健脾补肾活血法治疗早期糖尿病肾病的疗效观察

发布时间：2018-08-02 14:17

【摘要】：目的：临床观察自拟健脾补肾活血之固肾汤对早期糖尿病肾病血糖、血脂、C反应蛋白、尿白蛋白排泄率、血浆纤维蛋白原及中医证候积分改善情况,观察健脾补肾活血法治疗早期糖尿病肾病的总体临床疗效及安全性,为中医药治疗早期糖尿病肾病的作用研究提供临床依据。方法：本研究纳入早期糖尿病肾病患者60例,简单随机分组,其中对照组30例,治疗组30例。治疗期间因治疗组失访1例,对照组自行退出2例。最终纳入57例患者,其中治疗组29例,对照组28例。两组均给予运动及饮食控制、戒烟、限酒、降糖、调脂、控制血压等对症支持治疗,治疗组在基础治疗上,辅以自拟健脾补肾活血之固肾汤内服,疗程2个月。2个月后收集两组治疗前后血糖、糖化血红蛋白、血脂、C反应蛋白、尿白蛋白排泄率、凝血功能、肝肾功能、血浆纤维蛋白原检测、中医证候积分等数据,进行统计学分析,进一步研究健脾补肾活血法治疗早期糖尿病肾病的疗效及安全性。结果：1.两组治疗后中医证候总积分均有所下降,均具有统计学意义(P0.05)；组间比较,差异有统计学意义(P0.05)。2.两组中医疗效比较,治疗组总有效率高于对照组,具有统计学差异(P0.05)。3.两组西医疗效比较,治疗组总有效率高于对照组,差异具有统计学意义(P0.05)。4.两组治疗后血糖、糖化血红蛋白均有所下降,差异有统计学意义(P0.05)；组间比较,差异无统计学意义(P0.05)。5.两组治疗前后尿白蛋白排泄率比较,均具有统计学意义(P0.05)；治疗后组间比较,差异有统计学意义(P0.05)。6.两组治疗前后甘油三酯、总胆固醇、低密度脂蛋白比较,差异有统计学意义(P0.05)；组间比较,差异有统计学意义(P0.05)。7.治疗组治疗后C反应蛋白水平有所下降,组间比较,差异有统计学意义(P0.05),提示治疗组优于对照组。8.两组治疗前后血浆纤维蛋白原比较,差异均具有统计学意义(P0.05)；治疗后组间比较,差异有统计学意义(P0.05),提示治疗组优于对照组。9.两组治疗前后肝肾功能、凝血功能比较,差异无统计学意义(P0.05),无合并毒副作用。结论：以健脾补肾活血为治法组方的固肾汤能明显提高早期病肾病患者的临床疗效,降低患者尿蛋白量,能改善血脂代谢、慢性炎症状态及肾脏微循环高凝状态,延缓糖尿病肾病的进展,且安全未出现不良反应。
[Abstract]:Objective: to observe the improvement of blood glucose, serum lipids and C-reactive protein, urinary albumin excretion rate, plasma fibrinogen and TCM syndromes score in early diabetic nephropathy with self-made decoction for invigorating spleen and invigorating kidney and activating blood circulation. To observe the general clinical efficacy and safety of invigorating spleen and invigorating kidney and activating blood circulation in the treatment of early diabetic nephropathy, and to provide clinical basis for the study of the effect of traditional Chinese medicine on early diabetic nephropathy. Methods: 60 patients with early diabetic nephropathy were randomly divided into control group (n = 30) and treatment group (n = 30). During the treatment, 1 case was lost in the treatment group, 2 cases in the control group. 57 patients were included, including 29 cases in the treatment group and 28 cases in the control group. Both groups were given exercise and diet control, smoking cessation, alcohol restriction, sugar lowering, lipid regulation, blood pressure control and other symptomatic support treatment. After 2 months of treatment, blood glucose, glycosylated hemoglobin, serum lipids and C-reactive protein, urinary albumin excretion rate, coagulation function, liver and kidney function, plasma fibrinogen test, TCM syndrome score and so on were collected before and after treatment. To further study the efficacy and safety of invigorating spleen and tonifying kidney and activating blood circulation in the treatment of early diabetic nephropathy. The result is 1: 1. After treatment, the total scores of TCM syndromes in the two groups were all decreased with statistical significance (P0.05), and the difference between the two groups was statistically significant (P0.05). Two groups of traditional Chinese medicine efficacy comparison, the treatment group total effective rate is higher than the control group, has the statistical difference (P0.05). 3. The total effective rate of the treatment group was higher than that of the control group, and the difference was statistically significant (P0.05). After treatment, blood glucose, glycosylated hemoglobin in the two groups were decreased, the difference was statistically significant (P0.05), there was no significant difference between the two groups (P0.05). The urinary albumin excretion rate of the two groups before and after treatment were statistically significant (P0.05); after treatment, the difference was statistically significant (P0.05). Before and after treatment, triglyceride, total cholesterol, low density lipoprotein were significantly different between the two groups (P0.05), the difference between the two groups was statistically significant (P0.05). The level of C-reactive protein decreased after treatment in the treatment group, the difference between the groups was statistically significant (P0.05), suggesting that the treatment group is better than the control group. 8. Plasma fibrinogen in the two groups before and after treatment, the difference was statistically significant (P0.05); after treatment, the difference was statistically significant (P0.05), suggesting that the treatment group is better than the control group. 9. There was no significant difference in liver and kidney function and coagulation function between the two groups before and after treatment (P0.05). Conclusion: Gushen decoction with invigorating spleen and tonifying kidney and activating blood circulation can obviously improve the clinical effect of patients with early stage nephropathy, reduce the urine protein content, improve the metabolism of blood lipid, chronic inflammation and hypercoagulability of renal microcirculation. Delay the progression of diabetic nephropathy, and safe no adverse reactions.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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