补脾肾活血法对早期糖尿病肾病患者肾小管保护作用的临床研究

发布时间：2018-03-14 02:33

  本文选题：补脾肾活血法　切入点：早期糖尿病肾病　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察早期糖尿病肾病患者用补脾肾活血中药治疗前后尿液中尿NGAL、β2-MG、NAG,血糖、血脂等生化指标及炎症反应标志物IL-6、氧化应激标志物SOD的变化,从而探讨补脾肾活血中药对早期糖尿病肾病患者肾小管保护作用的可能机制。方法:选择在广州中医药大学祈福医院肾内科住院的符合纳入标准的早期糖尿病肾病患者60例,随机分为对照组和治疗组,对照组予基础治疗,治疗组在对照组的基础上加用补脾肾活血中药。4周后,分别检测两组治疗前后尿NGAL、尿β2-MG、尿NAG,血肌酐、内生肌酐清除率、血糖、血脂等各项生化指标,炎症指标IL-6以及氧化应激标志物SOD水平。结果:(1)两组治疗前后尿NGAL、尿β2-MG、尿NAG比较:相比治疗前,治疗组治疗后尿NGAL、β2-MG、NAG均有所下降,差异有统计学意义(P0.05);两组间比较,治疗后治疗组尿NGAL、β2-MG均较对照组低,差异有统计学意义(P0.05),治疗组尿NAG低于对照组,但两者间无显著差异(P0.05)。(2)两组治疗前后血糖、血脂、血压比较:相比治疗前,治疗组治疗后血糖、血脂、血压均有所下降,差异有统计学意义(P0.05);两组间比较,治疗后治疗组血糖、血脂明显较对照组低,差异有统计学意义(P0,05);治疗后治疗组舒张压明显低于对照组,差异有统计学意义(P0.05),治疗后治疗组收缩压稍低于对照组,但差异无统计学意义(P0.05)。(3)两组治疗前后炎症指标IL-6、氧化应激指标SOD比较:治疗前后比较,治疗后治疗组IL-6较治疗前降低,SOD较治疗前升高,差异有统计学意义(P0.05);治疗后两组间比较,治疗组IL-6较对照组降低,SOD较对照组升高,差异有统计学意义(P0.05)。(4)两组治疗前后肾功能比较:治疗组治疗前后比较,治疗后血肌酐较治疗前低,差异无显著意义(P0.05);内生肌酐清除率较治疗前下降,差异有统计学意义(P0.05),治疗后两组间比较,治疗组血肌酐、内生肌酐清除率较对照组低,差异有统计学意义(P0.05)(5)相关性分析:尿NGAL与其他肾损伤标志物尿β2-MG、尿NAG、尿微量白蛋白呈正相关关系,r值分别为0.502、0.422、0.684(P0.05);尿NGAL与血糖、血脂、收缩压、舒张压呈正相关关系,r值分别为0.281、0.435、0.355、0.611(P0.05);尿NGA1与炎症反应标志物IL-6呈正相关关系,r值为0.325(P0.05);尿NGAL与氧化应激标志物SOD呈负相关关系,r值为-0.570(P0.05);尿NGAL与血肌酐无相关关系,r值为-0.004,(P0.05);与内生肌酐清除率呈正相关关系,r值为0.562(P0.05)。结论:(1)补脾肾活血法可降低早期糖尿病肾病患者尿NGAL水平,有效保护早期糖尿病肾病患者的肾小管,延缓糖尿病肾病进展。(2)补脾肾活血法可降低早期糖尿病肾病患者IL-6水平,提高早期糖尿病肾病患者SOD水平,可有效改善早期糖尿病肾病患者体内微炎症状态及氧化应激反应,具有抗炎症反应、抗氧化应激作用。(3)补脾肾活血法可有效调节早期糖尿病肾病患者血糖、血脂水平。(4)补脾肾活血法可有效调节早期糖尿病肾病患者血压水平,降低肾小球滤过压,降低肾内高灌注。(5)尿NGAL可与尿β2-MG、尿NAG、尿微量白蛋白共同成为糖尿病早期肾损伤标志物。(6)补脾肾活血法保护早期糖尿病肾病患者肾小管的机制可能是与其具有调节血糖、血脂、血压,抗炎症反应,抗氧化应激,降低肾内高灌注等作用有关。
[Abstract]:Objective: To observe the effect of early diabetic nephropathy patients with spleen and kidney blood before and after treatment of traditional Chinese medicine supplement urine NGAL, beta 2-MG, NAG, blood glucose, blood lipid and other biochemical indicators of inflammation and oxidative stress markers IL-6, changes of markers of SOD, and to explore the possible mechanism of bupishenhuoxue therapy on early diabetic nephropathy in patients with renal tubule protective effect. Methods: Clifford Hospital of Nephrology at the Guangzhou University of Chinese Medicine hospital in accordance with the inclusion criteria of patients with early diabetic nephropathy in 60 cases, were randomly divided into control group and treatment group, control group received basic treatment, the treatment group in the control group based on the use of bupishenhuoxue therapy after.4 weeks, were detected before and after two the treatment group NGAL urine, urine beta 2-MG, urine NAG, serum creatinine, creatinine clearance, blood glucose, blood lipids and other biochemical indexes, inflammation index IL-6 and markers of oxidative stress in SOD level. Results: (1) the two groups before and after treatment Urine NGAL, urine beta 2-MG, urinary NAG compared before treatment, after treatment of urinary NGAL, beta 2-MG, NAG were decreased, the difference was statistically significant (P0.05); comparison between the two groups, the treatment group NGAL urine after treatment, beta 2-MG was lower than the control group, the difference was statistically significant (P0.05 the treatment group), urine NAG lower than the control group, but there was no significant differences between them (P0.05). (2) the two groups before and after treatment of blood glucose, blood lipid, blood pressure compared before treatment, after treatment, blood glucose, blood lipid, blood pressure decreased, the difference was statistically significant (P0.05); comparison between the two groups. The treatment group after treatment of blood glucose, blood lipids were significantly lower than the control group, the difference was statistically significant (P0,05); after treatment, diastolic blood pressure was significantly lower than the control group, the difference was statistically significant (P0.05). After treatment, the systolic blood pressure was slightly lower than the control group, but the difference was not statistically significant (P0.05). (3) IL-6 the inflammatory indexes before and after treatment in two groups, Comparison of oxidative stress index SOD: comparison before and after treatment, after treatment, IL-6 was decreased, SOD increased than that before treatment, the difference was statistically significant (P0.05); comparison between the two groups after treatment, IL-6 treatment group than the control group decreased, SOD increased compared with the control group, the difference was statistically significant (P0.05). (4) comparison of renal function before and after treatment in two groups: the treatment group after treatment, serum creatinine after treatment than before treatment, no significant difference (P0.05); creatinine clearance rate decreased than that before treatment, the difference was statistically significant (P0.05). The comparison between the two groups after treatment, treatment group, serum creatinine, creatinine clearance rate is lower than the control group, the difference was statistically significant (P0.05) (5) correlation analysis: markers of urine beta 2-MG, urinary NGAL and other renal injury urinary NAG, urinary albumin positive correlation, r = 0.502,0.422,0.684 (P0.05); urine NGAL and blood glucose, blood lipid, blood pressure Shu. The pressure was positively correlated, r = 0.281,0.435,0.355,0.611 (P0.05); urinary NGA1 and inflammatory markers of IL-6 were positively correlated. The R value was 0.325 (P0.05); urinary NGAL and markers of oxidative stress is negatively related to SOD, r = -0.570 (P0.05); no correlation between urinary NGAL and serum creatinine, R value is -0.004 (P0.05); the clearance rate was positively correlated with the endogenous creatinine, r = 0.562 (P0.05). Conclusion: (1) bupishenhuoxue therapy can reduce the level of urinary NGAL in patients with early diabetic nephropathy, the effective protection of early diabetic nephropathy in patients with renal tubule, slow the progression of diabetic nephropathy (. 2) bupishenhuoxue therapy can reduce the level of IL-6 in patients with early diabetic nephropathy, improve the level of SOD in patients with early diabetic nephropathy, can effectively improve the patients with early diabetic nephropathy and oxidative stress state of micro inflammation, has anti-inflammatory, anti oxidative stress. (3) bupishen Circulation can effectively regulate blood sugar and blood lipid levels in patients with early stage diabetic nephropathy. (4) bupishenhuoxue therapy can regulate the level of blood pressure in patients with early diabetic nephropathy, reduce glomerular filtration pressure, reduce renal hyperperfusion. (5) the urine NGAL and urine beta 2-MG, urinary NAG, urinary albumin as early diabetic renal injury markers. (6) bupishenhuoxue therapy of early diabetic nephropathy in patients with renal tubular protective mechanism may be associated with regulating blood glucose, blood lipid, blood pressure, anti-inflammatory, anti oxidative stress, reduce a kidney high perfusion effect.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R692.9
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本文编号：1609214