糖肾宝冲剂治疗糖尿病肾病的临床研究

发布时间：2018-04-15 17:24

本文选题：糖尿病肾病 + 糖肾宝冲剂　；参考：《广西中医药大学》2016年硕士论文

【摘要】：目的:以宏观辨证与微观辨证相结合为理论依据,采用益气化瘀法为治法,观察中药复方糖肾宝冲剂治疗糖尿病肾病(diabetic nephropathy,DN)的临床疗效,并探讨其可能作用机制。方法:选择2014年3月至2015年12月广西中医药大学附属瑞康医院肾病内科住院及门诊随诊的DN患者,中医证型属气虚血瘀型病例94例,全部为2型糖尿病。将患者按照随机数字表法分为对照组和治疗组,各47例。两组患者在年龄、性别、糖尿病病程、DN分期、合并症等方面无统计学差异(P0.05)。对照组采用控制血压、血糖,调节血脂等常规治疗,并在此基础上加服予厄贝沙坦,治疗组在对照组基础上加服中药复方糖肾宝冲剂,每日一剂,分2次服用,疗程12周。观察两组治疗前后空腹血糖(FPG)、糖化血红蛋白(HbA1c)、血压、血清肌酐(Scr)、血清胱抑素C(Cyst c)、尿N-乙酰β-D氨基葡萄糖苷酶(NAG)、尿白蛋白排泄率(UAER)、24h尿微量白蛋白、血清单核细胞趋化蛋白-1(MCP-1)、细胞间黏附分子-1(ICAM-1)、白细胞介素-6(IL-6)、白细胞介素-17(IL-17)、中医证候总积分及中医证候疗效等的变化。结果:(1)两组患者治疗前后FPG、Hb A1c无显著性差异(P0.05)。(2)与治疗前比较,治疗后两组患者血压均明显降低(P0.01),但组间比较无显著性差异(P0.05)。(3)与治疗前比较,治疗后两组Scr变化均无统计学意义(P0.05);治疗后两组Cyst c较治疗前均降低明显(P0.05,P0.01),但治疗组明显低于对照组(P0.05)。(4)与治疗前对比,两组患者治疗后24h尿微量白蛋白及UAER均明显降低(P0.05,P0.01),但治疗组低于对照组(P0.05,P0.01);治疗后治疗组尿NAG较治疗前明显降低(P0.01),且低于对照组(P0.01),而对照组治疗前后差异无统计学意义(P0.05)。(5)两组治疗后血清MCP-1、ICAM-1、IL-6、IL-17的水平与同组治疗前比较均有明显降低(P0.01),但治疗组明显低于对照组(P0.05,P0.01)。(6)治疗后两组中医证候积分均明显降低(P0.01),但治疗组治疗后中医证候积分显著低于对照组(P0.05)。(7)治疗组总有效率80.85%,对照组68.09%,差异有统计学意义(P0.01)。(8)治疗前后,两组患者均无恶性心律失常发生,肝功能及血常规未见明显异常,相关指标比较,差异均无统计学意义(P0.05),且组间比较,均无统计学意义(P0.05)。结论:(1)糖肾宝冲剂可显著改善DN患者临床症状,疗效确切,无明显毒副作用,安全性好;(2)糖肾宝冲剂能降低DN患者血清Cyst c,减少UAER及24h尿微量白蛋白,降低尿NAG,减轻肾脏损害;(3)糖肾宝冲剂能降低DN患者血清MCP-1、IL-6、ICAM-1、IL-17等多种炎症因子水平;(4)糖肾宝冲剂对DN患者肾脏具有明显保护作用,其机制可能与抑制炎症反应有关。
[Abstract]:Objective: to observe the clinical effect of Tangshenbao granule on diabetic nephropathy (diabetic nephropathy DNs) and explore its possible mechanism based on the combination of macro syndrome differentiation and micro syndrome differentiation and the method of supplementing qi and removing blood stasis.Methods: from March 2014 to December 2015, 94 patients with DN in Department of Nephrology, Ruikang Hospital affiliated to Guangxi University of traditional Chinese Medicine were selected. 94 cases of TCM syndromes belonged to qi deficiency and blood stasis, all of which were type 2 diabetes.Patients were randomly divided into control group and treatment group, 47 cases each.There was no significant difference in age, sex, DN stage and complication between the two groups (P 0.05).The control group was treated with routine therapy such as controlling blood pressure, blood glucose and regulating blood lipid, and Irbesartan was added to the control group. The treatment group was treated with traditional Chinese medicine compound Tangshenbao granule once a day for 12 weeks.Before and after treatment, fasting blood glucose (FPG), glycosylated hemoglobin (HbA1cN), blood pressure (BP), serum creatinine (SCR), serum cystatin (C(Cyst), urinary N-acetyl 尾 -D-glucosaminidase (NAGN), urinary albumin excretion rate (UAER) and 24 hours urinary microalbumin were observed.The changes of serum monocyte chemoattractant protein (MCP-1), intercellular adhesion molecule-1 (ICAM-1), interleukin-6 (IL-6), interleukin-17 (IL-17), the total integral of TCM syndromes and the curative effect of TCM syndromes, etc.Results there was no significant difference between the two groups before and after treatment (P 0.05). Compared with before and after treatment, the blood pressure of the two groups decreased significantly (P 0.01), but there was no significant difference between the two groups (P 0.05).After treatment, the changes of Scr in the two groups were not statistically significant (P 0.05), the Cyst c of the two groups were significantly lower than that of before treatment, but significantly lower in the treatment group than that in the control group.The urinary microalbumin and UAER decreased significantly in both groups 24 hours after treatment, but in the treatment group were lower than those in the control group, but the urinary NAG in the treatment group was significantly lower than that in the control group before and after treatment, and was lower than that in the control group before and after treatment, but there was no significant difference between the two groups before and after treatment.The level of serum MCP-1 ICAM-1 / IL-6IL-17 was significantly lower than that of the same group before treatment, but the treatment group was significantly lower than that of the control group (P0.05P0.01P0.01P0.01U .Y6) after treatment, the scores of TCM syndromes in both groups were significantly lower than those in the control group, but the TCM syndrome accumulation after treatment in the treatment group was significantly lower than that in the control group (P 0.05N, P 0.01N, P 0.01g / L), but after treatment, the TCM syndromes in the treatment group were significantly lower than those in the control group.The total effective rate of the treatment group was 80.85, while that of the control group was 68.09. The difference was statistically significant before and after the treatment.There were no malignant arrhythmias in the two groups, no obvious abnormality in liver function and blood routine, and there was no significant difference in the related indexes between the two groups (P 0.05), and there was no significant difference between the two groups (P 0.05).ConclusionTwenty one) Tangshenbao granules can significantly improve the clinical symptoms of DN patients, the curative effect is definite, there are no obvious side effects, and the safety is good. Tangshenbao granule can reduce serum Cyst c, UAER and 24 h urinary microalbuminuria in DN patients.Reducing urinary NAG3) Tangshenbao granule can reduce the level of various inflammatory factors, such as MCP-1T, IL-6, ICAM-1, IL-17, and other inflammatory factors in the serum of patients with DN. Tangshenbao granule has an obvious protective effect on the kidney of DN patients, and its mechanism may be related to the inhibition of inflammatory reaction.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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