参芪地黄汤化裁方结合西医常规疗法治疗Ⅳ期糖尿病肾病临床研究  

Clinical research on Shenqi-Dihuang Decoction combined with conventional western medicine in the treatment of stageⅣdiabetic nephropathy

作　　者：吕翠岩[1] 张岩[2] 贾晓蕾 郑爽 李倩[1] 刘铜华[5] Lyu Cuiyan;Zhang Yan;Jia Xiaolei;Zheng Shuang;Li Qian;Liu Tonghua(Department of Nephrology,Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University,Beijing 100010,China;Department of Traditional Chinese Medicine,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 100050,China;Department of Education,the Third Affiliated Hospital of Beijing University of Chinese Medicine,Beijing 100029,China;Master Degree Student of Grade 2019,College of Clinical Medicine,Beijing University of Chinese Medicine,Beijing 100029,China;Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京中医医院肾内科,100010 [2]首都医科大学附属北京友谊医院中医科,100050 [3]北京中医药大学第三附属医院教育处,100029 [4]北京中医药大学临床医学院,100029 [5]北京中医药大学,100029

出　　处：《国际中医中药杂志》2020年第5期431-436,共6页International Journal of Traditional Chinese Medicine

基　　金：国家重大新药创制项目(2012ZX09102201-001);首都医科大学科研培育基金(校基金)(PYZ2017140);北京市属医院科研培育计划项目(PZ2017017)。

摘　　要：目的评价参芪地黄汤化裁方结合西医常规疗法治疗Ⅳ期DN的疗效。方法回顾性分析2017年6月-2018年6月首都医科大学附属北京中医医院、北京中医药大学附属第三医院就诊的Ⅳ期DN气阴两虚夹瘀证患者80例,根据治疗方法分为2组,每组40例。对照组采用西医常规疗法治疗,治疗组在对照组基础上服用参芪地黄汤化裁方。2组均连续治疗12周。分别于治疗前后进行中医证候评分;采用全自动生化分析仪检测空腹血糖、2 hPG、BUN、SCr、Alb、TC、TG、血尿酸(uric acid,UA)、SOD、同型半胱氨酸(homocysteine,HCY)水平;采用HPLC法检测HbA1c,免疫比浊法检测24小时尿蛋白定量(24-hour urine total protein quantity,24 hUTP);计算肾小球滤过率(estimated Glomerular Filtration Rate,eGFR),评价临床疗效。结果治疗组总有效率为87.5%(35/40)、对照组为67.5%(27/40),2组比较差异有统计学意义(χ^2=4.557,P=0.033)。治疗后,治疗组尿浊、双下肢浮肿、倦怠乏力、腰膝酸软评分及总分均低于对照组(t值分别为-2.178、-1.675、-3.667、-1.904、-4.835,P值均<0.01);空腹血糖、HbA1c水平低于对照组(t值分别为-3.781,-8.557,P值均<0.01);收缩压低于对照组(t=-2.883,P=0.005);血清TC水平低于对照组(t=-3.321,P=0.008);24 h UTP、HCY水平低于对照组(t值分别为-2.819、-2.053,P值分别为0.008、0.043),SOD水平高于对照组(t=2.489,P=0.018)。结论参芪地黄汤化裁方结合西医常规疗法可有效降低Ⅳ期DN气阴两虚夹瘀证患者24 hUTP,减轻肾损伤,延缓DN发展,提高疗效,保护肾功能。Objective To observe the clinical efficacy of Shenqi-Dihuang Decoction combined with conventional western medicine in the treatment of stageⅣDiabetic Nephropathy(DN).Methods Made a retrospective analysis of 80 patients of stageⅣDN with the syndrome of qi and yin deficiency combined with blood stasis from June 2017 to June 2018,from Beijing Hospital of Traditional Chinese Medicine and The Third Affiliated Hospital of Beijing University of Chinese Medicine.The 80 patients were divided into treatment group and control group,40 in each group.The control group was given the conventional western treatment.The treatment group was given Shenqi-Dihuang Decoction on the basic of the control group.Both of the treatments for the two groups lasted for 12 weeks.Before and after the treatment,the changes of TCM syndrome scores were observed in each group.The automatic biochemical analyzer was used to detect the level of fasting plasma glucose,2-hour postprandial glucose(2 hPG),Boold Urea Nitrogen(BUN),Serum Creatinine(SCr),Plasma Albumin(Alb),Total Cholesterol(TC),Triglyceride(TG),Uric Acid(UA),Superoxide Dismutase(SOD),Homocysteine(HCY)before and after treatment.The Glycosylated Hemoglobin Alc were measured by high performance liquid chromatographic(HPLC),24-hour urine total protein quantity(24 hUTP)were measured by immunoturbidimetric assay before and after treatment,and then Glomerular Filtration Rate(eGFR)was estimated to evaluate clinical effect.Results After the treatment,the total effective rate in the treatment group was 87.5%(35/40),and the control group was 67.5%(27/40)and the difference was statistically significant(χ^2=4.557,P=0.033).After the treatment,the scores of urine turbid,weakness of waist and knees,fatigue,edema of both lower limbs were decreased in both groups,and the treatment group was significantly better than those of the control group(t value were-2.178,-1.675,-3.667,-1.904,-4.835,respectively,all Ps<0.01).After the treatment,the level of FPG and HbA1c were significantly lower than those of the c

关 键 词：糖尿病肾病 气阴两虚 瘀血阻络 参芪地黄汤化裁方 中西医结合疗法 

分 类 号：R692[医药卫生—泌尿科学] R587[医药卫生—外科学]