坤草芪莲汤治疗消渴病并尿微量蛋白的临床研究  

Clinical study of Kuncao Qinlian Decoction in the treatment of diabetes mellitus with urinary microprotein

作　　者：唐立明 邱楚雄 覃娜 陈梅芳 刘绮 毛辉 龙世松 董芬芳 TANG Liming;QIU Chuxiong;QIN Na;CHEN Meifang;LIU Qi;MAO Hui;LONG Shisong;DONG Fenfang(Hezhou Hospital of Traditional Chinese Medicine,Hezhou 542800,Guangxi,China)

机构地区：[1]广西壮族自治区贺州市中医医院,广西贺州542800

出　　处：《现代中西医结合杂志》2018年第35期3884-3887,3891,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：广西卫计委自筹经费科研课题(Z20170984)

摘　　要：目的观察坤草芪莲汤治疗消渴病并尿微量蛋白症患者的临床疗效。方法将246例消渴病并尿微量蛋白症患者随机分为3组:坤草芪莲汤联合组给予坤草芪莲汤和马来酸依那普利片治疗,六味地黄汤联合组给予六味地黄汤和马来酸依那普利片治疗,西药组给予马来酸依那普利片治疗。检测3组治疗前及治疗3个月后人尿微量蛋白(HALB)、胱抑素C(Cys C)、血清肌酐(SCr)水平及内生肌酐清除率(Ccr),根据上述指标改善情况计算3组各指标有效率,并记录3组中医证候存余率及不良反应发生情况。结果 3组治疗后H-ALB、Cys C、SCr水平均明显降低(P均<0. 05),Ccr水平均明显升高(P均<0. 05),且各指标改善情况坤草芪莲汤联合组和六味地黄汤联合组改善情况明显优于西药组(P均<0. 05),坤草芪莲汤联合组明显优于六味地黄汤联合组(P均<0. 05);坤草芪莲汤联合组和六味地黄汤联合组H-ALB、Cys C、SCr、Ccr有效率均显著高于西药组(P均<0. 05),且坤草芪莲汤联合组H-ALB、Ccr有效率均显著高于六味地黄汤联合组(P均<0. 05),但Cys C、SCr有效率与六味地黄汤联合组比较差异均无统计学意义(P均> 0. 05)。坤草芪莲汤联合组和六味地黄汤联合组小便频数、尿液混浊、腰膝酸软、脉细、头晕耳鸣、畏寒肢冷症状存余率均显著低于西药组(P均<0. 05);坤草芪莲汤联合组小便频数、尿液混浊、畏寒肢冷存余率均显著低于六味地黄汤联合组(P均<0. 05),但腰膝酸软、脉细、头晕耳鸣存余率与六味地黄汤联合组比较差异均无统计学意义(P均> 0. 05)。3组治疗过程中口干、腹胀、恶心发生率比较差异均无统计学意义(P均> 0. 05)。结论坤草芪莲汤能够有效修复消渴病并尿微量蛋白症患者肾小球过滤膜通透性,降低H-ALB、Cys C水平,改善患者的中医证候并恢复肾功能,且安全性高,值得临床推广应用。Objective It is to observe the clinical efficacy of Kuncao Qinlian Decoction in the treatment of patients with diabetes mellitus complicated with microalbuminuria. Methods A total of 246 patients with diabetes mellitus and microalbuminuria were randomly divided into 3 groups： Kuncao Qinlian Decoction combination group （group A） treated with Kuncao Lilian Decoction plus enalapril maleate tablets, Liuwei Dihuang Decoction combination group （group B） treated with Liuwei Dihuang Decoction plus enalapril maleate tablets, western medicine group treated with enalapril maleate tablets. The levels of human urine microprotein （H-ALB）, cystatin C （CysC）, serum creatinine （SCr） and endogenous creatinine clearance （Ccr） were measured before treatment and after 3 months of treatment. According to the improvements of above indicators, the efficiency rate of each group was calculated, and the survival rate of TCM syndromes and adverse reactions of the three groups were recorded. Results The levels of H-ALB, CysC and SCr were significantly decreased and that of Ccr was significantly increased in the three groups （ P 〈0.05）. The improvements in group A and group B were better than that in group C（ P 〈0.05）,group B was better than group C（ P 〈0.05）.The effective rates of H-ALB, CysC, SCr and Ccr in group A and group B were significantly higher than those of group C （ P 〈0.05）, and the effective rates of H-ALB and Ccr in group A were significantly higher than those in group B（ P 〈0.05）, however, there was no significant difference in the efficiency of CysC and SCr between group A and group B（ P 〉0.05）. The residual rate of urinary frequency, urine turbidity, weak waist and knee, thin pulse, dizziness, tinnitus, chills and cold limbs were significantly lower in group A and group B than that in group C（ P 〈0.05）. The residual rate of urinary frequency, urine turbidity, chills and cold limbs in group A were significantly lower than that in group B（ P 〈0.05）, but

关 键 词：坤草芪莲汤 消渴病 尿微量蛋白 肾阴阳两虚 马来酸依那普利 

分 类 号：R255.4[医药卫生—中医内科学]