清热利湿益气养阴活血法联合西药治疗糖尿病合并尿路感染的临床研究

发布时间：2018-01-23 08:22

本文关键词： 清热利湿益气养阴活血法糖尿病合并尿路感染中医药　出处：《北京中医药大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究目的观察清热利湿益气养阴活血法的中西医结合方案治疗糖尿病合并尿路感染的临床症状、实验室指标及总体疗效,探索中西医结合治疗糖尿病合并尿路感染的优势,为糖尿病合并尿路感染提供诊疗方案。研究方法采用前瞻性、随机对照研究,收集2013年12月1日～2015年1月1日望京医院门诊及住院病例中符合纳入标准的69例患者,将患者随机分成试验组34例,对照组35例,试验组剔除3例,脱落1例,对照组剔除2例,脱落3例,试验组、对照组各完成30例。试验组给予中药配合西医治疗,对照组给予西医治疗。西医治疗包括西医强化降糖治疗和抗生素抗感染治疗,中医药治疗采用清热利湿益气养阴活血法,疗程共计2周,停药后6周进行随访。治疗后2周比较两组治疗后中医症状、细菌清除率、实验室指标的差异,停药后6周随访统计复发率,观察中西医综合治疗方案治疗糖尿病合并尿路感染的临床疗效。研究结果：1、对全部入组病例的年龄、性别、糖尿病病程、BMI、糖化血红蛋白、空腹及餐后血糖结果分析显示,糖尿病合并尿路感染患者年龄多集中于50-75年龄段；高发人群为绝经后中老年女性；高发于DM病程在5年以上,BMI指数大于23kg/m2及糖化血红蛋白水平高于7%,FPG大于7.3mmol/L,2hPG大于8.7mmol/L的患者。2、对致病菌种分布情况分析结果显示,主要致病菌为革兰氏阴性杆菌共计48株占80%,革兰氏阳性菌共计10株,占16.7%,真菌2株,占3.3%。大肠埃希氏菌为最主要致病菌,共分离出41株,占总体68.3%,其次为葡萄球菌属,共分离出6株,占总体10%,粪肠球菌4株,占总体6.7%,肺炎克雷伯菌共分离出4株,占总体6.7%。3、试验组、对照组疗效结果比较,总体疗效试验组的总有效率93.3%,对照组的总有效率86.7%,试验组总体疗效显著优于对照组(P0.05)。试验组中医证候疗效总有效率96.7%,对照组中医证候疗效总有效率86.7%,试验组中医证候疗效显著优于对照组(P0.05),小便频急而短、尿道涩痛、倦怠乏力、咽干口渴4个主症,气短懒言、手足心热2个次症改善试验组极显著优于对照组(P0.01),尿道灼热、小腹刺痛2个次症试验组显著优于对照组(P0.05),腰酸痛症状的改善试验组与对照组未显示统计学差异(P0.05)。4、治疗后试验组细菌清除率为90%,对照组细菌清除率76.7%,试验组细菌清除率大于对照组,差异无统计学意义(P0.05)。疗后停药6周随访试验组尿路感染复发率为11.1%,对照组为34.8%,两组具有显著统计学差异(P0.05)。5、治疗前后试验组与对照组尿镜检WBC均值下降结果显示,试验组WBC均值小于对照组WBC均值,有显著统计学差异(P0.05)。治疗前后试验组与对照组患者的空腹、餐后2h血糖均值下降,无统计学差异(P0.05)。治疗前后两组尿镜检WBC差值与餐后2小时血糖差值的相关性分析结果显示尿镜检WBC差值与餐后2小时血糖差值存在线性关系,说明2hPG差值越大,尿镜检WBC差值越大,提示积极控制餐后2小时血糖对控制感染有意义。结论：清热利湿益气养阴活血法联合抗生素治疗糖尿病并发尿路感染可有效缓解临床症状,提高细菌清除率,降低尿路感染复发率,并且疗效优于抗生素治疗。中西医综合治疗可有效防治糖尿病并发尿路感染,提高尿路感染患者痊愈率。
[Abstract]:Objective: To observe the qingrelishi bvqnyabc combining traditional Chinese and Western medicine clinical symptoms in treatment of diabetes complicated with urinary tract infection, laboratory index and overall curative effect, treatment of diabetes complicated with urinary tract infection and the advantage of combining traditional Chinese and Western medicine treatment of urinary tract infection, provide for diabetic patients. Methods a prospective, randomized study, collection from December 1, 2013 to January 1, 2015 in Wangjing Hospital outpatient and inpatient cases in 69 cases in accordance with the inclusion criteria were randomly divided into experimental group 34 cases, control group 35 cases, 3 cases were removed, off 1 cases, control group 2 cases were excluded, 3 cases of loss, experimental group, control group completed 30 cases. The experimental group was given traditional Chinese medicine combined with western medicine treatment, the control group received western medicine. Western medicine including western medicine intensivehypoglycemictherapies and antibiotic treatment, Chinese medicine treatment with Yiqi Qingre dampness Nourishing yin and activating blood, 2 weeks of treatment, follow-up 6 weeks after drug withdrawal. 2 weeks after treatment were compared between the two groups after treatment of TCM symptoms, the bacterial clearance rate, the difference of laboratory index, 6 week follow-up recurrence rate after stopping, to observe the clinical effect of integrated traditional Chinese and Western medicine treatment regimen in the treatment of diabetes complicated with urinary tract infection. Results: 1 of all the patients, age, gender, duration of diabetes, BMI, HbA1c, fasting and postprandial blood glucose results, more concentrated in the 50-75 age age in patients with diabetes complicated with urinary tract infection; high risk population for postmenopausal elderly women; high incidence in the course of DM in more than 5 years. The BMI index is greater than 23kg/m2 and HbA1c levels higher than 7%, FPG greater than 7.3mmol/L, 2hPG than 8.7mmol/L in patients with.2, the pathogenic bacteria distribution analysis showed that the main pathogens were gram negative bacilli 48 strains accounted for 80% Gram positive bacteria, 10 strains, accounting for 16.7%, 2 strains of fungi, accounting for 3.3%. of Escherichia coli as the main pathogenic bacteria were isolated from 41 strains, accounting for 68.3% of the overall, followed by Staphylococcus, 6 strains were isolated, accounting for 10% of the overall, Enterococcus faecalis 4 strains, accounting for 6.7% of the overall primary pneumonia, Craig 4 strains of bacteria were isolated, accounting for the overall 6.7%.3, experimental group, control group curative effect comparison, total effective rate was 93.3% in the overall efficacy of the experimental group, the control group the total efficiency of 86.7%, the overall effect of the experimental group was significantly better than the control group (P0.05). The efficacy of TCM treatment group total effectiveness 96.7%, the control group curative effect the total effective rate of TCM Syndromes of 86.7% groups, TCM syndrome curative effect was significantly better than the control group (P0.05), acute urinary frequency and short, urethral acerbity pain, lassitude, throat thirsty 4 main symptoms, shortness of breath, hand foot heart heat 2 times improvement test group was significantly better than the control group (P0.01) the hot thorn, urethral, abdomen 2 times of pain in experimental group was significantly better than the control group (P0.05), improve the symptoms of lumbar pain in experimental group and control group showed no significant difference (P0.05.4), experimental group after treatment, the bacterial clearance rate was 90%, the control group, the bacterial clearance rate was 76.7%, the bacterial clearance rate of experimental group than the control group, the difference was not statistically significant (P0.05) after discontinuation of therapy. The recurrence rate was 11.1% after 6 weeks of test group, urinary tract infection, the control group was 34.8%, two groups had significant difference (.5, P0.05) before and after treatment in the experimental group and the control group of urine microscopic examination results showed that the average WBC decreased, the mean WBC of the experimental group than the control group with WBC mean. Significant difference (P0.05) before and after treatment. The experimental group and the control group of patients with fasting and postprandial 2H mean blood glucose decreased, no significant difference (P0.05). The two groups before and after treatment urine microscopy WBC difference and postprandial blood glucose difference correlation analysis showed that 2 hour urine microscopy WBC There is a linear relationship between the difference of blood glucose 2 hours after meal difference and 2hPG difference, the greater the greater the difference in microscopic examination of urine WBC, suggesting that the positive control 2 hour postprandial blood glucose control of infection. Conclusion: the significance of infection can effectively relieve the clinical symptoms of qingrelishi bvqnyabc combined with antibiotics in the treatment of diabetes complicated with urinary bacteria, improve the clearance rate, reduce the recurrence rate of urinary tract infection, and the curative effect is better than antibiotic treatment. Treatment of TCM and Western medicine can effectively prevent diabetes complicated with urinary tract infection, improve the cure rate of the patients with urinary tract infection.

【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1;R691.3

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