芪黄消肾方对早期2型糖尿病肾病疗效观察及机制探讨
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摘要
目的:在基因检测预测较高风险的基础上运用芪黄消肾方对早期2型糖尿病肾病气阴两虚兼血瘀水停证的临床治疗进行观察,探讨其作用机制。方法:将符合标准的75例早期2型糖尿病肾病患者随机分成为3组,即空白组、对照组和治疗组,每组各25例患者。每组患者均予以基础治疗即用西药控制血糖、血脂等一般指标。其中空白组仅给予基础治疗,对照组在给予基础治疗的基础上联合缬沙坦胶囊治疗,治疗组给予基础治疗联合芪黄消肾方治疗,分别监测3组所有患者治疗前与治疗后3个月的中医证候积分、尿微量白蛋白、尿视黄醇结合蛋白、血清胱抑素C、血糖、血脂和肝肾功能等相关指标,并做统计学分析。结果:空白组、对照组、治疗组的总有效率分别为24%、72%和92%;与空白组和对照组中医证候积分相比较,治疗组积分减少更明显(P<0.05);与空白组及对照组比较,治疗组的FPG、PPG、HbA1c有更明显的降低(P<0.05);脂代谢方面,治疗组与对照组相比较,也有明显改善作用(P<0.05)。尿微量白蛋白、尿视黄醇结合蛋白和血清胱抑素C等临床指标显著下降。治疗组治疗后在检测指标的改善上均显著优于空白组和对照组(P<0.05),所有患者均未发生任何不良反应。结论:芪黄消肾方能够有效改善早期2型糖尿病肾病的临床症状,减少尿微量白蛋白、尿视黄醇结合蛋白和血清胱抑素C的排泄,改善糖脂代谢等紊乱,安全性较好,对延缓疾病向终末期肾病进展具有较好的作用,对防治2型糖尿病肾病具有积极的意义。
Objective:On the basis of genetic testing in higher risk,using Qihuang Xiaoshen Decoction to treat early type 2 diabetic nephropathy Qi and Yin deficiency with blood stasis and water stopped syndrome,then to observe its clinical curative effect and discuss its mechanism. Methods:75 patients with early type 2 diabetic nephropathy who met the standard were randomly divided into three groups,named blank group,control group and treatment group,each group had 25 patients. All the three groups were given basic treatment with Western medicine to control blood glucose,blood lipids and other general indicators. The blank group was only for basic treatment;the control group was given basic treatment combined with valsartan capsule;the treatment group was given Qihuang Xiaoshen Decoction besides basic treatment. All the three groups of patients were observed with TCM syndrome integral,urine trace albumin,urine retinol binding protein,serum cystatin C,blood glucose,blood lipid and liver and kidney function and other related indicators before and after there months treatment,and then given statistical analysis. Results:The total effective rate of the blank group,the control group and the treatment group respectively was 24%,72% and 92%;Compared with the other two groups,treatment group score reduction was more pronounced(P<0.05);and compared with the other two groups,FPG,PPG,HbA1 c were also reduced more obviously in the treatment group(P<0.05);In lipid metabolism,the treatment group also had significant improvement compared with the other two groups(P<0.05);Urine trace albumin,urine retinol binding protein and serum inhibition C and other clinical index decreased significantly in treatment group,better than the blank group and the control group(P<0.05),and all patients were found no adverse reactions. Conclusion:Qihuang Xiaoshen Decoction can effectively ameliorate the clinical symptoms of early type 2 diabetic nephropathy,decrease the urine trace albumin,urine retinol binding protein and serum cystatin C excretion,ameliorate glucolipid metabolic disorders. Meanwhile,it also has good security. So it has positive effect on delaying the progress to the end-stage of nephropathy,and has positive significance for the prevention and treatment of type 2 diabetic nephropathy.
Objective:On the basis of genetic testing in higher risk,using Qihuang Xiaoshen Decoction to treat early type 2 diabetic nephropathy Qi and Yin deficiency with blood stasis and water stopped syndrome,then to observe its clinical curative effect and discuss its mechanism. Methods:75 patients with early type 2 diabetic nephropathy who met the standard were randomly divided into three groups,named blank group,control group and treatment group,each group had 25 patients. All the three groups were given basic treatment with Western medicine to control blood glucose,blood lipids and other general indicators. The blank group was only for basic treatment;the control group was given basic treatment combined with valsartan capsule;the treatment group was given Qihuang Xiaoshen Decoction besides basic treatment. All the three groups of patients were observed with TCM syndrome integral,urine trace albumin,urine retinol binding protein,serum cystatin C,blood glucose,blood lipid and liver and kidney function and other related indicators before and after there months treatment,and then given statistical analysis. Results:The total effective rate of the blank group,the control group and the treatment group respectively was 24%,72% and 92%;Compared with the other two groups,treatment group score reduction was more pronounced(P<0.05);and compared with the other two groups,FPG,PPG,HbA1 c were also reduced more obviously in the treatment group(P<0.05);In lipid metabolism,the treatment group also had significant improvement compared with the other two groups(P<0.05);Urine trace albumin,urine retinol binding protein and serum inhibition C and other clinical index decreased significantly in treatment group,better than the blank group and the control group(P<0.05),and all patients were found no adverse reactions. Conclusion:Qihuang Xiaoshen Decoction can effectively ameliorate the clinical symptoms of early type 2 diabetic nephropathy,decrease the urine trace albumin,urine retinol binding protein and serum cystatin C excretion,ameliorate glucolipid metabolic disorders. Meanwhile,it also has good security. So it has positive effect on delaying the progress to the end-stage of nephropathy,and has positive significance for the prevention and treatment of type 2 diabetic nephropathy.
引文
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[9]时振声.中医研究肾炎的思路与方法[M]//中华中医药学会.中医药优秀论文选(下).北京:中华中医药学会,2009:4.
[10]王收宝,田林红.黄芪治疗糖尿病肾病分子机制研究进展[J].中医药学报,2011(1):118-121.
[11]康伟,徐燕颖.地黄多糖对糖尿病肾病大鼠模型的治疗作用及对RAGE/NF-κB信号通路的影响[J].天津中医药,2015(6):364-367.
[12]熊涛,吴兴军,王逸平.丹参多酚酸盐抑制低密度脂蛋白氧化修饰[J].中药药理与临床,2004(4):7-10.
[13]王尧,石凤英.灵芝对大鼠糖尿病肾病的保护作用[J].中国糖尿病杂志,2003(5):327-331.
[2]Ding Y,Choi M E. Autophagy in diabetic nephropathy[J].Journal of Endocrinology,2015,224(1):R15-R30.
[3]Al-Malki A L. Assessment of urinary osteopontin in association with podocyte for early predication of nephropathy in diabetic patients[J]. Disease Markers,2014,2014(1):493736.
[4]吴勉华,王新月.中医内科学[M].北京:中国中医药出版社,2012:383-390.
[5]Hamilton E J,Gianatti E,Strauss B J,et al. Increase in visceral and subcutaneous abdominal fat in men with prostate cancer treated with androgen deprivation therapy[J]. Clinical Endocrinology,2011,74(3):377-383.
[6]FontseréN,Esteve V,Saurina A,et al. The search for a new marker of renal function in older patients with chronic kidney disease stages 3-4:usefulness of cystatin C-based equations[J].Nephron Clinical Practice,2009,112(3):c164-c170.
[7]Tanaka Y,Kume S,Kitada M,et al. Autophagy as a therapeutic target in diabetic nephropathy[J]. Experimental Diabetes Research,2012,2012(12):628978.
[8]Salem MAK,El Habashy SA,Saeid OM,et al. Urinary excretion of n-acetyl-β-d-glucosaminidase and retinol binding protein as alternative indicators of nephropathy in patients with type 1diabetes mellitus[J]. Pediatric diabetes,2002,3(1):37-41.
[9]时振声.中医研究肾炎的思路与方法[M]//中华中医药学会.中医药优秀论文选(下).北京:中华中医药学会,2009:4.
[10]王收宝,田林红.黄芪治疗糖尿病肾病分子机制研究进展[J].中医药学报,2011(1):118-121.
[11]康伟,徐燕颖.地黄多糖对糖尿病肾病大鼠模型的治疗作用及对RAGE/NF-κB信号通路的影响[J].天津中医药,2015(6):364-367.
[12]熊涛,吴兴军,王逸平.丹参多酚酸盐抑制低密度脂蛋白氧化修饰[J].中药药理与临床,2004(4):7-10.
[13]王尧,石凤英.灵芝对大鼠糖尿病肾病的保护作用[J].中国糖尿病杂志,2003(5):327-331.