益肾通络汤治疗糖尿病肾病
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摘要
目的:观察中药益肾通络汤对糖尿病肾病(DN)的治疗效果。方法:将142例DN患者随机双盲分为3组,对照组40例单纯采用西医糖尿病基础治疗,治疗A组50例在对照组治疗的基础上加用银杏达莫粉针液,静脉滴注4周;治疗B组52例在对照组治疗的基础上加用黄芪注射液静脉滴注4周,中药益肾通络汤内服,1剂/d,水煎早晚分服,14 d为1个疗程,连用2个疗程。治疗后观察患者的临床疗效及空腹血糖(FBG),餐后血糖(PBG),总胆固醇(TC),甘油三酯(TG),低密度脂蛋白胆固醉(LDL-L),高密度脂蛋白胆固醉(HDL-L),24 h尿白蛋白定量,尿白蛋白排泄率(UAER)及尿β2微球蛋白(尿β2-MG),尿素氮(BUN),血肌酐(SCr),内生肌酐清除率(CCr),糖化血红蛋白(Hb A1c),血浆同型半胱氨酸(Hcy),颈动脉中层内膜厚度(颈动脉IMT)等指标。结果:治疗A组50例中,显效17例,有效17例,无效16例,总有效率68.0%。治疗B组52例中,显效37例,有效8例,无效7例,总有效率86.5%。对照组40例中,显效8例,有效14例,无效18例,总有效率55.0%。3组有效率相比,有显著性差异(P<0.01)。治疗B组与治疗A组比较,差异均有统计学意义(P<0.05)。结论:银杏达莫注射液可减少尿微量白蛋白,具有改善血液流变学作用,从而延缓DN的发展,对DN有治疗和保护作用。黄芪联合中药益肾通络汤治疗糖尿病肾病疗效更加显著,明显改善症状及减少尿蛋白,能保护肾功能,延缓肾功能衰竭的发生及发展,疗效确切,值得推广。
Objective: To observe therapeutic effects of traditional Chinese medicine Yishen Tongluo decoction on diabetic nephropathy( DN). Method: One hundred and forty-two patients with diabetic nephropathy were random Ly divided into three Groups. 40 patients in control group were treated only by western medicine,50 patients in treatment group were treated Ginkgo-dipyridolum injection( GDI) combined with western medicines;52 patients in treatment group were treated by astragalus injection and Yishen Tongluo decoction combined with western medicines,with a treatment course of 4 weeks for three groups. The changes of the therapeutic efficacy,fasting blood glucose( FBG),postprandial dlood glucose( PBG),total cholesterol( TC),triglyceride( TG),low-density lipoprotein( LDL-L), high-density lipoprotein( HDL-L),24-hour urinary protein quantity, urine albumin excretion rate( UAER), urineβ2-microgiobulin( β2-MG), blood urine nitrogen( BUN), serum creatinine( SCr),creatinine clearance rate( CCr),glycosylated hemoglobin( Hb A1c),homocysteine( Hcy),intima-media thickness( IMT),et al. Result: The total effective rate in treatment group A was 68. 0%( 34 /50cases),and in treatment group B was 86. 5%( 45 /52 cases),which was obviously higher than that in control group( 55. 5%,22 /40 cases)( P < 0. 05). Between in treatment groups,deffrences are statistically significant( P < 0. 05). Conclusion: GDI can decrease the amount of excretingm icroalbum inuria in diabetes. astragalus injection plus Yishen Tongluo decoction can decrease significantly the amount of excretingm icroalbum inuria and protect renal function in diabetes.
Objective: To observe therapeutic effects of traditional Chinese medicine Yishen Tongluo decoction on diabetic nephropathy( DN). Method: One hundred and forty-two patients with diabetic nephropathy were random Ly divided into three Groups. 40 patients in control group were treated only by western medicine,50 patients in treatment group were treated Ginkgo-dipyridolum injection( GDI) combined with western medicines;52 patients in treatment group were treated by astragalus injection and Yishen Tongluo decoction combined with western medicines,with a treatment course of 4 weeks for three groups. The changes of the therapeutic efficacy,fasting blood glucose( FBG),postprandial dlood glucose( PBG),total cholesterol( TC),triglyceride( TG),low-density lipoprotein( LDL-L), high-density lipoprotein( HDL-L),24-hour urinary protein quantity, urine albumin excretion rate( UAER), urineβ2-microgiobulin( β2-MG), blood urine nitrogen( BUN), serum creatinine( SCr),creatinine clearance rate( CCr),glycosylated hemoglobin( Hb A1c),homocysteine( Hcy),intima-media thickness( IMT),et al. Result: The total effective rate in treatment group A was 68. 0%( 34 /50cases),and in treatment group B was 86. 5%( 45 /52 cases),which was obviously higher than that in control group( 55. 5%,22 /40 cases)( P < 0. 05). Between in treatment groups,deffrences are statistically significant( P < 0. 05). Conclusion: GDI can decrease the amount of excretingm icroalbum inuria in diabetes. astragalus injection plus Yishen Tongluo decoction can decrease significantly the amount of excretingm icroalbum inuria and protect renal function in diabetes.
引文
[1]Williams M E.Diabetic nephropathy:the proteinuria hypothesis[J].Am J Nephrol,2005,25(2):77-94.
[2]Yang Wenyin,Lu Juming,Weng Jianping.Prevalence of diabetes among men and women in China[J].New Eng J Med,2010,362(12):1090-1096.
[3]Molitch M E,De Fronzo R A,Franz M J,et al.Diabetic nephropathy[J].Diabetes Care,2003,26(Suppl 1):S94-S102.
[4]高国丽,车光升,董瑶,等.糖尿病肾病发病机制的研究进展[J].中国老年学杂志,2007,27(22):2254-2255.
[5]Anon.Definition,diagnosis and classification of diabetes mellitus and its complications,report of a WHO consultation.Part 1:Diagnosis and classification of diabetes mellitus[M].Geneva:WHO,1999:1-65.
[6]Mogensen C E.Early diabetic renal involvelent and nephropathy[M].Los Angeles:Elsev Sc publ,1987:30.
[7]邓铁涛.中医证候规范[M].广州:广东科学技术出版社,1990:57-59.
[8]刘宝厚,刘新.血流变学测定在原发性肾小球疾病中临床意义[J].中华肾脏病杂志,1987,3(2):128-130.
[9]赵岚,杨立欣.黄芪注射液治疗糖尿病肾病临床分析[J].中国中医药信息杂志,2005,12(5):9-12.
[10]从莉萍,刘庆彦,赵凯华.当归对糖尿病肾病的保护作用[J].现代医药卫生,2004,20(14):1351-1354.
[11]钟先阳,罗仁,魏连波,等.丹参酮ⅡA对大鼠出血性休克再灌注肾损伤的防治作用[J].中国中西医结合肾病杂志,2002,3(1):13-15.
[12]张洁,曾晓荣,杨艳,等.丹参酮ⅡA磺酸钠和丹参素对猪冠状动脉平滑肌细胞钙激活钾通道的激活机制[J].中国药理学与毒理学杂志,2005,19(3):270-273.
[13]王雪琴,赵凤春,吴润梅.大黄制剂与苯那普利联合治疗老年2型糖尿病肾病慢性肾功不全临床观察[J].中国药物与临床,2007,7(6):478-479.
[14]圈启芳.银杏达莫注射液治疗早期糖尿病肾病临床观察[J].临床荟萃,2003,18(18):1059-1060.
[2]Yang Wenyin,Lu Juming,Weng Jianping.Prevalence of diabetes among men and women in China[J].New Eng J Med,2010,362(12):1090-1096.
[3]Molitch M E,De Fronzo R A,Franz M J,et al.Diabetic nephropathy[J].Diabetes Care,2003,26(Suppl 1):S94-S102.
[4]高国丽,车光升,董瑶,等.糖尿病肾病发病机制的研究进展[J].中国老年学杂志,2007,27(22):2254-2255.
[5]Anon.Definition,diagnosis and classification of diabetes mellitus and its complications,report of a WHO consultation.Part 1:Diagnosis and classification of diabetes mellitus[M].Geneva:WHO,1999:1-65.
[6]Mogensen C E.Early diabetic renal involvelent and nephropathy[M].Los Angeles:Elsev Sc publ,1987:30.
[7]邓铁涛.中医证候规范[M].广州:广东科学技术出版社,1990:57-59.
[8]刘宝厚,刘新.血流变学测定在原发性肾小球疾病中临床意义[J].中华肾脏病杂志,1987,3(2):128-130.
[9]赵岚,杨立欣.黄芪注射液治疗糖尿病肾病临床分析[J].中国中医药信息杂志,2005,12(5):9-12.
[10]从莉萍,刘庆彦,赵凯华.当归对糖尿病肾病的保护作用[J].现代医药卫生,2004,20(14):1351-1354.
[11]钟先阳,罗仁,魏连波,等.丹参酮ⅡA对大鼠出血性休克再灌注肾损伤的防治作用[J].中国中西医结合肾病杂志,2002,3(1):13-15.
[12]张洁,曾晓荣,杨艳,等.丹参酮ⅡA磺酸钠和丹参素对猪冠状动脉平滑肌细胞钙激活钾通道的激活机制[J].中国药理学与毒理学杂志,2005,19(3):270-273.
[13]王雪琴,赵凤春,吴润梅.大黄制剂与苯那普利联合治疗老年2型糖尿病肾病慢性肾功不全临床观察[J].中国药物与临床,2007,7(6):478-479.
[14]圈启芳.银杏达莫注射液治疗早期糖尿病肾病临床观察[J].临床荟萃,2003,18(18):1059-1060.