丹芪益肾方对糖尿病肾病患者临床疗效及肾保护作用机制研究  

Clinical Efficacy and Renal Protective Mechanism of Dan Qi Yishen Prescription in Treating Patients with Diabetic Nephropathy

作　　者：李建平 朱德礼 马贞 陈晓曼 罗干 钟林 汪杰 高荣理 林海霞 LI Jianping;ZHU Deli;MA Zhen;CHEN Xiaoman;LUO Gan;ZHONG Lin;WANG Jie;GAO Rongli;LIN Haixia(Sanya Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine,Sanya 572000 Hainan,China;Graduate in 2024,Guangzhou University of Chinese Medicine,Guangzhou 510006 Guangdong,China)

机构地区：[1]广州中医药大学附属三亚中医院,海南三亚572000 [2]广州中医药大学2024级硕士研究生,广东广州510006

出　　处：《广州中医药大学学报》2025年第2期350-357,共8页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：海南省自然科学基金高层次人才项目(编号:821RC1146);海南省卫健委科研立项课题(编号:19A200186)。

摘　　要：【目的】观察丹芪益肾方对糖尿病肾病(DN)的治疗效果,并分析其肾保护作用机制。【方法】将2021年10月至2023年4月广州中医药大学附属三亚中医院收治的150例DN气阴两虚夹瘀证患者按随机数字表法随机分成对照组和观察组,每组各75例。2组患者均给予饮食治疗、控制血糖、控制血压、降脂治疗以及并发症治疗等常规治疗,在此基础上,对照组给予注射用还原型谷胱甘肽静脉滴注治疗,观察组给予丹芪益肾方煎剂内服及肾区中药离子导入治疗。30 d为1个疗程,共治疗3个疗程。观察2组患者治疗前后中医证候积分、肾功能指标、肾脏血流动力学指标、凝血纤溶指标、血管内皮功能指标的变化情况。【结果】(1)中医证候积分方面,治疗后,2组患者的疲倦乏力、心悸气短、头晕耳鸣、自汗盗汗、心烦失眠、口渴喜饮等中医证候积分均较治疗前降低(P<0.01),且观察组的降低幅度均明显优于对照组(P<0.01)。(2)肾功能指标方面,治疗后,2组患者的血尿素氮(BUN)、血肌酐(SCr)、Ⅳ型胶原(CⅣ)、血浆层黏蛋白(LN)等肾功能指标均较治疗前改善(P<0.01),观察组的改善幅度均明显优于对照组(P<0.01)。(3)肾脏血流动力学指标方面,治疗后,2组患者肾主动脉(MRA)、叶间动脉(IRA)处的收缩期最大血流速度(Vsmax)、舒张期最低血流速度(Vdmin)均较治疗前升高(P<0.05或P<0.01),MRA处的阻力指数(RI)、搏动指数(PI),IRA处的RI以及观察组IRA处的PI均较治疗前降低(P<0.05或P<0.01),且观察组对MRA和IRA处Vsmax、Vdmin的升高幅度及对MRA和IRA处RI、PI的降低幅度均明显优于对照组(P<0.05或P<0.01)。(4)凝血纤溶指标方面,治疗后,2组患者的血浆凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、D-二聚体(D-D)和纤维蛋白原(FIB)等凝血纤溶指标均较治疗前改善(P<0.01),且观察组的改善幅度均明显优于对照组(P<0.01)。(5)血管内皮功能指标方面Objective To observe the clinical efficacy of Dan Qi Yishen Prescription in treating diabetic nephropathy(DN)and explore its renal protective mechanism.Methods A total of 150 patients with DN of qi-yin deficiency complicated with blood stasis syndrome who admitted to Sanya Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine from October 2021 to April 2023 were divided into a control group and an observation group according to the random number table method,with 75 patients in each group.Both groups were given conventional therapies such as dietary treatment,blood glucose control,blood pressure control,lipid-lowering treatment and treatment of complications.Additionally,the control group was given intravenous injection of reduced glutathione,while the observation group was given oral use of the decoction of Dan Qi Yishen Prescription and ionic introduction of Dan Qi Yishen Prescription in renal region.Thirty days constituted one course of treatment,and both groups were treated for three courses.Before and after treatment,the scores of traditional Chinese medicine(TCM)syndrome,and the levels of renal function indicators,renal hemodynamic indicators,coagulation and fibrinolysis indicators,and vascular endothelial function indicators in the two groups were observed.Results(1)After treatment,the scores of TCM symptoms such as fatigue and weakness,palpitations and shortness of breath,dizziness and tinnitus,spontaneous sweating and night sweating,restlessness and insomnia,and thirst with preference for drinks in the two groups were decreased compared with those before treatment(P<0.01),and the decrease in the observation group was significantly superior to that in the control group(P<0.01).(2)After treatment,the levels of renal function indicators such as blood urea nitrogen(BUN),serum creatinine(SCr),collagenⅣ(CⅣ),and plasma laminin(LN)of patients in the two groups were improved compared with those before treatment(P<0.01),and the improvement in the observation group was

关 键 词：糖尿病肾病 气阴两虚夹瘀证 丹芪益肾方 肾功能 血流动力学 凝血纤溶系统 血管内皮功能 

分 类 号：R259.872[医药卫生—中西医结合]