±21.51*#230.12±11.74*#12.05±7.14*#2.34±0.87*#
), ArticleFig(id=1322925267102073378, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925251239215594, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间TGF-β1/（ng/mL）FN/（mg/L）TIMP-1/（μg/mL）
常规组54治疗前224.14±28.95229.78±31.021.71±0.41
治疗后152.58±25.41*145.23±26.57*1.35±0.31*
观察组54治疗前221.03±31.47231.04±28.541.69±0.45
治疗后111.89±21.06*#117.46±24.11*#1.20±0.24*#
), ArticleFig(id=1322925267206930979, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925251239215594, language=CN, label=表3, caption=

两组肾小肾球炎患者肾纤维化相关因子比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间TGF-β1/（ng/mL）FN/（mg/L）TIMP-1/（μg/mL）
常规组54治疗前224.14±28.95229.78±31.021.71±0.41
治疗后152.58±25.41*145.23±26.57*1.35±0.31*
观察组54治疗前221.03±31.47231.04±28.541.69±0.45
治疗后111.89±21.06*#117.46±24.11*#1.20±0.24*#
), ArticleFig(id=1322925267584418340, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925251239215594, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间肢体浮肿腰膝酸软神疲乏力腹胀纳呆形寒肢冷口渴不欲饮面色萎黄大便稀溏尿频或夜尿多
常规组54治疗前4.42±0.494.05±0.394.23±0.483.78±0.332.36±0.251.82±0.262.06±0.312.15±0.332.32±0.21
治疗后2.11±0.28*1.99±0.31*2.09±0.36*1.81±0.26*1.64±0.22*1.11±0.24*0.98±0.25*1.21±0.25*1.04±0.19*
观察组54治疗前4.36±0.554.10±0.364.20±0.523.82±0.402.41±0.311.85±0.262.01±0.292.11±0.382.29±0.26
治疗后1.63±0.23*#1.24±0.25*#1.58±0.27*#1.24±0.22*#0.74±0.21*#0.69±0.20*#0.64±0.22*#0.77±0.23*#0.61±0.18*#
), ArticleFig(id=1322925268368753190, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925251239215594, language=CN, label=表4, caption=

两组肾小肾球炎患者中医证候评分比较（±s）

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组别例数时间肢体浮肿腰膝酸软神疲乏力腹胀纳呆形寒肢冷口渴不欲饮面色萎黄大便稀溏尿频或夜尿多
常规组54治疗前4.42±0.494.05±0.394.23±0.483.78±0.332.36±0.251.82±0.262.06±0.312.15±0.332.32±0.21
治疗后2.11±0.28*1.99±0.31*2.09±0.36*1.81±0.26*1.64±0.22*1.11±0.24*0.98±0.25*1.21±0.25*1.04±0.19*
观察组54治疗前4.36±0.554.10±0.364.20±0.523.82±0.402.41±0.311.85±0.262.01±0.292.11±0.382.29±0.26
治疗后1.63±0.23*#1.24±0.25*#1.58±0.27*#1.24±0.22*#0.74±0.21*#0.69±0.20*#0.64±0.22*#0.77±0.23*#0.61±0.18*#
), ArticleFig(id=1322925268817543719, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925251239215594, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治愈显效有效无效总有效
常规组549（16.67）19（35.19）16（29.63）10（18.52）44（81.48）
观察组5417（31.48）24（44.44）10（18.52）3（5.56）51（94.44）#
), ArticleFig(id=1322925270457516585, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925251239215594, language=CN, label=表5, caption=

两组肾小肾球炎患者疗效比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治愈显效有效无效总有效
常规组549（16.67）19（35.19）16（29.63）10（18.52）44（81.48）
观察组5417（31.48）24（44.44）10（18.52）3（5.56）51（94.44）#
), ArticleFig(id=1322925270562374186, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925251239215594, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数腹泻肝功能异常头晕胃胀恶心累计不良反应
常规组541（1.85）0（0.00）1（1.85）1（1.85）1（1.85）4（7.41）
观察组543（5.56）1（1.85）0（0.00）0（0.00）1（1.85）5（9.26）
), ArticleFig(id=1322925270927278638, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322925251239215594, language=CN, label=表6, caption=

两组肾小肾球炎患者不良反应比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数腹泻肝功能异常头晕胃胀恶心累计不良反应
常规组541（1.85）0（0.00）1（1.85）1（1.85）1（1.85）4（7.41）
观察组543（5.56）1（1.85）0（0.00）0（0.00）1（1.85）5（9.26）
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祛风通络健肾方治疗慢性肾小球肾炎对p38MAPK、ICAM-1、MCP-1表达水平的影响
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甄俊红 , 周冰 , 史晓娜
中华中医药学刊 | 省级项目平台 2025,43(5): 238-242
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中华中医药学刊 |省级项目平台 2025 , 43 (5) : 238 -242
祛风通络健肾方治疗慢性肾小球肾炎对p38MAPK、ICAM-1、MCP-1表达水平的影响
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甄俊红（1979-），男，山西太原人，主管技师，硕士，研究方向：生物化学和分子生物学、质谱技术蛋白质组学。

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甄俊红（1979-），男，山西太原人，主管技师，硕士，研究方向：生物化学和分子生物学、质谱技术蛋白质组学。

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甄俊红, 周冰, 史晓娜
作者信息
  • 山西医科大学第二医院，山西 太原 030001
作者简介:

甄俊红（1979-），男，山西太原人，主管技师，硕士，研究方向：生物化学和分子生物学、质谱技术蛋白质组学。

Effect of Qufeng Tongluo Jianshen Prescription（祛风通络健肾方）on Expression Levels of p38MAPK, ICAM-1 and MCP-1 in Patients with Chronic Glomerulonephritis
Junhong ZHEN, Bing ZHOU, Xiaona SHI
Affiliations
  • The Second Hospital of Shanxi Medical University，Taiyuan 030001，Shanxi，China
出版时间: 2025-05-10 doi: 10.13193/j.issn.1673-7717.2025.05.045
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摘要
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目的

观察祛风通络健肾方治疗慢性肾小肾球炎（Chronic glomerulonephritis，CGN）对患者p38丝裂原活化蛋白激酶（p38 mitogen-activated protein kinase，p38MAPK）、细胞间黏附分子-1（Intercellularadhesionmolecule-1，ICAM-1）、单核细胞趋化蛋白-1（Monocytechemotacticprotein1，MCP-1）表达水平的影响。

方法

将2020年8月—2023年2月在医院接受治疗的108例CGN患者采用简单随机法分为两组，常规组给予常规西药对症治疗，观察组在对症基础上给予祛风通络健肾方治疗，均连续治疗8周。比较两组治疗前和治疗后肾功能相关指标、肾纤维化相关因子及p38MAPK、ICAM-1、尿红细胞计数（Red blood cell count，RBC）、MCP-1、高敏-C反应蛋白（Hypersensitive C-reactive protein，hs-CRP）水平，记录两组疗效、不良反应和中医证候评分。

结果

两组患者治疗前肾功能及肾纤维化指标比较，差异无统计学意义（P>0.05）。两组治疗后血肌酐（Serum creatinine，SCr）、转化生长因子-β1（Transforming growth factor-β1，TGF-β1）、尿素氮（Urea nitrogen，BUN）、纤维连接蛋白（Fibronectin，FN）、24 h尿蛋白定量（24 h urine protein quantification，24 h Upro）、胱抑素C（Cystatin C，CysC）、金属蛋白酶组织抑制因子-1（Metalloproteinase tissue inhibitory factor-1，TIMP-1）等低于治疗前（P<0.05）。观察组治疗后肾功能指标、肾纤维化相关因子均低于常规组治疗后（P<0.05）。两组患者治疗前p38MAPK相对表达量、ICAM-1、MCP-1、尿RBC、hs-CRP等因子比较，差异无统计学意义（P>0.05）。两组治疗后p38MAPK相对表达量、ICAM-1、MCP-1、尿RBC、hs-CRP等低于治疗前，同时观察组治疗后低于常规组（P<0.05）。两组患者治疗前4项主症和5项次症评分比较，差异无统计学意义（P>0.05）。两组治疗后肢体浮肿，腰膝酸软，神疲乏力，腹胀纳呆4项主症和形寒肢冷，口渴不欲饮，面色萎黄，大便稀溏，尿频或夜尿多5项次症评分低于治疗前，同时观察组治疗后低于常规组（P<0.05）。观察组总有效率94.44%（51/54）高于常规组的81.48%（44/54），差异有统计学意义（P<0.05）。观察组出现腹泻、恶心及肝功能异常等累计不良反应率与常规组比较，差异无统计学意义（P>0.05）。

结论

祛风通络健肾方治疗CGN可改善肾功能，抑制肾纤维化，调节ICAM-1、MCP-1等因子水平，提高疗效。

祛风通络健肾方  /  慢性肾小球肾炎  /  肾功能  /  肾纤维化  /  疗效
Objective

To observe the effects of Qufeng Tongluo Jianshen Prescription（祛风通络健肾方）on the expression levels of p38 mitogen-activated protein kinase（p38MAPK），intercellular adhesion molecule-1（ICAM-1）and monocyte chemotactic protein-1（MCP-1）in patients with chronic glomerulonephritis（CGN）.

Methods

A total of 108 CGNpatients treated in the hospital from August 2020 to February 2023 were divided into two groups by simple random method. The conventional group was given conventional symptomatic treatment with Western medicine，while the observation group was given Qufeng Tongluo Jianshen Prescription on the basis of symptomatic treatment，all of which were treated continuously for 8 weeks. The levels of renal function related indexes，renal fibrosis related factors，p38MAPK，ICAM-1，urine red blood cell count（RBC），MCP-1 and high sensitivity C-reactive protein（hs-CRP）were compared between the two groups before and after treatment，and the efficacy，adverse reactions and TCM syndrome scores were recorded between the two groups.

Results

There was no statistical significance in renal function or renal fibrosis before treatment between the two groups（P>0.05）. The levels of serum creatinine（SCr），transforming growth factor-β1（TGF-β1），urea nitrogen（BUN），fibronectin（FN），24 h urinary protein quantity（24 h Upro），cystatin C（CysC），tissue inhibitor of metalloproteinase-（TIMP-1）were lower in two groups after treatment than those before treatment（P<0.05）. The renal function indexes and factors related to renal fibrosis in the observation group were lower than those in the conventional group（P<0.05）. There was no statistical significance in the relative expression levels of p38MAPK，ICAM-1，MCP-1，urinary RBC and hs-CRPbetween the two groups before treatment（P>0.05）. The relative expression levels of p38MAPK，ICAM-1，MCP-1，urinary RBC and hs-CRP in the two groups after treatment were lower than those before treatment，while the levels of the observation group were lower than those of the conventional group after treatment（P<0.05）. There was no statistical significance in the scores of 4 major and 5 secondary symptoms before treatment between the two groups（P>0.05）. After treatment，the scores of four major symptoms（edema of limbs，sore waist and knees，fatigue，abdominal distension），and 5 secondary symptoms（cold appearance and cold limbs，thirst and unwilling to drink，pale complexion，loose stools，frequent urination or nocturia）in the two groups were lower than those before treatment，while the scores of the observation group were lower than those of the conventional group after treatment（P<0.05）. The total effective rate of the observation group was 94.44%（51/54），which was higher than that（81.48%，44/54）of the conventional group，with statistical significance（P<0.05）. The cumulative adverse reaction rate of diarrhea，nausea and abnormal liver function in the observation group was not statistically significant compared with that in the conventional group（P>0.05）.

Conclusion

Qufeng Tongluo Jianshen Prescription can improve the renal function，inhibit renal fibrosis，regulate ICAM-1，MCP-1 and other factors in the treatment of CGN，and improve the curative effect.

Qufeng Tongluo Jianshen Prescription（祛风通络健肾方）  /  chronic glomerulonephritis  /  kidney function  /  renal fibrosis  /  curative effect
甄俊红, 周冰, 史晓娜. 祛风通络健肾方治疗慢性肾小球肾炎对p38MAPK、ICAM-1、MCP-1表达水平的影响. 中华中医药学刊, 2025 , 43 (5) : 238 -242 . DOI: 10.13193/j.issn.1673-7717.2025.05.045
Junhong ZHEN, Bing ZHOU, Xiaona SHI. Effect of Qufeng Tongluo Jianshen Prescription（祛风通络健肾方）on Expression Levels of p38MAPK, ICAM-1 and MCP-1 in Patients with Chronic Glomerulonephritis[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (5) : 238 -242 . DOI: 10.13193/j.issn.1673-7717.2025.05.045
正文
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慢性肾小肾球炎（Chronic glomerulonephritis，CGN）是临床常见的慢性肾脏病，临床表现为水肿、蛋白尿、高血压、肾功能进行性下降等，其发病机制比较复杂，与过度劳累、感染、免疫异常、应激反应、药物等多种原因有关[1]。CGN早期如得不到有效治疗，可能导致肾功能衰竭而影响预后。西医临床常采用控制血压、限制蛋白摄入、调脂、降低蛋白尿等措施保护肾功能，但尚无根治性药物，且长期用药的不良反应明显[2]。
中医学理论认为，CGN属于“肾风”“水肿”“尿浊”等范畴，其病位在肾，与脾虚有关，以脾肾两虚为本，瘀血、湿浊为标。脾虚则统摄无权，肾虚则无以封藏，使水谷精微随尿液下泄。治则以健脾益肾、祛风通络为法[3]。本研究以此为指导自拟祛风通络健肾方治疗CGN，探讨其对患者p38丝裂原活化蛋白激酶（p38 mitogen-activated protein kinase，p38MAPK）、细胞间黏附分子-1（Intercellularadhesionmolecule-1，ICAM-1）、单核细胞趋化蛋白-1（Monocyte chemotactic protein-1，MCP-1）表达水平的影响。
1　资料与方法
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1.1　一般资料
本研究性质为前瞻性，将2020年8月—2023年2月在我院接受治疗的108例CGN患者采用简单随机法分为两组，常规组男28例，女26例；年龄21～65岁，平均（50.12±11.25）岁；病程0.5～5年，平均（2.75±0.64）年；病理类型：系膜增生性肾炎，共27例，占比50.00%，局灶性阶段性肾小球硬化，共21例，占比38.89%，细末毛细血管性肾炎6例，占比11.11%；动脉压94～119 mm Hg，平均（107.85±6.54）mm Hg。观察组男30例，女24例；年龄20～65岁，平均（59.46±10.47）岁；病程0.5～5年，平均（2.71±0.71）年；病理类型：系膜增生性肾炎，共25例，占比46.30%，局灶性阶段性肾小球硬化，共22例，占比40.74%，细末毛细血管性肾炎7例，占比12.96%；动脉压96～122 mm Hg，平均（108.04±6.17）mm Hg。两组一般资料组间进行比较差异无统计学意义，具有可比性（P>0.05）。
1.2　诊断标准
CGN符合《慢性肾小球肾炎诊疗指南》[4]中标准：①起病缓慢，病情迁延，或轻或重或时轻时重，肾功能逐步恶化，后期伴贫血、电解质紊乱等；②出现水肿、血尿、高血压及蛋白尿等；③排除继发性肾小球肾炎；④病程中可因其他疾病诱发急性发作。
中医符合《中药新药临床研究指导原则》[5]中脾肾两虚型标准：①主症：肢体浮肿，腰膝酸软，神疲乏力，腹胀纳呆；②次症：形寒肢冷，口渴不欲饮，面色萎黄，大便稀溏，尿频或夜尿多；③舌脉：舌质淡胖、苔薄白、脉细或脉缓无力。
1.3　纳入排除标准
纳入标准：①符合CGN标准，属于脾肾两虚型；②病例均成年，最大年龄65岁；③慢性肾小球肾炎（Chronic glomerulonephritis，GFR）≥30 mL·min-1·1.73 m-2；④首次确诊，未接受其他药物治疗；⑤签署同意书。
排除标准：①存在严重感染或伴有慢性消耗性疾病；②妊娠或哺乳期患者；③伴有肾积水、肾肿瘤等其他肾脏疾病；④伴有精神疾病；⑤急性肾小球肾炎；⑥伴有肝脏、心脏或脑血管疾病。
1.4　方法
1.4.1　常规组
常规组给予常规西药对症治疗，口服血管紧张素转化酶抑制剂或血管紧张素Ⅱ受体拮抗剂控制血压，1周后血压仍不能达标者加用β-受体抑制剂。伴感染者选择抗生素治疗；伴高脂血症者加用他汀类药物降脂。指导患者注意休息，给予低盐、低脂、优质低蛋白饮食，避免使用肾毒性药物。
1.4.2　观察组
观察组在对症基础上给予祛风通络健肾方治疗，祛风通络健肾方：黄芪30 g，茯苓15 g，女贞子10 g，墨旱莲10 g，杜仲10 g，鬼箭羽10 g，桃仁10 g，丹参15 g，泽兰10 g，泽泻10 g，白茅根10 g，鸡血藤15 g，海风藤15 g，甘草6 g。上药每日1剂，加水浸泡、煎煮两次，合并煎液约300 mL，早晚各服用150 mL。两组均治疗8周。
1.5　观察指标
1.5.1　检测方法
于治疗前、治疗8周后抽取患者空腹静脉血10 mL，4℃静置30 min后离心，转速：3000 r/min，时长：10 min，取血清采用酶联免疫吸附法检测p38MAPK、ICAM-1、MCP-1、高敏-C反应蛋白（High sensitivity C-reactive protein，hs-CRP）、纤维连接蛋白（Fibronectin，FN）、转化生长因子-β1（Transforming growth factor-β1，TGF-β1）、胱抑素C（Cystatin C，CysC）、金属蛋白酶组织抑制因子-1（Metalloproteinase tissue inhibitor-1，TIMP-1），试剂盒为上海酶联生物科技有限公司产品，仪器为赛默飞MK3型酶标仪。采用日本日立株式会社7600型全自动生化分析仪检测血肌酐（Blood creatinine，SCr）、尿素氮（Urea nitrogen，BUN）。取患者24 h尿液，采用生化分析仪检测24 h尿蛋白定量（24-hour urine protein quantification，24 h Upro），在显微镜下数尿红细胞计数（Red blood cell count，RBC）。
1.5.2　中医证候评分
参考《中药新药临床研究指导原则》[5]制定，肢体浮肿，腰膝酸软，神疲乏力，腹胀纳呆4项主症，根据症状的轻至重分为4级，对应0、2、4、6分。形寒肢冷，口渴不欲饮，面色萎黄，大便稀溏，尿频或夜尿多5项次症，根据症状的轻至重分为4级，对应0、1、2、3分。
1.5.3　疗效标准
根据《中药新药临床研究指导原则》[5]制定，分为治愈、显效、有效、无效4个等级。其中治愈：症状体征消失，中医证候评分降低≥90%，同时满足以下两项，24 h Upro<0.15 g，且尿蛋白转阴；显效：症状体征基本消失，70%≤中医证候评分降低<90%，同时满足尿蛋白降低≥50%，0.15 g≤24 h Upro<0.3 g；有效：症状体征减轻，30%≤中医证候评分降低<70%，同时满足25%≤尿蛋白降低<50%，0.3 g≤24 h Upro<1.5 g；无效：上述24 h Upro、中医证候评分等均未达到。
1.5.4　不良反应
记录两组腹泻、肝功能异常、头晕等不良反应的发生情况。
1.6　统计学方法
数据用SPSS 26.0处理，涉及的计量指标均为正态分布或近似正态分布，同时满足方差齐性，均以表示，比较用t检验，如病理类型、性别涉及计数资料用例数描述，比较用χ2检验，以α＝0.05为标准。
2　结果
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2.1　肾功能相关指标比较
两组患者治疗前肾功能比较，差异无统计学意义（P>0.05）。两组治疗后SCr、BUN、24 h Upro、CysC等低于治疗前（P<0.05）。观察组治疗后上述4个因子低于常规组（P<0.05）。见表1。
2.2　p38MAPK、ICAM-1、MCP-1、尿RBC、hs-CRP比较
两组患者治疗前p38MAPK相对表达量、ICAM-1、MCP-1、尿RBC、hs-CRP等因子比较，差异无统计学意义（P>0.05）。两组治疗后p38MAPK相对表达量、ICAM-1、MCP-1、尿RBC、hs-CRP等低于治疗前（P<0.05）。观察组治疗后上述5个指标均低于常规组治疗后（P<0.05）。见表2。
2.3　肾纤维化相关因子比较
两组患者治疗前相关因子比较，差异无统计学意义（P>0.05）。两组治疗后TGF-β1、FN、TIMP-1等低于治疗前（P<0.05）。观察组治疗后上述3个因子低于常规组（P<0.05）。见表3。
2.4　中医证候评分比较
两组患者治疗前中医证候评分比较，差异无统计学意义（P>0.05）。两组治疗后肢体浮肿，腰膝酸软，神疲乏力，腹胀纳呆4项主症和形寒肢冷，口渴不欲饮，面色萎黄，大便稀溏，尿频或夜尿多5项次症评分低于治疗前（P<0.05）。观察组治疗后上述9项评分低于常规组（P<0.05）。见表4。
2.5　疗效比较
观察组总有效率94.44%（治愈17例、显效24例、有效10例）高于常规组的81.48%（治愈9例、显效19例、有效16例），差异有统计学意义（P<0.05）。见表5。
2.6　不良反应比较
观察组出现腹泻、恶心及肝功能异常等累计不良反应率与常规组比较，差异无统计学意义（P>0.05）。见表6。
3　讨论
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CGN可发生于任何年龄段，好发于中青年，男性发病率高于女性[6]。CGN起病隐匿，病情迁延，病程较长，其病情进展一般较缓慢，但如不及时治疗，可进展至终末期肾病阶段。西医临床对于CGN的常规治疗为限制饮食、调节血压、减少尿蛋白等。糖皮质激素、免疫抑制剂等药物的不良反应明显，且部分患者可出现药物反应不敏感，治疗效果有限[7]。近年来中医药在CGN治疗中的辅助作用已逐步得到临床重视，越来越多的学者认同采用中药辅助治疗CGN[8]。
中医学理论认为，“肾风”可因外邪侵袭或饮食劳倦而发病。脾居中焦，功主运化，脾虚则运化无权，使气血生化乏源，脏腑失养、水湿停滞、精微下泄。肾居下焦，司水之气化蒸腾，肾气不足则水之蒸化无力、精微固摄失职而致水肿、蛋白尿。风邪贯穿“肾风”之始终，早期以风邪袭表为主，中后期则为风邪入络、内风伤肾。治则以健脾补肾、祛风通络为法[9]。祛风通络方中以黄芪为君药，功擅补气健脾、生津养血。茯苓健脾渗湿、宁心安神；泽泻利水渗湿、泄热化浊。二药共为臣药，可增强利水渗湿之功，纠正脾虚湿困之证。佐以女贞子、墨旱莲、杜仲滋补肝肾；鬼箭羽、桃仁、丹参、泽兰活血通经、散瘀止痛。白茅根清热凉血、利尿通淋；鸡血藤活血养血，善除肾络之瘀血；海风藤祛风通络，善除肾络伏风。甘草为使药，调和药性。诸药共奏健脾益肾、祛风通络之功效[10-11]。
本研究发现，两组治疗后肢体浮肿，腰膝酸软，神疲乏力，腹胀纳呆4项主症和形寒肢冷，口渴不欲饮，面色萎黄，大便稀溏，尿频或夜尿多5项次症评分低于治疗前。观察组治疗后上述中医证候评分均低于常规组治疗后。观察组总有效率高于常规组。上述结果提示，祛风通络健肾方治疗CGN可减轻中医证候，具有更好的疗效。祛风通络健肾方中君药黄芪的皂苷及多糖类成分可抑制肾小球系膜细胞增生，延缓肾小球硬化，并可通过抗氧化、扩张肾血管等机制减轻肾小球及足细胞损伤[12]。女贞子所含的多糖体可提高免疫功能、降低血浆黏度、抑制血小板聚集，从而保护肾小球内膜的完整性[13]。墨旱莲所含的螃蜞菊内酯、色素苷具有保肝、降压、调脂、抗氧化、抗炎、镇痛等作用[14]。杜仲所含的桃叶珊瑚苷、环烯醚萜类成分具有提高抗应激能力、改善能量代谢、增强机体免疫力等药理作用[15]。白茅根所含的三萜类化合物具有止血、利尿、抗炎等作用，可缓解肾小球血管痉挛，促进血压稳定[16]。
随着病程进展，CGN患者肾功能呈现进行性下降，并出现肾纤维化。24h Upro、SCr、BUN是临床常用的肾功能指标，其水平升高提示肾功能下降[17]。CysC与肾纤维化有关，参与肾间质纤维化过程[18]。TGF-β1可调节肾小球细胞外基质成分FN的功能，通过自分泌方式影响肾小管上皮细胞，引起肾纤维化[19]。TIMP-1可抑制基质金属蛋白酶活性，促进炎症细胞浸润，促进肾间质纤维化[20]。本研究发现，两组治疗后SCr、TGF-β1、BUN、FN、24h Upro、CysC、TIMP-1等低于治疗前；观察组治疗后肾功能指标、肾纤维化相关因子均低于常规组治疗后。这一结果提示，祛风通络健肾方治疗CGN可改善肾功能，抑制肾纤维化。这是由于黄芪所含的黄芪甲苷可下调肾小球系膜细胞NF-κB及FN蛋白的表达水平，抑制NF-κB信号转导，降低FN水平[21]。茯苓所含的茯苓素是一种四环三萜类化合物，与醛固酮结构相似，可拮抗醛固酮受体而起到利尿作用；茯苓多糖可抑制急、慢性炎症反应，阻止炎症渗出物沉积于肾组织，从而阻止肾纤维化进程[22]。
局部及全身炎症反应是CGN患者重要的病理改变，p38MAPK信号通路激活后可激活下游炎症信号通路，促进促炎因子释放，p38MAPK相对表达量提高提示肾脏炎症性损伤程度加重[23]。ICAM-1介导白细胞与内皮细胞之间发生黏附、促进血管硬化、肾小球硬化[24]。MCP-1可趋化并激活单核细胞，引起炎症细胞浸润、促炎因子和细胞外基质分泌，加重肾小球炎症性损伤和肾间质纤维化[25]。尿RBC水平反映血尿严重程度，CGN患者肾区毛细血管破裂可引起尿RBC升高[26]。hs-CRP是敏感的炎症指标，在炎症早期即可升高[27]。本研究发现，两组治疗后p38MAPK 相对表达量、ICAM-1、MCP-1、尿RBC、hs-CRP等低于治疗前；观察组治疗后上述5个指标均低于常规组治疗后。这一结果提示，祛风通络健肾方治疗CGN可减轻机体炎症反应，这是其治疗CGN的重要机制。
本研究还发现，观察组累计不良反应发生率与常规组相仿。这一结果提示，祛风通络健肾方治疗CGN的安全性良好，不会增加不良反应风险。
综上所述，祛风通络健肾方治疗CGN可改善肾功能，抑制肾纤维化，调节ICAM-1、MCP-1等因子水平，提高疗效。
基金
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  • 山西省基础研究计划项目(20210302123300)
文献
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2025年第43卷第5期
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doi: 10.13193/j.issn.1673-7717.2025.05.045
  • 首发时间：2026-10-30
  • 出版时间：2025-05-10
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山西省基础研究计划项目(20210302123300)
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    山西医科大学第二医院，山西 太原 030001
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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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