参芪固肾汤对早期糖尿病肾病胱抑素C、白细胞介素-6、白细胞介素-8表达的影响

发布时间：2018-06-13 16:50

本文选题：早期糖尿病肾病 + 胱抑素C　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:通过“参芪固肾汤”联合西医基础治疗早期糖尿病肾病患者,观察治疗前后中医症候积分、尿白蛋白排泄率、胱抑素C、白细胞介素-6、白细胞介素-8水平的变化,客观评估“参芪固肾汤”对早期糖尿病肾病的临床疗效,并试图从炎症角度探讨本方对于糖尿病肾病早期发生发展的作用机制,为中医药对于糖尿病肾病保肾、延缓肾衰提供证据,为本方日后运用于临床提供坚实基础。方法:1课题选取为2016年1月到2017年1月于河北省中医院内分泌科门诊的符合纳入标准的早期DN患者60例,将用上述患者随机分配为对照组(30例)、试验组(30例),两组在性别、年龄、糖化血红蛋白、肾病分期、病程长久等方面差异无统计学意义,具有可比性(P0.05)。2对照组给于糖尿病饮食、运动基础上口服胰激肽原酶肠溶片,试验组加用参芪固肾汤(药物组成:黄芪、丹参、茯苓、山药、芡实、金樱子、太子参、白术、五味子、麦冬、川芎)进行治疗。所有入组患者疗程为3个月。3在入组前及治疗后采空腹静脉血检查,检测糖化血红蛋白、尿白蛋白排泄率、胱抑素C、IL-6、IL-8对比前后水平变化;安全性指标采取检测血常规、尿常规、大便常规、肝功、检查心电图等;观察入组患者治疗前后主要临床症状及体征的变化情况、不良反应等。结果:试验组与对照组组内前后对比,均能有效改善早期DN患者的临床证候积分,均能降低早期DN患者血清Cys-C、IL-6、IL-8水平(P0.01),但治疗后试验组与对照组组间对比,试验组降低患者体内炎性因子水平和尿白蛋白排泄率方面要强于对照组,二者相比具有统计学意义(P0.01)。两组患者治疗前后各安全性指标无明显差异(P0.05),具有良好的安全性。结论:参芪固肾汤联合西医基础治疗早期气阴两虚兼夹瘀证DN患者疗效满意,能够有效改的善DN患者中医证候积分,能够提高早期DN患者的生活质量;对于降低患者尿白蛋白排泄率、血清胱抑素C、血清炎症因子指标IL-6和IL-8方面,效果优于单纯西医基础治疗,这表明本方剂具有保护肾小球,修复受损肾脏的作用,能对抗和减轻早期DN患者体内炎症损伤的作用。在对于降低早期DN患者血糖水平方面试验组、对照组无统计学差异,这说明参芪固肾汤改善DN患者肾脏功能的保护机制可能是通过其它途径实现的。参芪固肾汤短期服用,安全性较高。
[Abstract]:Objective: To observe the TCM syndrome score, urinary albumin excretion rate, Cystatin C, interleukin -6 and interleukin -8 level before and after treatment by "Shenqi Gu Shen Decoction" combined with western medicine, and objectively evaluate the clinical effect of "Shenqi Gu Shen Decoction" on early diabetic nephropathy and try to get from the inflammation. To explore the mechanism of the early development of diabetic nephropathy, provide evidence for Chinese medicine to protect the kidney of diabetic nephropathy, delay the renal failure, and provide a solid basis for the use of the clinic in the future. Methods: 1 subjects were selected for January 2016 to January 2017 in the Department of endocrinology of the Hospital of traditional Chinese medicine in Hebei province. 60 cases of early DN patients were randomly assigned to the control group (30 cases) and the experimental group (30 cases). The two groups had no statistically significant differences in sex, age, glycated hemoglobin, nephrotic staging, and long course of disease, with a comparable (P0.05).2 control group for diabetes diet, exercise based on oral Pancreatic Kininogenase Enteric-coated Tablets, experimental group. Addition of Shenqi Gu kidney soup (drug composition: Astragalus, Salvia miltiorrhiza, Poria, tuckahoe, yam, cherry seed, Radix stigma, Rhizoma Atractylodes, Radix Ophiopogon, Ophiopogon japonicus, Rhizoma Ophiopogon, Ligusticum chuanxiong). The treatment course of all the patients was 3 months.3 before the group and after the treatment, the hemoglobin, urinary albumin excretion rate, Cystatin C, IL-6, IL-8 were compared. Level changes; safety indexes were detected by blood routine, urine routine, routine stool, liver function, examination of electrocardiogram, and the changes of main clinical symptoms and signs before and after treatment in the group, and adverse reactions. Results: the clinical syndrome scores of early DN patients could be effectively improved by comparison between the experimental group and the control group. All the results could be reduced. The serum level of Cys-C, IL-6 and IL-8 (P0.01) in the low early DN patients, but compared with the control group after treatment, the level of inflammatory factors and urinary albumin excretion rate in the experimental group were stronger than those in the control group, and the two groups were statistically significant (P0.01). There was no significant difference between the two groups before and after treatment (P0.05). Conclusion: the effect of Shenqi Gu Shen kidney soup combined with western medicine on DN patients with Qi Yin deficiency and stagnation of blood stasis syndrome is satisfactory. The integral of TCM syndrome in patients with good DN can be effectively improved, and the quality of life in early DN patients can be improved; the urinary albumin discharge rate, serum cystatin C, and serum inflammatory factor index IL-6 can be reduced. And IL-8, the effect is better than the simple western medicine basic treatment, which shows that the prescription has the role of protecting the glomeruli, repairing the damaged kidney, and can counteract and reduce the effect of the early DN patients' inflammation in the body. There is no statistical difference between the experimental group and the control group in reducing the blood sugar level of the early DN patients. This shows that Shenqi Gu Shen decoction can improve the DN suffering. The protective mechanism of renal function may be achieved through other means. Shenqi Gu Shen decoction is safe for short-term use.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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