益肾祛湿化瘀汤联合百令胶囊治疗早期糖尿病肾病临床观察
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摘要
目的:观察益肾祛湿化瘀汤联合百令胶囊治疗糖尿病肾病患者的临床疗效。方法:将150例糖尿病肾病患者随机分为观察组和对照组,每组75例。对照组给予糖尿病标准饮食方案,胰岛素皮下注射控制血糖,餐后半小时快速行走运动30 min,有高血压者采用钙离子通道阻滞剂降压;观察组患者在对照组治疗的基础上给予益肾祛湿化瘀汤治疗,2组疗程均为4周;观察2组治疗前后尿白蛋白/尿肌酐比率(ACR)、24h尿蛋白定量、血肌酐(SCr)、血清转化生长因子β-1 (TGF-β1)、基质金属蛋白酶9 (MMP-9)、金属蛋白酶组织抑制因子1 (TIMP-1)水平及MMP-9/TIMP-1值,统计其治疗后临床疗效及不良反应。结果:总有效率观察组为91.43%,对照组为74.29%,2组比较,差异有统计学意义(P <0.05)。治疗后,2组患者尿ACR、24h尿蛋白定量、SCr水平均较治疗前明显降低(P <0.05),且观察组患者上述指标降低较对照组更显著(P <0.05)。治疗后,2组患者血清TGF-β1、TIMP-1水平较治疗前降低(P <0.05),MMP-9水平、MMP-9/TIMP-1值较治疗前升高(P <0.05);且观察组上述各项指标改善较对照组更显著(P <0.05)。2组患者治疗过程中均未见明显不良反应及过敏反应。结论:益肾祛湿化瘀汤联合百令胶囊治疗早期糖尿病肾病疗效显著,能明显减少糖尿病肾病患者尿蛋白的排泄率及肌酐水平,改善微炎症状态,且安全性较好。
Objective:To observe the clinical effect of Yishen Qushi Huayu tang combined with Bailing capsules for early diabetic nephropathy. Methods:Divided 150 cases of patients with diabetic nephropathy into the observation group and the control group randomly,75 cases in each group. The control group was given diabetes diet,subcutaneous injection of insulin to control blood glucose,fast walking for 30 min in half an hour after meal,and antihypertensive treatment of calcium channel blocker for patients with hypertension. The observation group was additionally given Yishen Qushi Huayu tang based on the treatment of the control group. The treatment lasted for four weeks in the two groups. Observed the urinary albumin-to-creatinine ratio(ACR),levels of 24 h urinary protein,serum creatinine(Scr),serum transforming growth factor β1(TGF-β1),matrix metalloproteinase 9(MMP-9) and the values of tissue inhibitor of metalloproteinase 1(TIMP-1),and the ratio of MMP-9 to TIMP-1 before and after treatment in the two groups,and observed the clinical effect and the adverse reaction. Results:The total effective rate was 91.43% in the observation group and was 74.29% in the control group,the difference being significant(P < 0.05). After treatment, levels of ACR, 24 h urinary protein and Scr were all obviously decreased when compared with those before treatment(P < 0.05),and the decrease in the observation group was more obvious than that in the control group(P < 0.05). After treatment,levels of TGF-β1 and TIMP-1 in serum in the two groups were decreased when compared with those before treatment(P < 0.05),while the level of MMP-9 and the ratio of MMP-9 to TIMP-1 were increased when compared with those before treatment(P < 0.05). The improvement of the above indexes in the observation group was more obvious than that in the control group(P < 0.05). No adverse reaction and allergic reaction was found during the treatment in the two groups. Conclusion:The therapy of Yishen Qushi Huayu tang combined with Bailing capsules has significant effect in treating early diabetic nephropathy,which can obviously decrease the urinary albumin excretion and the level of creatinine,and improve micro-inflammation with good safety.
Objective:To observe the clinical effect of Yishen Qushi Huayu tang combined with Bailing capsules for early diabetic nephropathy. Methods:Divided 150 cases of patients with diabetic nephropathy into the observation group and the control group randomly,75 cases in each group. The control group was given diabetes diet,subcutaneous injection of insulin to control blood glucose,fast walking for 30 min in half an hour after meal,and antihypertensive treatment of calcium channel blocker for patients with hypertension. The observation group was additionally given Yishen Qushi Huayu tang based on the treatment of the control group. The treatment lasted for four weeks in the two groups. Observed the urinary albumin-to-creatinine ratio(ACR),levels of 24 h urinary protein,serum creatinine(Scr),serum transforming growth factor β1(TGF-β1),matrix metalloproteinase 9(MMP-9) and the values of tissue inhibitor of metalloproteinase 1(TIMP-1),and the ratio of MMP-9 to TIMP-1 before and after treatment in the two groups,and observed the clinical effect and the adverse reaction. Results:The total effective rate was 91.43% in the observation group and was 74.29% in the control group,the difference being significant(P < 0.05). After treatment, levels of ACR, 24 h urinary protein and Scr were all obviously decreased when compared with those before treatment(P < 0.05),and the decrease in the observation group was more obvious than that in the control group(P < 0.05). After treatment,levels of TGF-β1 and TIMP-1 in serum in the two groups were decreased when compared with those before treatment(P < 0.05),while the level of MMP-9 and the ratio of MMP-9 to TIMP-1 were increased when compared with those before treatment(P < 0.05). The improvement of the above indexes in the observation group was more obvious than that in the control group(P < 0.05). No adverse reaction and allergic reaction was found during the treatment in the two groups. Conclusion:The therapy of Yishen Qushi Huayu tang combined with Bailing capsules has significant effect in treating early diabetic nephropathy,which can obviously decrease the urinary albumin excretion and the level of creatinine,and improve micro-inflammation with good safety.
引文
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[8]王兴,田力铭,李春香,等.糖尿病肾病的中医病机研究进展[J].中国中医急症,2015,24(12):2172-2174.
[9] Kanwar YS, Wada J, Sun L, et al.Diabetic nephropathy:mechanisms of renal disease progression[J].Exp Biol Med(Maywood),2008,233(1):4-11.
[10]何新军,王思平.血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体拮抗剂联用治疗糖尿病肾病的不良反应文献分析[J].中国临床药学杂志,2014,23(1):39-45.
[11]刘春燕,陈云霞,苏俊平,等.百令胶囊对糖尿病肾病患者肾功能的影响[J].河北医药,2016,38(1):52-54.
[2]赵进喜,王世东,李靖,等.糖尿病肾脏疾病中医辨证与疗效评价标准研究述评[J].世界中医药,2013,8(5):481-483.
[3]钱莹.百令胶囊治疗慢性肾小球肾炎疗效观察[J].山西中医,2011,27(1):20-28.
[4]魏洁,高芳坤,陈仁涉.糖尿病肾病的早期诊断指标[C]//中国医师协会.99世界养生大会论文集,北京:[出版者不详],1999:352-353.
[5]高云霞,张宁.对2型糖尿病肾病分期标准的评价[C]//中国中西医结合学会肾脏疾病专业委员会.第10届全国中西医结合肾脏病学术会议论文汇编,西安:[出版者不详],2009:8-9.
[6]杨霓芝,刘旭生.糖尿病肾病诊断、辨证分型及疗效评定标准(试行方案)[J].上海中医药杂志,2007,41(7):7-8.
[7]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:233.
[8]王兴,田力铭,李春香,等.糖尿病肾病的中医病机研究进展[J].中国中医急症,2015,24(12):2172-2174.
[9] Kanwar YS, Wada J, Sun L, et al.Diabetic nephropathy:mechanisms of renal disease progression[J].Exp Biol Med(Maywood),2008,233(1):4-11.
[10]何新军,王思平.血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体拮抗剂联用治疗糖尿病肾病的不良反应文献分析[J].中国临床药学杂志,2014,23(1):39-45.
[11]刘春燕,陈云霞,苏俊平,等.百令胶囊对糖尿病肾病患者肾功能的影响[J].河北医药,2016,38(1):52-54.