益气养阴通络方对糖尿病肾病3期气阴亏虚夹瘀型的疗效及对MCP-1的影响

发布时间：2018-02-15 04:33

本文关键词： 益气养阴通络方糖尿病肾病气阴亏虚夹瘀单核细胞趋化因子-1(MCP-1)　出处：《南京中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：背景：糖尿病有多种常见的并发症,而糖尿病肾病是其中之一。1期和2期DN必需要肾脏病理才能诊断,3期DN通过检测尿液等就能诊断,临床诊断较为方便。3期DN通过积极治疗,可以修复肾脏损伤,病情得以缓解。早期DN的西医治疗措施包括控制血糖,运用ACEI或ARB,可是临床效果往往不理想。中医中药在糖尿病肾病的防治方面是有比较突出的优势。我们依据糖尿病肾病早期多见气阴不足,瘀阻肾络的特点,确立了益气养阴通络的治疗大法,拟订了益气养阴通络方来治疗DN3期气阴亏虚夹瘀型患者。目的：本研究将通过对DN3期气阴亏虚夹瘀型患者治疗前后的临床症状(口干、多饮、多尿等)、中医证候积分及理化检查(尿微量白蛋白、肾功能指标、尿MCP-1水平等)进行观察,评价益气养阴通络方治疗DN3期气阴亏虚夹瘀型患者的临床效果,并探讨其可能具有的抗炎机制。方法：设立实验组和对照组,各48例糖尿病肾病3期气阴亏虚夹瘀型患者,对照组予常规基础治疗,实验组在常规基础治疗的基础上联合中药汤剂益气养阴通络方,疗程均为12周,观察分析并进行统计检验患者的相关指标,比较两组患者的中医证候积分,尿微量白蛋白,及FPG、2hPG、Scr、BUN、尿MCP-1水平等的变化。结果：1、临床综合疗效：对照组治疗的总有效率为47.92%,治疗组治疗的总有效率89.58%,二组疗效比较有统计学差异(P0.05)2、对中医证候的改善作用：两组疗前后中医证候积分差值比较差别有统计学意义(P0.05),治疗组病人口干、多饮、舌红少苔等证候的消失数高于对照组,两组差别有统计学意义(P0.05)。3、对尿微量蛋白排除率(UAER)、空腹血浆葡萄糖(FPG)、血肌酐(Cr)、尿素氮(BUN)的影响：根据实验前后对实验组和对照组的尿微量蛋白排除率(UAER)进行检验,得出P0.05,有显著差异,说明效果明显；又对空腹血浆葡萄糖(FPG)、餐后2小时血浆葡萄糖(2hPG)进行检验,同样得出P0.05,效果显著；对血肌酐(Cr)、尿素氮(BUN)等指标行实验前后对比,两组无显著性差异(P0.05)。4、对尿MCP-1的影响：对尿MCP-1行实验前后对比,实验组患者尿MCP-1水平较治疗前均明显降低(P0.01),且实验组患者的尿MCP-1水平较对照组亦明显降低(P0.01)。结论：采用益气养阴通络方治疗DN3期气阴亏虚夹瘀型患者,能有效改善患者的临床症状,改善口干、多饮、舌红少苔等中医证候,降低患者的尿微量蛋白排除率(UAER)、FPG、2hPG等。益气养阴通络方发挥作用的机制可能与使肾脏组织细胞产生MCP-1减少,从而减轻炎症反应有关。
[Abstract]:Background: diabetes mellitus has many common complications, and diabetic nephropathy is one of them, stage .1 and stage 2 DN must need renal pathology to diagnose stage 3 DN by detecting urine, and clinical diagnosis is more convenient for stage .3 DN through active treatment. It can repair kidney damage and alleviate the condition. Western medicine treatment for early DN includes controlling blood sugar. Using ACEI or ARB, but the clinical effect is often not ideal. Traditional Chinese medicine has more prominent advantages in the prevention and treatment of diabetic nephropathy. According to the characteristics of deficiency of qi and yin and stagnation of kidney collaterals in early stage of diabetic nephropathy, The treatment method of supplementing qi and nourishing yin and unblocking collaterals was established, and the prescription of replenishing qi and nourishing yin and dredging collaterals was formulated to treat the patients with deficiency of qi and yin and blood stasis in DN3 stage. Objective: this study will be carried out through the clinical symptoms (dry mouth, multiple drinks) before and after treatment in patients with Qi and yin deficiency and blood stasis in DN3 stage. In order to evaluate the clinical effect of Yiqi Yangyin Tongluo recipe in treating the patients with Qi and Yin deficiency and stasis in DN3, we observed the syndromes and physical and chemical examination (urine microalbuminuria, renal function index, urine MCP-1 level, etc.) of diuresis, syndromes and syndromes of traditional Chinese medicine. Methods: the experimental group and the control group were set up, 48 cases of diabetic nephropathy were treated with Qi and Yin deficiency and stasis, the control group was treated with routine basic therapy. On the basis of routine basic treatment, the experimental group combined with traditional Chinese medicine decoction Yiqi Yangyin Tongluo recipe, the course of treatment was 12 weeks. The related indexes of the patients were observed and analyzed, and the TCM syndromes score and urinary microalbumin were compared between the two groups. Results: the total effective rate of the control group was 47.92 and the total effective rate of the treatment group was 89.58. There was statistical difference between the two groups in the improvement of TCM syndrome. Before and after treatment, the difference of TCM syndromes integral difference was statistically significant (P 0.05). The patients in the treatment group were dry in the mouth. The number of disappearance of syndrome such as more drinking, less tongue red and less fur was higher than that in the control group. The difference between the two groups was statistically significant (P0.05U. 3). The effects of urinary microalbumen exclusion rate (UAERA), fasting plasma glucose FPGU, serum creatinine creatinine (Cr) and urea nitrogen bun (bun) were measured before and after the experiment, and the UAERs of the experimental group and the control group were examined. The results showed that there was a significant difference in P0.05, which showed that the effect was obvious; the fasting plasma Glucose-FPGN and the plasma Glucose-2 hPGs were also tested, and P0.05 was also found to be effective. The blood creatinine (Cr), bun (bun), and so on, were compared before and after the experiment. There was no significant difference between the two groups (P0.05. 4). The effect of the two groups on urinary MCP-1 was compared before and after the experiment on urinary MCP-1. The level of urinary MCP-1 in the experimental group was significantly lower than that before treatment, and the level of urinary MCP-1 in the experimental group was significantly lower than that in the control group. Conclusion: Yiqi Yangyin Tongluo recipe was used to treat the patients with Qi and Yin deficiency and stasis in DN3 stage, and the level of urine MCP-1 in the experimental group was significantly lower than that in the control group. It can effectively improve the clinical symptoms of patients, improve the syndromes of dry mouth, drink more, tongue red and less fur, and reduce the rate of removing trace protein in urine. The mechanism of Yiqi Yangyin-Tongluo recipe may be related to the decrease of MCP-1 production in renal tissue cells, and the mechanism of the effect of Yiqi Yangyin-Tongluo recipe may be related to the decrease of MCP-1 production in renal tissue cells. So as to alleviate the inflammatory response related.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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