Objective: To observe the effect of electroacupuncture (EA) of "Biao-Ben acupoints" (Biao indicates pathogenic factors of disease; Ben refers to body constitution) on renal function, hemorheology and endothelial nitric oxide synthase (eNOS) level in patients with early diabetic kidney disease (DKD), so as to explore its mechanism underlying relieving early DKD.
Methods: A total of 120 patients with early DKD were selected and randomized into 3 groups: medication, conventional acupoints, and "Biao-Ben"acupoints groups by stratified randomization method, with 40 cases in each group. Patients of the me-dication group were treated by routine symptomatic supportive treatment (gleziquantel tablets or subcutaneous injection of insulin \[for hyperglycemia\], candesartan tablet \[hypertension\], simvastatin tablets \[hyperlipidemia\], etc.).Based on the medication group, patients of the conventional acupoint group were treated by EA of bilateral Feishu (BL13), Weiwanxiashu (EX-B3), Weishu (BL21), Shenshu (BL23), Sanyinjiao (SP6), Taixi (KI3) (main acupoints), etc., and those of the Biao-Ben acupoint group treated by EA of main acupoints Zhongwan (CV12), Fenglong (ST40), Xuehai (SP10) and Taichong (LR3) (Biao acupoints), and Guanyuan (CV4) and Zusanli (ST36) (Ben acupoints). The EA treatment was conducted one daily, 5 days a week for 8 weeks. The urine microprotein level in 24 h was detected using an automatic specific protein analyzer, followed by calcula-ting the urine albumin excretion rate (UAER). The serum creatinine (Scr), urea nitrogen (BUN) and cystatin (CysC) contents were detected by using an automatic biochemical analyzer, and the whole blood low-cut viscosity (ηbL), whole blood mid-cut viscosity (ηbM), whole blood high-cut viscosity (ηbH), plasma viscosity (ηp) and fibrinogen (FIB) levels were detected using an automatic hemorheology tester, and the serum eNOS and nitric oxide (NO) levels assayed using enzyme linked immunosorbent assay. The total clinical effective rates were compared and the adverse reactions of the treatment were recorded.
Results: Compared with the values before the treatment in each group, the levels of UAER, Scr, BUN, CysC, ηbL, ηbM, ηbH, ηp and FIB were all significantly decreased (P<0.01), while serum eNOS and NO levels significantly increased in the three groups after the treatment (P<0.01). Compared with the medication group, the levels of UAER, Scr, BUN, CysC, ηbL, ηbM, ηbH, ηp and FIB were notably lower (P<0.01, P<0.05), and serum eNOS and NO contents obviously higher in both the conventional acupoint and "Biao-Ben" acupoint groups (P<0.01). Comparison between the two EA groups showed that the levels of UAER, BUN, ηbL, ηbM, ηbH and ηp were lower (P<0.05), whereas the serum eNOS and NO contents were considerably higher (P<0.05) in the "Biao-Ben" acupoint group than in the conventional acupoint group. After the treatment, the total clinical effective rate of the "Biao-Ben" acupoint group was 89.74%(35/39), being significantly higher than those of both the conventional acupoint group (71.05%, 27/38,P<0.05) and medication group (64.10%, 25/39, P<0.05).
Conclusion: EA of "Biao-Ben" acupoints can improve renal function and reduce microcirculation disorders in patients with early DKD, which may be related to its function in up-regulating the levels of serum eNOS and NO.
目的：观察“标本配穴”电针疗法对早期糖尿病肾病(DKD)患者肾功能、血液流变学和内皮型一氧化氮合酶(eNOS)水平的影响，探讨“标本配穴”电针对早期DKD的保护作用及机制。方法：选取120例早期DKD患者，随机分为西药组、常规组、标本配穴组，每组40例。西药组予常规控制血糖、血压、血脂治疗；在西药组治疗的基础上，标本配穴组根据“标本配穴”法电针“标”穴中脘、丰隆、血海、太冲及“本”穴关元、足三里，常规组电针双侧肺俞、胃脘下俞、胃俞、肾俞、三阴交、太溪。各组均治疗1次/d，5 d/周，共治疗8周。分别于治疗前后采用全自动特异性蛋白质分析仪检测各组患者24 h尿微量白蛋白排泄率(UAER)；全自动生化分析仪检测血清肌酐(Scr)、尿素氮(BUN)、胱抑素(CysC)含量；全自动血流变测试仪检测全血低切黏度(ηbL)、全血中切黏度(ηbM)、全血高切黏度(ηbH)、血浆黏度(ηp)和纤维蛋白原(FIB)水平；酶联免疫吸附试验测定血清eNOS和一氧化氮(NO)水平。比较各组治疗的总有效率并观察其不良反应。结果：与本组治疗前比较，3组患者治疗后UAER及血清Scr、BUN、CysC，ηbL、ηbM、ηbH、ηp、FIB水平均显著下降(P<0.01)，血清eNOS、NO含量显著升高(P<0.01)。治疗后与西药组比较，常规组和标本配穴组UAER及血清Scr、BUN、CysC，ηbL、ηbM、ηbH、ηp、FIB水平降低(P<0.01，P<0.05)，血清eNOS、NO含量显著升高(P<0.01)；与常规组比较，标本配穴组UAER及血清BUN，ηbL、ηbM、ηbH、ηp降低(P<0.05)，血清eNOS、NO水平升高(P<0.05)。标本配穴组总有效率为89.74%(35/39)，常规组为71.05%(27/38)，西药组为64.10%(25/39)，标本配穴组明显高于常规组和西药组(P<0.05)。结论：“标本配穴”电针能改善早期DKD患者肾脏功能，减轻微循环障碍，其机制可能与上调血清eNOS和NO水平有关。.
Keywords: Diabetic kidney disease; Electroacupuncture; Endothelial nitric oxide synthase; Hemorheology; “Biao-Ben”acupoint combination.