【摘要】 目的 探討六味地黃丸對糖尿病合并高血壓病所致慢性腎臟疾病（chronic kidney disease，CKD）患者腎損害及胰島素抵抗的影響。 方法 收集2008年7月1日-2010年7月1日在成都市第五人民醫院住院部及門診就診的120例糖尿病合并高血壓病患者相關資料，隨機分為對照組和治療組各60例，對照組給予西醫治療，治療組在西醫治療的基礎上加用六味地黃丸，12周為1個療程。觀察治療前后尿白蛋白∕尿肌酐（ACR），內生肌酐清除率（Ccr）及胰島素抵抗指數（HOMA-IR）、C反應蛋白（CRP）、血脂等指標的變化。 結果 治療后治療組與對照組比較，ACR（P=0.012）、血清CRP（P=0.000）和低密度脂蛋白（P=0.014）差異有統計學意義。HOMA-IR治療前后結果差異有統計學意義（Plt;0.05），但與對照組比較差異無統計學意義（Pgt;0.05）。 結論 六味地黃丸可改善腎損害實驗室指標，改善胰島素抵抗，減輕體內炎性反應，改善脂代謝異常。【Abstract】 Objective To investigate the efficacy of Liuwei Dihuang pill on patients with chronic kidney disease (CKD) induced by diabetes mellitus and hypertensive diseases in terms of renal injury and insulin resistance. Methods We collected the clinical data of 120 patients with diabetes mellitus and hypertensive diseases in the Fifth People’s Hospital of Chengdu from July 1, 2008 to July 1, 2010, and randomly divided them into two groups. In the control group, patients only received therapy of western medicine, while for patients in the treatment group, Liuwei Dihuang pills were added on the basis of western medicine treatment with a treatment course of 12 weeks. Before and after the treatment, urinary albumin / urinary creatinine (ACR), creatinine clearance rate (Ccr) and insulin resistance index (HOMA-IR), C-reactive protein (CRP), and lipids were evaluated and compared. Results After treatment, ACR (P=0.012), serum CRP (P=0.000) and low-density lipoproteins (LDL) (P=0.014) for the treatment group were significantly different from those for the control group. HOMA-IR for the treatment group before and after the treatment was significantly different (Plt;0.05), while there was no statistical difference between the two groups in HOMA-IR (Pgt;0.05). Conclusion Kidney-nourishing therapy with Liuwei Dihuang pill can improve the laboratory indicators of renal injury or insulin resistance, reduce the inflammatory response in vivo, and ameliorate disorders of lipid metabolism.
Objective To examine the associations of cumulative serum uric acid to high-density lipoprotein cholesterol ratio (cumUHR) and the trajectories of uric acid to high-density lipoprotein cholesterol ratio (UHR) with the risk of new-onset cardiometabolic multimorbidity (CMM) in middle-aged and older Chinese adults. Methods This study utilized data from the China Health and Retirement Longitudinal Study. A total of 2597 participants who were not diagnosed with CMM at baseline were included. First, K-means clustering analysis was applied to identify UHR trajectories over the 2012–2015 period. In addition, multivariable logistic regression models were used to assess the associations of cumUHR and UHR trajectories with CMM risk. Restricted cubic spline (RCS) model was performed to explore the dose-response relationship between cumUHR and CMM risk. Moreover, subgroup analyses and interaction tests were conducted to examine potential effect modifications by age and sex, etc. Finally, the predictive performance of cumUHR and UHR trajectories for CMM was assessed using receiver operating characteristic (ROC) curve analysis. Results The cumulative incidence of CMM was 3.31%, with 86 cases developing during the follow-up period until 2020. K-means clustering identified three groups of cumUHR trajectories. Multivariable logistic regression found a significant positive association between cumUHR and CMM risk [odds ratio (OR)=43.41, 95% confidence interval (CI) (4.32, 412.06), P=0.001]. Compared to the low-stable trajectory group, individuals in the sustained-high trajectory group had a significantly higher risk of developing CMM [OR=2.48, 95%CI (1.22, 4.99), P=0.011]. RCS analysis demonstrated a linear dose-response relationship between cumUHR and CMM risk (Poverall=0.004, Pnon-linear=0.727). The ROC analysis demonstrated area under the curve values of 0.755 and 0.759 for cumUHR and UHR trajectories, respectively. Conclusions Both cumUHR exposure and a sustained-high UHR trajectory are significantly associated with an increased risk of CMM in middle-aged and older Chinese adults. Long-term dynamic monitoring of UHR is of significant importance for the early prevention of CMM.