Objective: To study the curative effect of rehmannia glutinosa leaves total glycoside capsules and the role of mitochondrial autophagy on nucleos(t)ide drug-induced renal injury. Methods: Adefovir dipivoxil (ADV) was used to construct a hepatitis B virus (HBV) transgenic mouse model for renal injury. Renal function was measured in each group at one and two weeks of modeling. Mitochondrial autophagy indicators were measured at two weeks of modeling in renal tissue. Transmission electron microscopy was used to detect mitochondrial autophagy phenomena in renal tissue. The model was established for two weeks. Mouse with renal injury were treated with rehmannia glutinosa leaves total glycoside capsules or isotonic saline for eight weeks by intragastric administration. Renal function was measured. Renal tissue morphology was observed. Mitochondrial autophagy indicators were detected in renal tissue. The protective effect of different concentrations of verbascoside (the main active ingredient of rehmannia glutinosa capsule) was observed on HK-2 cell damage induced by ADV. HK-2 cells were divided into control, ADV, and ADV plus verbascoside groups. The effects of verbascoside at different times and concentrations were observed on the HK-2 mitochondrial autophagy indicators. Fifty patients with chronic hepatitis B were collected who presented with renal injury after treatment with nucleos(t)ide analogs. The random number method was used to divide 29 cases into a control group that received conventional treatment. The treatment group of 21 cases was treated with rehmannia glutinosa leaves total glycoside capsules on the basis of the control group. Serum creatinine (Scr) and urinary protein were detected at eight weeks.The χ(2) test or t-test was used for statistical analysis. Results: Compared with the control group, two weeks of modeling in the ADV group induced renal function injury in HBV mice. The expression of autophagy indicators was higher in the renal tissue of the ADV group than that of the control group. Transmission electron microscopy had revealed mitochondrial autophagy in the renal tissue of the ADV group. Compared with the control group, the renal function of HBV mice treated with rehmannia glutinosa leaves total glycoside capsules improved for two months, and the expressions of autophagy indicators were down-regulated.Verbascoside promoted proliferation in ADV-damaged HK-2 cells, and the expression of autophagy indicators was down-regulated compared with the ADV alone group. In 50 patients with renal function injury, the urinary protein improvement was significantly superior in the treatment group than that in the control group, with eighteen and three cases being effective and ineffective in the treatment group and 12 and 17 cases being effective and ineffective in the control group, with a statistically significant difference (χ(2) = 9.975 0, P = 0.001 6). Serum creatinine was decreased in the treatment group compared with the control group, with 11 and 10 cases being effective and ineffective in the treatment group and 12 and 17 cases being effective and ineffective in the control group, with no statistically significant difference (χ(2) = 0.593 5, P = 0.441 1). Conclusion: Rehmannia glutinosa leaves total glycoside capsule can improve the nucleos(t)ide drug-induced renal function injury in chronic hepatitis B, possibly playing a role via inhibiting PINK1/Parkin-mediated mitochondrial autophagy.
目的： 研究地黄叶总苷胶囊对核苷类药物所致肾损伤的疗效及线粒体自噬的作用。 方法： 使用阿德福韦酯（ADV）建立乙型肝炎病毒（HBV）转基因乙型肝炎小鼠肾损伤模型，造模1周及2周检测各组肾功能，造模2周时检测肾脏组织线粒体自噬指标，透射电镜检测肾脏组织线粒体自噬现象。后分别予地黄叶总苷胶囊或等渗盐水对肾损伤小鼠灌胃治疗8周，检测肾功能，观察肾脏组织形态并检测肾脏组织线粒体自噬指标。观察不同浓度毛蕊花糖苷（地黄叶总苷胶囊主要有效成分）对ADV引起HK-2细胞损伤后的保护作用。将HK-2细胞分为对照组、ADV以及ADV加毛蕊花糖苷组。观察不同时间及不同浓度毛蕊花糖苷对HK-2细胞线粒体自噬指标的影响。收集50例使用核苷（酸）类似物治疗后出现肾损伤的慢性乙型肝炎患者。随机数法分为对照组29例按常规治疗，治疗组21例在对照组的基础上给予地黄叶总苷胶囊治疗，8周检测血清肌酐（Scr）、尿蛋白。统计学方法用χ(2) 或t检验。 结果： ADV组造模2周引起HBV小鼠肾功能损伤，ADV组肾组织自噬指标表达高于对照组；透射电镜观察到ADV组肾脏组织线粒体自噬现象。与对照组相比，地黄叶总苷胶囊治疗2个月HBV小鼠肾功能好转，自噬指标表达下调。毛蕊花糖苷促进ADV损害的HK-2细胞的增殖，且较单独ADV组自噬指标表达下调。50例有肾功能损伤的患者中，治疗组的尿蛋白改善显著优于对照组，治疗组有效18例、无效3例，对照组有效12例、无效17例，差异有统计学意义（χ(2) = 9.975 0，P = 0.001 6）。治疗组血肌酐减低，治疗组有效11例、无效10例，对照组有效12例、无效17例，2组差异无统计学意义（χ(2) = 0.593 5，P = 0.441 1）。 结论： 地黄叶总苷胶囊可改善核苷（酸）类似物所致慢性乙型肝炎的肾功能损伤，可能通过抑制PINK1/PARKIN介导的线粒体自噬发挥作用。.
Keywords: Acteoside; Mitochondrial autophagy; Nucleos(t)ide analogues; Rehmannia glutinosa leaves total glycoside; Renal insufficiency.