益气养阴补肾活血方剂治疗72例早期Ⅱ型糖尿病肾病的临床疗效
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摘要
目的分析益气养阴补肾活血方剂治疗早期糖尿病肾病的临床疗效。方法以2015年10月至2017年4月于上海市浦东新区花木社区卫服务中心门诊随访及诊治的Ⅱ型糖尿病患者,诊断为早期糖尿病肾病(Ⅲ期)的患者72例为研究对象,已排除原发性和继发性肾脏疾病。随机分为治疗组:在对照组治疗的基础上加中药健脾益气补肾活血汤,对照组:氯沙坦钾100 mg/d口服治疗(商品名:科素亚,由杭州默沙东制药公司生产),每组36例。治疗后,比较2组早期糖尿病肾病疗效、监测用药安全性问题,并对比用药前后患者空腹血糖水平(fasting blood-glucose,FBG)、餐后2h血糖(2-hour postprandial blood glucose, 2hPBG)、糖化血红蛋白(glycosylated hemoglobin type A1c, HbA1c)水平的差异。干预前后患者尿微量白蛋白水平、尿素氮水平、肌酐平均清除率、血清超敏C反应蛋白水平的差异。结果对照组早期糖尿病肾病治疗效果(80.56%,29/36)低于治疗组(97.22%,35/36),差异有统计学意义(P<0.05)。干预后,治疗组FBG[(7.61±1.82)mmol/L]、2hPBG[(9.15±2.74) mmol/L]、HbA1c[(6.21±2.54)%]水平均优于对照组[(9.21±2.51)mmol/L、(11.42±5.22)mmol/L、(8.53±1.94)%],组间差异有统计学意义(P<0.05)。干预后治疗组尿微量白蛋白水平、尿素氮水平、肌酐平均清除率、血清超敏C反应蛋白水平分别为(176.91±70.45)mg/L、(12.34±2.32)mmol/L、(35.25±10.21)ml/min、(0.76±0.26)mg/L,对照组分别为(245.64±90.55)mg/L、(14.21±2.52)mmol/L、(30.14±8.20)ml/min、(0.95±0.26)mg/L,组间差异有统计学意义(P<0.05)。结论益气养阴补肾活血方益气养阴、补肾活血功效显著,可有效提升早期糖尿病肾病患者肾功能,并可辅助控制患者血糖水平。
Objective To analyze clinical effects of Yiqi Yangyin Bushen Huoxue prescription on early diabetic nephropathy.Methods Seventy-two patients with type Ⅱ diabetes mellitus who were diagnosed as early stage diabetic nephropathy(stage Ⅲ), had medical follow-ups and received medical care in the Huamu Community Health Service Center from October 2015 to April 2017 were recruited as research subjects. Primary and secondary kidney disorders were excluded. They were randomly divided into the treatment group and the control group, each consisting of 36 patients. The control group was treated with losartan potassium at a dosage of 100 mg/d orally, while the treatment group received Jianpi Yiqi Bushen Huoxue decoction in addition to the treatment received by the control group. Medication safety was closely monitored during treatment. Curative effects on early diabetic nephropathy and the differences in the levels of fasting blood glucose(FBG), 2-h postprandial blood glucose(2 hPBG) and glycosylated hemoglobin type A1 c(HbA1 c) were compared between the 2 groups after treatment. Differences in the levels of urinary micro-albumin, urea nitrogen, the rate of creatinine clearance and the level of serum hypersensitive C-reactive protein both before and after intervention were also compared and analyzed.Results The therapeutic effect on early diabetic nephropathy in the control group was 80.56%(29/36), which was obviously lower than that(97.22%, 35/36) in the treatment group(P<0.05). After intervention, the levels of FBG(7.61±1.82) mmol/L, 2-h PBG(9.15±2.74) mmol/L and HbA1 c(6.21±2.54)% of the treatment group were all superior to those of the control group(9.21±2.51) mmol/L,(11.42±5.22) mmol/L,(8.53±1.94)%. Statistical significance could be found when comparisons were made between the 2 groups(P<0.05). After treatment, the levels of urinary micro-albumin, urea nitrogen, creatinine clearance and serum hypersensitive C-reactive protein in the treatment group were respectively(176.91±70.45) mg/L,(12.34±2.32) mmol/L,(35.25±10.21) ml/min and(0.76±0.26) mg/L, and those in the control group were respectively(245.64±90.55) mg/L,(14.21±2.52) mmol/L,(30.14±8.20) ml/min and(0.95±0.26) mg/L, also with statistical significance(P<0.05).Conclusion Yiqi Yangyin Bushen Huoxue prescription has the effects of nourishing Qi and Yin, invigorating kidney and activating blood circulation, improves renal function of the patients with early diabetic nephropathy, and in the meantime helps to control serum sugar level.
Objective To analyze clinical effects of Yiqi Yangyin Bushen Huoxue prescription on early diabetic nephropathy.Methods Seventy-two patients with type Ⅱ diabetes mellitus who were diagnosed as early stage diabetic nephropathy(stage Ⅲ), had medical follow-ups and received medical care in the Huamu Community Health Service Center from October 2015 to April 2017 were recruited as research subjects. Primary and secondary kidney disorders were excluded. They were randomly divided into the treatment group and the control group, each consisting of 36 patients. The control group was treated with losartan potassium at a dosage of 100 mg/d orally, while the treatment group received Jianpi Yiqi Bushen Huoxue decoction in addition to the treatment received by the control group. Medication safety was closely monitored during treatment. Curative effects on early diabetic nephropathy and the differences in the levels of fasting blood glucose(FBG), 2-h postprandial blood glucose(2 hPBG) and glycosylated hemoglobin type A1 c(HbA1 c) were compared between the 2 groups after treatment. Differences in the levels of urinary micro-albumin, urea nitrogen, the rate of creatinine clearance and the level of serum hypersensitive C-reactive protein both before and after intervention were also compared and analyzed.Results The therapeutic effect on early diabetic nephropathy in the control group was 80.56%(29/36), which was obviously lower than that(97.22%, 35/36) in the treatment group(P<0.05). After intervention, the levels of FBG(7.61±1.82) mmol/L, 2-h PBG(9.15±2.74) mmol/L and HbA1 c(6.21±2.54)% of the treatment group were all superior to those of the control group(9.21±2.51) mmol/L,(11.42±5.22) mmol/L,(8.53±1.94)%. Statistical significance could be found when comparisons were made between the 2 groups(P<0.05). After treatment, the levels of urinary micro-albumin, urea nitrogen, creatinine clearance and serum hypersensitive C-reactive protein in the treatment group were respectively(176.91±70.45) mg/L,(12.34±2.32) mmol/L,(35.25±10.21) ml/min and(0.76±0.26) mg/L, and those in the control group were respectively(245.64±90.55) mg/L,(14.21±2.52) mmol/L,(30.14±8.20) ml/min and(0.95±0.26) mg/L, also with statistical significance(P<0.05).Conclusion Yiqi Yangyin Bushen Huoxue prescription has the effects of nourishing Qi and Yin, invigorating kidney and activating blood circulation, improves renal function of the patients with early diabetic nephropathy, and in the meantime helps to control serum sugar level.
引文
[1] Yu N, Zhang Y, Xu Y. Value of virtual touch tissue quantification in stages of diabetic kidney disease[J]. J Ultrasound Med, 2014, 33(5): 787-792. DOI:10.7863/ultra.33.5.787.
[2] 施贝德,唐婷婷.益气养阴活血经验方剂对早期糖尿病肾病患者肾功能及血糖血脂的影响[J]. 中华中医药学刊, 2015(4):990-992. DOI:10.13193/j.issn.1673-7717.2015.04.068.
[3] 蔡庆春,李华. 养阴益气活血汤治疗早期糖尿病肾病临床研究[J]. 中医学报, 2015, 30(8): 1111-1113. DOI:10.16368/j.issn.1674-8999.2015.08.383.
[4] Yavuz M. American society of biomechanics clinical biomechanics award 2012: plantar shear stress distributions in diabetic patients with and without neuropathy[J]. Clin Biomech (Bristol, Avon), 2014, 29(2): 223-229. DOI:10.1016/j.clinbiomech.2013.11.003.
[5] 张鹏,吕芹,郭东义,等. 益气养阴化浊通络方对早期糖尿病肾脏疾病患者内皮细胞及血液流变学的影响[J]. 科学技术与工程, 2016, 16(17):119-122.
[6] 陈路燕.益气养阴补肾活血法治疗早期糖尿病肾病的临床研究[D].北京中医药大学,2005:1-55.
[7] Guo C, Zhang Z, Zhang P, et al. Novel transgenic mouse models develop retinal changes associated with early diabetic retinopathy similar to those observed in rats with diabetes mellitus[J]. Exp Eye Res, 2014, 119: 77-87. DOI:10.1016/j.exer.2013.12.009.
[8] 胡国庆,陈筑红. 益气养阴活血汤治疗气阴两虚型早期糖尿病肾病临床疗效研究[J]. 中国药业, 2016, 25(15):43-45.
[9] 安然.基于糖尿病结构化中医住院病历数据的糖尿病肾脏疾病病证结合诊疗规律探讨[D].中国中医科学院,2013:1-66.
[10] 郭相宽. 益气养阴消癥通络方治疗早期糖尿病肾病临床观察[J]. 光明中医, 2017, 32(20): 2968-2969. DOI:10.3969/j.issn.1003-8914.2017.20.031.
[11] 侯宝渊. 益气养阴补肾活血方剂治疗早期糖尿病肾病的临床疗效[J]. 临床合理用药杂志, 2016, 9(12): 119-120. DOI:10.15887/j.cnki.13-1389/r.2016.12.062.
[12] 吴吉萍,方朝晖,倪英群. 益气养阴活血中药对2型糖尿病合并血管病变的干预研究[J]. 安徽医药, 2014, 18(4):735-737. DOI:10.3969/j.issn.1009-6469.2014.04.049.
[13] 孙瑞茜,彭静,郭健,等. 鬼箭羽的现代药理作用研究成果[J]. 环球中医药, 2015, 8(2):245-249. DOI:10.3969/j.issn.1674-1749.2015.02.039.
[14] 马婕. 益气养阴清热活血法治疗早期糖尿病肾病的疗效及对血液流变学的影响[J]. 吉林中医药, 2014, 34(12): 1225-1228. DOI:10.13463/j.cnki.jlzyy.2014.12.013.
[15] 丁云东. 养阴活血泄浊方治疗早期糖尿病肾病的效果与安全性观察[J]. 中国医药科学, 2015, 5(17):19-22.
[16] 秦瑞君,闫菊. 益气养阴补肾活血方剂治疗早期糖尿病肾病的临床分析[J]. 中医临床研究, 2014(5):78-79. DOI:10.3969/j.issn.1674-7860.2014.05.039.
[2] 施贝德,唐婷婷.益气养阴活血经验方剂对早期糖尿病肾病患者肾功能及血糖血脂的影响[J]. 中华中医药学刊, 2015(4):990-992. DOI:10.13193/j.issn.1673-7717.2015.04.068.
[3] 蔡庆春,李华. 养阴益气活血汤治疗早期糖尿病肾病临床研究[J]. 中医学报, 2015, 30(8): 1111-1113. DOI:10.16368/j.issn.1674-8999.2015.08.383.
[4] Yavuz M. American society of biomechanics clinical biomechanics award 2012: plantar shear stress distributions in diabetic patients with and without neuropathy[J]. Clin Biomech (Bristol, Avon), 2014, 29(2): 223-229. DOI:10.1016/j.clinbiomech.2013.11.003.
[5] 张鹏,吕芹,郭东义,等. 益气养阴化浊通络方对早期糖尿病肾脏疾病患者内皮细胞及血液流变学的影响[J]. 科学技术与工程, 2016, 16(17):119-122.
[6] 陈路燕.益气养阴补肾活血法治疗早期糖尿病肾病的临床研究[D].北京中医药大学,2005:1-55.
[7] Guo C, Zhang Z, Zhang P, et al. Novel transgenic mouse models develop retinal changes associated with early diabetic retinopathy similar to those observed in rats with diabetes mellitus[J]. Exp Eye Res, 2014, 119: 77-87. DOI:10.1016/j.exer.2013.12.009.
[8] 胡国庆,陈筑红. 益气养阴活血汤治疗气阴两虚型早期糖尿病肾病临床疗效研究[J]. 中国药业, 2016, 25(15):43-45.
[9] 安然.基于糖尿病结构化中医住院病历数据的糖尿病肾脏疾病病证结合诊疗规律探讨[D].中国中医科学院,2013:1-66.
[10] 郭相宽. 益气养阴消癥通络方治疗早期糖尿病肾病临床观察[J]. 光明中医, 2017, 32(20): 2968-2969. DOI:10.3969/j.issn.1003-8914.2017.20.031.
[11] 侯宝渊. 益气养阴补肾活血方剂治疗早期糖尿病肾病的临床疗效[J]. 临床合理用药杂志, 2016, 9(12): 119-120. DOI:10.15887/j.cnki.13-1389/r.2016.12.062.
[12] 吴吉萍,方朝晖,倪英群. 益气养阴活血中药对2型糖尿病合并血管病变的干预研究[J]. 安徽医药, 2014, 18(4):735-737. DOI:10.3969/j.issn.1009-6469.2014.04.049.
[13] 孙瑞茜,彭静,郭健,等. 鬼箭羽的现代药理作用研究成果[J]. 环球中医药, 2015, 8(2):245-249. DOI:10.3969/j.issn.1674-1749.2015.02.039.
[14] 马婕. 益气养阴清热活血法治疗早期糖尿病肾病的疗效及对血液流变学的影响[J]. 吉林中医药, 2014, 34(12): 1225-1228. DOI:10.13463/j.cnki.jlzyy.2014.12.013.
[15] 丁云东. 养阴活血泄浊方治疗早期糖尿病肾病的效果与安全性观察[J]. 中国医药科学, 2015, 5(17):19-22.
[16] 秦瑞君,闫菊. 益气养阴补肾活血方剂治疗早期糖尿病肾病的临床分析[J]. 中医临床研究, 2014(5):78-79. DOI:10.3969/j.issn.1674-7860.2014.05.039.