青藤碱治疗糖尿病肾病对T淋巴细胞亚群的影响及临床疗效观察

发布时间：2018-05-02 10:09

本文选题：青藤碱 + 糖尿病肾病　；参考：《湖北中医药大学》2016年硕士论文

【摘要】：目的通过研究青藤碱对糖尿病肾病患者临床症状、尿蛋白及T淋巴细胞亚群的影响,观察其治疗糖尿病肾病的临床疗效,并探讨其疗效的可能机制。方法1.从2013年9月到2015年9月在湖北省中医院肾病门诊或者住院部接受治疗的患者中,根据本研究的纳入标准选择48例患者作为观察病例。随机分为治疗组和对照组,每组24例。青藤碱治疗组采用西医基础治疗加青藤碱口服(120mg/次,每天2次);对照组仅予以基础治疗,观察疗程为期3个月。两组糖尿病肾病患者在来源、性别、年龄、病程、体重指数等方面经分析评估,均无显著性差异。2.观察指标:(1)治疗前后青藤碱治疗组与对照组的中医临床症状积分变化;(2)疗效指标:24h尿蛋白定量、尿微量白蛋白、超敏C反应蛋白、T淋巴细胞亚群(CD4+、CD8+及CD4+/CD8+)、糖化血红蛋白;(3)安全性指标:血常规、肝功能、血清胱抑素C、心电图等。3.统计学处理:观察数据用(x±s)表示,采用SPSS19.0统计软件进行统计学计算分析。计数资料采用X2检验,等级资料采用秩和检验,同组数据的比较用配对t检验,组间资料的比较用独立样本t检验。结果1.两组患者总疗效比较:青藤碱治疗组的疾病总有效率为87.5%,优于对照组的45.8%,差异有统计学意义(p0.01)。青藤碱治疗组的中医证候总有效率91.6%,优于对照组的54.2%,差异有统计学意义(p0.01)。2.中医症状总积分比较:两组病例治疗后的临床症状总积分均有所下降,差异有统计学意义(p0.05);青藤碱治疗组症状总积分的改善程度优于对照组,且差异有统计学意义(p0.01)。3.单项症状积分比较:青藤碱治疗组治疗后神疲乏力、气短懒言、自汗易感、咽干口渴、腰膝酸痛等症状较治疗前均有改善,且优于对照组,差异有统计学意义(P0.01)。治疗后青藤碱治疗组烦热盗汗的症状与对照组比较,差异无统计学意义(P0.05)。治疗后对照组咽干口渴较治疗前明显改善,差异有统计学意义(P0.05)。4.24huprq、um Alb比较:青藤碱治疗组与对照组经治疗后24huprq、um Alb均有下降,差异有统计学意义(P0.05)。青藤碱治疗组患者的24huprq、um Alb下降程度优于对照组,差异有统计学意义(P0.01)。5.CD4+、CD8+、CD4+/CD8+比较:青藤碱治疗组治疗后CD4+降低、CD8+升高、CD4+/CD8+比值下降,与治疗前相比差异有统计学意义(P0.05);对照组治疗前后比较,T淋巴细胞亚群的参数值无显著性差异(p0.05);治疗后青藤碱治疗组与对照组比较,差异有统计学意义(p0.01)。6.CRP、Hb Alc、Cys C比较:青藤碱治疗组与对照组治疗后CRP都有所下降,与治疗前相比差异有统计学意义(p0.05);但是青藤碱治疗组治疗后CRP下降水平优于对照组,差异有统计学意义(p0.01)。治疗前后两组患者的Hb Alc、Cys C比较,无显著性差异(p0.05)。7.其它安全性指标评价:治疗前后两组病例的血液分析、肝功能、心电图等指标比较,差异无统计学意义(P0.05)。整个实验观察期间患者没有出现明显的药物不良反应。结论青藤碱可以有效的缓解糖尿病肾病患者的临床症状,减少24huprq和um Alb,维持T淋巴细胞亚群的平衡与稳定(降低CD4+、升高CD8+、降低其比值),降低CRP。并推断其可能通过调节人体免疫应答、纠正免疫功能紊乱、抑制机体炎症反应等作用机制来治疗糖尿病肾病,从而延缓其病情的进展。
[Abstract]:Objective To observe the effect of sinomenine on the clinical symptoms, urinary protein and T lymphocyte subsets in patients with diabetic nephropathy, observe the clinical effect of the treatment of diabetic nephropathy and explore the possible mechanism of its effect. Method 1. from September 2013 to September 2015 in patients receiving treatment in the nephrotic clinic or inpatient department of Hubei Provincial Traditional Chinese Medical Hospital According to the inclusion criteria of this study, 48 patients were selected as observation cases. They were randomly divided into treatment group and control group, with 24 cases in each group. The treatment group of sinomenine was treated with western medicine and sinomenine (120mg/ times, 2 times a day). The control group was only treated with basic treatment for a period of 3 months. Two groups of diabetic nephropathy patients were in source, sex, age and age. The course of disease, body mass index and other aspects of the analysis and evaluation, there were no significant differences in.2. observation indexes: (1) changes in the clinical symptom score of the sinomenine treatment group and the control group before and after treatment; (2) the curative effect index: 24h urine protein quantitative, urine microalbuminuria, hypersensitivity C reaction egg white, T lymphocyte subgroup (CD4+, CD8+ and CD4+/CD8+), glycosylated hemoglobin; (3 ) safety index: blood routine, liver function, serum cystatin C, electrocardiogram and other.3. statistical processing: the observation data were expressed with (x + s), and SPSS19.0 statistical software was used for statistical analysis. The count data were tested by X2 test, rank data were tested by rank sum test, the comparison of the same group data was tested by paired t, and the comparison of data between groups was compared with independent samples. T test. Results the total effective comparison between the 1. two groups: the total effective rate of sinomenine treatment group was 87.5%, superior to 45.8% in the control group. The difference was statistically significant (P0.01). The total effective rate of the TCM syndrome in the sinomenine treatment group was 91.6%, superior to 54.2% of the control group (P0.01), the total score of TCM symptoms was compared with the two groups of cases. The total score of the clinical symptoms after treatment decreased, the difference was statistically significant (P0.05); the improvement of the total symptom score of the sinomenine treatment group was better than that of the control group, and the difference was statistically significant (P0.01).3. symptom integral comparison: the sinomenine treatment group was treated with the fatigue, shortness of breath, self perspiration, thirst of the pharynx, and pain in the waist and knee. The symptoms were better than those before the treatment, and the difference was statistically significant (P0.01). There was no significant difference in the symptoms of bodyheat and night sweats in the sinomenine treatment group after treatment (P0.05). After treatment, the thirst of the control group was significantly better than before the treatment (P0.05).4.24huprq, um Alb compared: Green 24huprq, um Alb decreased after treatment in the treatment group and the control group, the difference was statistically significant (P0.05). The degree of 24huprq and um Alb in the group of sinomenine treatment group was better than that of the control group. The difference was statistically significant (P0.01).5.CD4+, CD8+, CD4+/CD8+ comparison: after the treatment group of sinomenine treatment, CD4+ decreased, increased, decreased ratio, Compared with before treatment, there was significant difference (P0.05), and there was no significant difference in the parameters of T lymphocyte subsets in the control group before and after treatment (P0.05); the difference was statistically significant (P0.01).6.CRP, Hb Alc, Cys C compared with the control group after treatment, and the CRP of the sinomenine treatment group and the control group decreased after treatment. The difference was statistically significant before treatment (P0.05), but the decrease of CRP in the sinomenine treatment group was better than that of the control group. The difference was statistically significant (P0.01). There was no significant difference in the Hb Alc and Cys C between the two groups of the patients before and after treatment, and there was no significant difference (P0.05).7. other safety index evaluation: the blood analysis, liver function, and heart of the two groups of patients before and after treatment. The difference was not statistically significant (P0.05). The patients had no obvious adverse drug reactions during the whole experimental observation. Conclusion sinomenine could effectively alleviate the clinical symptoms of diabetic nephropathy patients, reduce 24huprq and um Alb, maintain the balance and stability of the T lymphocyte subsets (lower CD4+, increase CD8+, reduce their ratio. Value), reduce CRP. and deduce that it may treat diabetic nephropathy by regulating the immune response, correcting the immune dysfunction and inhibiting the inflammatory response of the body to delay the progress of the disease.

【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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