温针灸联合滋肾降糖方对糖尿病肾病患者NO、eNOS及肾动脉血流动力学的影响  

Effect of Needle-Warming Moxibustion Combined with Zishen Jiangtang Formula on NO,eNOS and Hemodynamics of Renal Artery in Patients with DKD

作　　者：张慧杰 丁戊坤[1,2] 赵大鹏 栾仲秋[1,2] 毕述鹏[1] 宋立群 ZHANG Huijie;DING Wukun;ZHAO Dapeng;LUAN Zhongqiu;BI Shupeng;SONG Liqun(The First Affiliated Hospital of Heilongjiang University of Chinese Medicine,Harbin 150040,China;Heilongjiang University of Chinese Medicine,Harbin 150040,China)

机构地区：[1]黑龙江中医药大学附属第一医院,黑龙江哈尔滨150040 [2]黑龙江中医药大学,黑龙江哈尔滨150040

出　　处：《中医药信息》2022年第12期50-55,61,共7页Information on Traditional Chinese Medicine

基　　金：黑龙江省博士后科研启动金资助项目(LBH-Q18120);黑龙江省中医药管理局项目(ZHY18-001);黑龙江中医药大学教育教学研究课题(XJJY2018027);宋立群全国名老中医专家传承工作室建设项目(国中医药人教函〔2022〕75号)。

摘　　要：目的:探究温针灸联合滋肾降糖方对糖尿病肾病(diabetic kidney disease,DKD)脾肾阳虚证患者的疗效,并研究其对血清NO、eNOS和肾动脉血流动力学的影响。方法:选择符合纳入标准的DKD脾肾阳虚证患者84例,依据随机数字表随机分为对照组、中药治疗组与针药联合组,每组各28例。对照组给予常规治疗联合肾炎温阳胶囊治疗,中药治疗组给予常规治疗联合滋肾降糖方治疗,针药联合组给予常规治疗加滋肾降糖方联合温针灸背俞穴(脾俞、三焦俞、肾俞及膀胱俞)治疗,3组均治疗4周。观察比较3组患者治疗前后尿液及血清生化指标、24小时尿蛋白定量(24 h Upro)、糖化血红蛋白(HbA1c)、血清胱抑素C(Cys-C)、β2-微球蛋白(β2-MG)、总胆固醇(TC)及甘油三酯(TG)的水平差异;左肾肾主动脉(MRA)、肾段动脉(SRA)、叶间动脉(IRA)各段血流收缩期峰值流速(Vsmax)、舒张期血流速度(Vdmin)及阻力指数(RI)变化情况;血清一氧化氮(NO)及内皮型一氧化氮合酶(eNOS)含量差异;比较临床疗效。结果:治疗后,3组患者的血清生化指标、左肾肾动脉血液流速及阻力指数、血清NO及eNOS均较治疗前显著改善,差异有统计学意义(P<0.05),且针药联合组患者HbAlc、TC、TG水平,左肾肾动脉血液流速及阻力指数,血清NO及eNOS改善情况均优于对照组及中药治疗组,差异有统计学意义(P<0.05);对照组有效率71.43%(20/28),针药联合组有效率85.71%(24/28),中药治疗组有效率82.14%(23/28),针药联合组和中药对照组的有效率明显高于对照组(P<0.05);针药联合组和中药对照组的中医症状总积分也明显高于对照组(P<0.05)。结论:温针灸联合滋肾降糖方可有效改善肾脏功能,降低蛋白尿,降低血脂,提高NO、eNOS水平,改善DKD脾肾阳虚证患者肾脏血流动力学,改善肾脏缺血、缺氧状态,提高治疗疗效,改善患者预后。Objective:To explore the efficacy of needle-warming moxibustion combined with Zishen Jiangtang Formula in treatment of diabetic kidney disease(DKD)of Yang deficiency of Spleen and Kidney,and to study its influence to NO,eNOS and hemodynamics of renal artery.Methods:84 DKD patients met the inclusion criteria were randomly divided into the control group,the Chinese medication group and the combination group,with 28 cases in each group.The control group was treated with conventional treatment combined with Shenyan Wenyang Capsule,the Chinese medication group was treated with conventional treatment combined with Zishen Jiangtang Formula,and the combination group was treated with conventional treatment plus Zishen Jiangtang Formula combined with needle-warming moxibution at Pishu(BL20),Sanjiaoshu(BL22),Shenshu(BL23)and Pangguangshu(BL28).The three groups were treated for 4 weeks.The urine and serum biochemical indexes,24-hour urine protein quantification(24 hUpro),glycosylated hemoglobin(HbA1c),serum cystatin C(Cys-C),β2-microglobulin(β2-MG),total cholesterol(TC)and triglyceride(TG),peak systolic flow velocity(Vsmax),diastolic blood flow velocity(Vdmin)and resistance index(RI)of the left major renal aorta(MRA),segmental renal artery(SRA)and interlobar renal artery(IRA),as well as the serum levels of nitric oxide(NO)and endothelial nitric oxide synthase(eNOS)were observed and compared before and after the treatment in the three groups.The clinical efficacy was also compared among the three groups.Results:The serum biochemical indexes,left renal artery blood flow rate and resistance index,serum NO and eNOS,and TCM symptoms score were all significantly improved after the treatment compared with those before the treatment in the three groups(P<0.05),and the improvements were more significant in the combination group than those in the control group and the Chinese medication group(P<0.05).The total effective rate of the control group was 71.43%(20/28),it was 85.17%(24/28)in the combination group and 82.14%(23/28)in the C

关 键 词：糖尿病肾病 脾肾阳虚证 温针灸 滋肾降糖方 血流动力学 一氧化氮 内皮型一氧化氮合酶 

分 类 号：R259[医药卫生—中西医结合] R277.5[医药卫生—中医内科学]