大株红景天对中老年糖尿病肾病（气虚血瘀型）的临床干预研究

发布时间：2018-01-26 16:48

本文关键词： 大株红景天糖尿病肾病气虚血瘀型血管内皮生长因子热休克蛋白70　出处：《云南中医学院》2017年硕士论文　论文类型：学位论文

【摘要】：随着当今社会经济的发展、人民生活水平提高、老龄化问题的凸显以及我国糖尿病的多发,越来越多患者生命健康和生活质量都受到了极大的影响。糖尿病肾病作为糖尿病微血管病变最常见也是最严重的并发症之一,因其发病隐匿,病程缠绵难愈,许多患者发现时都已处于病情的中晚期而不能得到及时的救治和预防,相应的治疗仅能是改善症状以及治疗相关的并发症,减缓疾病的进程。祖国医学对该病的治疗和记载有悠久的历史,近几年来,很多学者和专家应用中药或是中药制剂治疗糖尿病肾病都取得了一定的疗效和成果。本研究旨在通过观察成分明确的大株红景天注射液对糖尿病肾病(气虚血瘀型)的相关实验指标的变化以及相应的中医临床症状的改善状况,为糖尿病肾病的治疗提供新依据。目的:通过观察大株红景天治疗糖尿病肾病(气虚血瘀证)患者中医临床症状积分和血管内皮生长因子(VEGF)、热休克蛋白70(HSP70)的变化,探讨大株红景天对糖尿病肾病(气虚血瘀型)的治疗机制,为拓展药物的治疗范围提供临床依据和支持。方法:将糖尿病肾病(气虚血瘀型)患者按照随机对照的方式随机分为对照组和治疗组各30例,对照组采取常规的西医治疗,治疗组在常规西医治疗对的基础上加用大株红景天注射液,疗程14天。观察两组患者神疲乏力、面色无华、浮肿等中医症状变化,以及血管内皮生长因子(VEGF)、热休克蛋白70(HSP70)、空腹血糖、糖化血红蛋白、血尿素氮、肌酐、尿酸、小便蛋白定量等实验指标的变化,进行数据分析,评价实验用药的治疗效果。结果:1.试验前,两组患者的一般情况比较无统计学意义(P0.05),具有临床可比性;2.中医部分:(1)各症状积分:两组面色无华、神疲乏力及少气懒言、腰痛、浮肿、肌肤甲错、肢体麻木症状治疗后较治疗前均有明显改善,具有统计学意义(P0.01)。治疗后治疗组在面色无华、神疲乏力及少气懒言、腰痛、肌肤甲错、肢体麻木症状改善优于对照组,具有统计学意义(P0.05),而在浮肿症状改善方面,效果不明显,无统计学意义(P0.05)。(2)症状总积分比较:治疗组和对照组在治疗后症状总积分均有所下降,具有统计学意义(P0.01)。治疗后治疗组积分下降情况优于对照组,有统计学意义(P0.05);(3)中医疗效比较:治疗后治疗组的总有效率为90%,治疗后治疗组对症状改善优于对照组,具有统计学意义(P0.05);3.西医方面:(1)临床观测指标比较:加用大株红景天的治疗组治疗后可以减少VEGF、HSP70的表达(P0.05),与对照组效果相比,具有统计学意义(P0.05);(2)治疗后治疗组降血尿素氮和尿酸的效果优于对照组,具有统计学意义(P0.05);(3)治疗后治疗组对空腹血糖、糖化血红蛋白、肌酐、24小时尿蛋白定量等指标的改善,与对照组相比,无统计学意义(P0.05)(4)西医疗效:治疗组糖尿病肾病有效率为83.3%,与对照组比较,无统计学意义(P0.05)。4.安全性评价:两组患者治疗前后的血常规(RBC、WBC、HGB、PLT)、肝功能(ALT、AST)、大便常规+隐血、心电图等,差异无统计学意义(P0.05);在观察周期内,所有患者均为出现不良反应。结论:1.大株红景天可以改善糖尿病肾病患者在中医方面的气虚血瘀症状;2.大株红景天可以降低患者血尿素氮和尿酸指标;3.大株红景天可以影响糖尿病肾病患者血管内皮生长因子(VEGF)、热休克蛋白70(HSP70)的表达,起到抗氧化应激的作用。
[Abstract]:With the development of social economy, people's living standards improve, highlighting the problem of aging and diabetes mellitus in China sent more, more patients health and quality of life and have been greatly affected. Diabetic nephropathy and diabetic microangiopathy as the most common complication is one of the most serious, because of its occult onset, duration of lingering many patients have been found, in the condition of advanced and can not get timely treatment and prevention, the corresponding treatment can only improve symptoms and treatment related complications, slow the progression of the disease. There is a long history of traditional Chinese medicine treatment and records of the disease, in recent years, many scholars and experts in the application Chinese medicine or traditional Chinese medicine preparation for treating diabetic nephropathy has curative effect and some achievements. This study was designed to observe the composition of clear Sofren injection for diabetes Diabetic nephropathy (Qi deficiency and blood stasis) changes in laboratory parameters and the clinical symptoms of the corresponding improvement, provide a new basis for the treatment of diabetic nephropathy. Objective: To observe the sofren treatment of diabetic nephropathy (Qi deficiency and blood stasis syndrome) in patients with clinical symptoms and vascular endothelial growth factor (VEGF), heat shock protein 70 (HSP70) changes of Rhadiola extract on diabetic nephropathy (Qi deficiency and blood stasis type) treatment mechanism, to provide clinical basis and support for the development of drug treatment. Methods: diabetic nephropathy (Qi deficiency and blood stasis type) were randomly controlled way, randomly divided into control group and treatment group with 30 cases in each group. The control group took the conventional western medicine treatment, the treatment group in the conventional western medicine treatment on the basis of on the use of Sofren injection, a course of 14 days. Two groups were observed in patients with fatigue, lusterless complexion, swelling and other traditional Chinese Medicine The changes of symptoms, and vascular endothelial growth factor (VEGF), heat shock protein 70 (HSP70), fasting blood glucose, glycosylated hemoglobin, blood urea nitrogen, creatinine, uric acid, urine protein quantitative change experiment index, data analysis, evaluation of experimental drug treatment effect. Results: 1. before the test, the general situation of two group of patients was not statistically significant (P0.05), with clinical comparability; 2. part: (1) the TCM symptom score: two groups of complexion, Shenpi fatigue, less gas lazy words, low back pain, edema, skin armour fault, numbness symptoms after treatment were significantly improved compared with before treatment, with statistical significance (P0.01). The treatment group in complexion, Shenpi fatigue, less gas lazy words, back pain, skin armour fault, numbness symptoms better than the control group, with statistical significance (P0.05), and swelling in symptom improvement, the effect is not obvious, no statistical significance (P0.05). (2) the total scores of symptoms: the treatment group and control group decreased in the total score of symptoms after treatment were, with statistical significance (P0.01). The treatment group score decreased than the control group, there was statistical significance (P0.05); (3) Chinese medicine curative effect comparison: after treatment in the treatment group the total efficiency 90%, after treatment of symptoms better than the control group, with statistical significance (P0.05); 3. (1): Western medicine clinical observation index: compared with the treatment group after treatment of sofren can reduce the expression of HSP70 (VEGF, P0.05), compared with the control group, with statistical significance (P0.05); (2) the effect of group blood urea nitrogen and uric acid treatment after treatment than the control group, with statistical significance (P0.05); (3) after treatment, the fasting blood glucose, glycosylated hemoglobin, creatinine, 24 hour urinary protein quantitative index improved, compared with the control group, no significant The significance of (P0.05) (4) the curative effect of Western medicine: the treatment group of diabetic nephropathy was 83.3%, compared with the control group, no statistical significance (P0.05).4. safety evaluation: two groups of patients before and after treatment the blood routine (RBC, WBC, HGB, PLT), liver function (ALT, AST), stool routine + occult blood, electrocardiogram, the difference was not statistically significant (P0.05); in the observation period, all patients had adverse reactions. Conclusion: 1. strains of Rhodiola can improve symptoms in traditional Chinese medicine of qi deficiency and blood stasis in patients with diabetic nephropathy; 2. strains of Rhodiola can reduce blood urea nitrogen and uric acid index; 3. strains of Rhodiola can grow effect of vascular endothelial growth factor in patients with diabetic nephropathy (VEGF), heat shock protein 70 (HSP70) expression to oxidative stress.

【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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