中西医结合治疗老年糖尿病肾病临床研究
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摘要
目的:观察中西医结合治疗糖尿病肾病(diabetic nephropathy,DN)的临床疗效。方法:将100例DN患者随机分为对照组53例和观察者47例。对照组采用西医糖尿病基础治疗加银杏达莫粉针液,静脉滴注14 d;观察组在对照组基础上加用:1黄芪注射液,静脉滴注14 d;2中药内服(中药益肾通络汤),每日1剂,水煎早晚分服。14 d为1个疗程,可连用2个疗程,后观察患者的临床疗效、中医证候积分及空腹血糖(fasting blood glucose,FBG)、餐后2小时血糖(2-hour postprandial blood glucose,PBG)、尿素氮(blood urine nitrogen,BUN)、血肌酐(serum creatinine,SCr)、内生肌酐清除率(creatinine clearance rate,Ccr)、24小时尿白蛋白定量、尿白蛋白排泄率(urine albumin excretion rate,UAER)及尿β2微球蛋白(urineβ2-microgiobulin,β2-MG)、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白(low-densitylipoprotein,LDL-L)、高密度脂蛋白(high-densitylipoprotein,HDL-L)等指标。结果:观察组47例中,显效15例,有效20例,有效率74.47%;对照组53例中,显效8例,有效22例,有效率56.60%;两组有效率比较,差异有统计学意义(P<0.05)。观察组治疗后中医证候积分较本组治疗前及对照组治疗后明显下降(P<0.05)。观察组治疗后FBG(6.70±2.20)mmol·L~(-1),PBG(11.60±1.50)mmol·L~(-1)、BUN(6.78±2.20)μmmol·L~(-1)、Scr(69.72±63.66)μmmol·L~(-1)、24小时尿白蛋白定量(0.38±0.30)g·24 h-1、UAER(67.75±15.50)μg·min-1、尿β2-MG(67.70±10.50)μg·L~(-1)、TC(4.00±1.63)mmol·L~(-1)、TG(1.70±1.40)mmol·L~(-1)、LDL-L(3.13±0.80)mmol·L~(-1)较治疗前及对照组治疗后明显下降(P<0.05,P<0.01),Ccr(93.73±17.50)m L·min-1、HDL-C(1.60±0.19)mmol·L~(-1)较治疗前及对照组治疗后明显提高(P<0.05,P<0.01)。结论:中西医结合治疗DN疗效显著。
Objective:To observe the therapeutic effect of combined treatment of traditional Chinese and western medicine on diabetic nephropathy. Methods:100 patients with diabetic nephropathy were randomly divided into two groups. 53 patients in control group were treated by Ginkgo-Dipyridolum injection( GDI) combined with western medicines and the other 47 patients in observation group were treated by GDI and astragalus injection,Yishen Tongluo Tang combined with western medicines,with a treatment course of 4 weeks for two groups. The changes of the therapeutic efficacy,Chinese medicine syndrome scores,fasting blood glucose(FBG),postprandial dlood glucose( PBG),blood urine nitrogen( BUN),serum creatinine( SCr),creatinine clearance rate(Ccr),24-hour urinary protein quantity,urine albumin excretion rate(UAER),urine β2-microgiobulin(β2-MG),total cholesterol(TC),triglyceride(TG),low-densitylipoprotein(LDL-L),high-densitylipoprotein(HDL-L) et al. Results:The total effective rates in treatment group and control group were 74. 47 % and 56. 60% respectively. After treatment the Chinese medicine syndrome scores were reduced significantly in the treatment group( P < 0. 05,P < 0. 01),After treatment the Chinese medicine FBG(6. 70 ±2. 20) mmol·L~(-1),PBG(11. 60 ±1. 50) mmol·L~(-1),BUN(6. 78 ± 2. 20) μmol·L~(-1),Scr(69. 72 ± 63. 66) μmol·L~(-1),24-hour urinary protein quantity(0. 38 ± 0. 30) g·24 h- 1,UAER(67. 75 ± 15. 50) μg·min- 1,β2-MG(67. 70 ± 10. 50) μg·L~(-1),TC(4. 00 ± 1. 63) mmol·L~(-1),TG(1. 70 ± 1. 40) mmol·L~(-1),LDL-L(3. 13 ± 0. 80) mmol·L~(-1)were reduced significantly in the treatment group( P < 0. 05,P < 0. 01),Ccr(93. 73 ± 17. 50) m L·min- 1,HDL-C(1. 60 ± 0. 19) mmol·L~(-1)were increased significantly in the treatment group( P < 0. 05,P < 0. 01),and showed significant difference when compared with those in the control group( P < 0. 05,P < 0. 01). Conclusion:The combination of traditional Chinese medicine with western medicine is effective in treating diabetic nephropathy.
Objective:To observe the therapeutic effect of combined treatment of traditional Chinese and western medicine on diabetic nephropathy. Methods:100 patients with diabetic nephropathy were randomly divided into two groups. 53 patients in control group were treated by Ginkgo-Dipyridolum injection( GDI) combined with western medicines and the other 47 patients in observation group were treated by GDI and astragalus injection,Yishen Tongluo Tang combined with western medicines,with a treatment course of 4 weeks for two groups. The changes of the therapeutic efficacy,Chinese medicine syndrome scores,fasting blood glucose(FBG),postprandial dlood glucose( PBG),blood urine nitrogen( BUN),serum creatinine( SCr),creatinine clearance rate(Ccr),24-hour urinary protein quantity,urine albumin excretion rate(UAER),urine β2-microgiobulin(β2-MG),total cholesterol(TC),triglyceride(TG),low-densitylipoprotein(LDL-L),high-densitylipoprotein(HDL-L) et al. Results:The total effective rates in treatment group and control group were 74. 47 % and 56. 60% respectively. After treatment the Chinese medicine syndrome scores were reduced significantly in the treatment group( P < 0. 05,P < 0. 01),After treatment the Chinese medicine FBG(6. 70 ±2. 20) mmol·L~(-1),PBG(11. 60 ±1. 50) mmol·L~(-1),BUN(6. 78 ± 2. 20) μmol·L~(-1),Scr(69. 72 ± 63. 66) μmol·L~(-1),24-hour urinary protein quantity(0. 38 ± 0. 30) g·24 h- 1,UAER(67. 75 ± 15. 50) μg·min- 1,β2-MG(67. 70 ± 10. 50) μg·L~(-1),TC(4. 00 ± 1. 63) mmol·L~(-1),TG(1. 70 ± 1. 40) mmol·L~(-1),LDL-L(3. 13 ± 0. 80) mmol·L~(-1)were reduced significantly in the treatment group( P < 0. 05,P < 0. 01),Ccr(93. 73 ± 17. 50) m L·min- 1,HDL-C(1. 60 ± 0. 19) mmol·L~(-1)were increased significantly in the treatment group( P < 0. 05,P < 0. 01),and showed significant difference when compared with those in the control group( P < 0. 05,P < 0. 01). Conclusion:The combination of traditional Chinese medicine with western medicine is effective in treating diabetic nephropathy.
引文
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[11]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.
[12]高秀梅,张伯礼,宫涛,等.丹参及提取物对心血管系统药理作用研究进展[J].天津中医,2002,19(1):74-76.
[13]杜烨辉,杨锦屏,孙丁美.百令胶囊治疗糖尿病肾病的临床观察[J].时珍国医国药,2006,17(11):2276-2277.
[2]Williams ME.Diabetic nephropathy:the proteinuria hypothesis[J].Am J Nephrol,2005,25(2):77-94
[3]Alberti KG,Zimmet PZ.Definition,diagnosis and classification of diabetes mellitus and its complications.Part 1:diagnosis and classification of diabetes mellitus provisional report of a WHO consultation[J].Diabet Med,1998,15(7):539-553.
[4]Mogensen CE,Schmitz A,Christensen CK.Comparative renal pathophysiology relevant to IDDM and NIDDM patients[J].Diabetes Metab Rev,1988,4(5):453-483.
[5]邓铁涛.中医证候规范[M].广州:广东科学技术出版社,1990:57-59.
[6]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,2002:156-168,215-219.
[7]Molitch ME,De Fronzo RA,Franz MJ,et al.Diabetic nephropathy[J].Diabetes Care,2003,26(Suppl 1):S94-98.
[8]Flyvbjerg A.Putative pathophysio1ogical role of growth factors and cytokines in experimental diabetic kidney disease[J].Diabetologia,2000,43(10):1205-1223.
[9]王晓文,张晓林,徐元华,等.氯沙坦联合银杏达莫治疗早期糖尿病肾病疗效观察[J].现代中西医结合杂志,2010,19(31):3393-3394.
[10]许成群,徐明松,王元.黄芪治疗糖尿病肾病研究近况[J].实用中医药杂志,2011,27(3):215-216.
[11]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.
[12]高秀梅,张伯礼,宫涛,等.丹参及提取物对心血管系统药理作用研究进展[J].天津中医,2002,19(1):74-76.
[13]杜烨辉,杨锦屏,孙丁美.百令胶囊治疗糖尿病肾病的临床观察[J].时珍国医国药,2006,17(11):2276-2277.