益肾降糖汤对糖尿病肾病患者胰岛素抵抗及血清IGF-1表达的影响  

Effect of Yishen Jiangtang Decoction on Insulin Resistance and Insulin-Like Growth Factor-1 Expression of Patients with Diabetic Nephropathy

作　　者：张玲[1] 李益明[1] 王志方 邢小珍 祝亮[1] 姜金孝 鲁庆红 ZHANG Ling;LI Yiming;WANG Zhifang;XING Xiaozhen;ZHU Liang;JIANG Jinxiao;LU Qinghong(The Central Hospital of Huanggang City,Huanggang Hubei China 43800)

机构地区：[1]黄冈市中心医院,湖北黄冈438000

出　　处：《中医学报》2018年第10期1908-1912,共5页Acta Chinese Medicine

基　　金：湖北省中医药管理局中医药公共卫生专项资金项目(2014-HBZY-5144-1015)

摘　　要：目的:观察益肾降糖汤对糖尿病肾病患者胰岛素抵抗及血清胰岛素样生长因子-1(insulin-like growth factor-1,IGF-1)表达的影响。方法:146例糖尿病肾病患者按照抽签方式分为对照组(n=73)及观察组(n=73)。所有患者均给予基础治疗,对照组在基础治疗的基础上给予盐酸吡格列酮片治疗,观察组在对照组治疗基础上给予益肾降糖汤。比较两组患者治疗前后两组24小时尿蛋白定量(24 hours urinary protein quantitative,24hUTP)、胰岛素抵抗指数(insulin resistance index,HOMA-IR)、空腹胰岛素(fasting insulin,FINS)、胰岛β细胞分泌功能指数(islet cells secrete a function index,HOMAIS)、糖化血红蛋白(glycosylated hemoglobin,Hb A1c)、空腹血糖(fasting plasma glucose,FBG)、IGF-1、血肌酐(serum creatinine,Scr)及尿微量白蛋白(urinary microalbumin,UAlb)水平,并比较两组患者临床疗效。结果:与治疗前比较,两组患者治疗后24hUTP、Scr、UAlb、HOMA-IR、FINS、FBG、Hb A1c及IGF-1均明显下降,而HOMA-IS明显上升,差异均有统计学意义(P <0. 05);观察组上述观察指标均明显优于对照组,差异有统计学意义(P <0. 05)。观察组有效率为91. 78%(67/73),对照组为79. 45%(58/73),两组有效率比较,差异有统计学意义(P <0. 05)。结论:益肾降糖汤治疗糖尿病肾病疗效显著,可降低血清IGF-1的表达,提高胰岛素敏感性,改善胰岛素抵抗状态。Objective： To observe the effect of Yishen Jiangtang Decoction on insulin resistance and serum insulin-like growth factor-1（ IGF-1） expression in patients with diabetic nephropathy. Methods： 146 patients with diabetic nephropathy were randomly divided into control group（ n = 73） and observation group（ n = 73）. All patients were given basic treatment. The control group was given pioglitazone hydrochloride tablets in addition to that of that basic treatment. The observation group was given Yishen Jiangtang Decoction in addition to that of the control group. The 24-hour urinary protein quantitative（ 24 hUTP）,insulin resistance index（ HOMA-IR）,fasting insulin（ FINS）,islet β-cell secretion function Islet cells secrete function index（ HOMA-IS）,glycosylated hemoglobin（ Hb A1 c）,fasting plasma glucose（ FBG）,IGF-1,serum creatinine（ Scr）,and urinary albumin（ Urinary microalbumin,m Alb） levels were compared between the two group and the clinical efficacy of the two groups of patients were compared. Results： Compared with that before treatment,the 24 hUTP,Scr,m Alb,HOMA-IR,FINS,FBG,Hb A1 c and IGF-1 significantly decreased significantly,while HOMA-IS significantly increased in the two groups after treatment（ P〈0. 05）. The above observation indexes of the observation group were significantly better than that of the control group（ P〈0. 05）. The effective rate of the observation group was 91. 78%,and that of the control group was 79. 45%. The difference of the effective rate of the two groups was statistically significant（ P〈0. 05）. Conclusion： Yishen Jiangtang Decoction has significant curative effect on diabetic nephropathy,which can reduce the expression of serum IGF-1,improve insulin sensitivity and improve insulin resistance.

关 键 词：益肾降糖汤 糖尿病肾病 胰岛素抵抗 胰岛素样生长因子-1:血脂 血糖 中西医结合 

分 类 号：R259.871[医药卫生—中西医结合]