益气活血汤加洛汀新对糖尿病肾病24小时尿蛋白、血肌酐及血尿素氮影响的临床观察
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摘要
目的：寻求延缓糖尿病肾病肾功能恶化的中西医结合治疗的有效方法。
方法：将60例病例随机分为A组及B组。两组在年龄、性别、24小时尿蛋白定量和血肌酐经统计学处理，未见显著差异。经饮食、运动及降糖药物治疗，有效严格地控制血糖，空腹血糖＜7.0mmol／L者，糖基化血红蛋白＜8％的情况下。A组为洛汀新治疗对照组，B组为益气活血汤+洛汀新组。治疗时间2个月，检测治疗前后24小时尿蛋白定量、Scr及血尿素氮(BUN)水平，观察指标用均数±标准差((?)±s)表示，治疗前后用成对t检验及组间对照用t检验。
结果：洛汀新组、益气活血汤+洛汀新组治疗前后Scr水平均无显著差异(p＞0.05)。洛汀新、益气活血汤+洛汀新组治疗后见尿蛋白定量的下降，有统计学意义(p＜0.05)。两组间比较，益气活血汤+洛汀新组降低尿蛋白的疗效明显优于洛汀新(p＜0.05)。
结论：中西医治疗在延缓糖尿病肾病肾功能恶化，改善患者生活质量方面疗效优于单用ACEI。
Objective:To explore the effective therapeutic method of combination of TCM and western medicine to postpone renal function deterioration of diabetic nephropathy.
Method:According to WHO diagnosis criteria and TCM differentiation criteria, we selected 60 cases (29 male and 31 female), Which were divided into two groups (A and B) at random.Two groups have no significant difference by statistics in age,sex,urine protein/24h and serum creatinine.With control die,sport and have hypoglycemic drug or subcutaneous injection insulin therapy to control blood glucose strictly , fasting plasms glucose(FPG) < 7.0mmol/L,glycosylated hemoglobin <8%,A group was treated by Lotensin ( 10mg-20mg. Qd ) for 2 months,B groups was treated by both yiqihuoxue decoction and Lotensin for 2 months,detected urine protein /24h, serum creatinine(SCR) and blood uria nitrogen(BUN),observing marker indicated by mean and standard deviation before and after theraphy,contrasted by paired
sample T-Test or independent sample T-Test between before and after theraphy for two groups.
Result: Scr and BUN of A group had no significant difference than those of B group (p>0.05 ) . urine protein/24h of two groups descented after theraphy , which has signficance difference in statistics . B group is prior to A group.
Conclusion: It's better to treat with combination of TCM and western medicine than only ACEI in postponing renal function deterioration of diabetic
nephropathy and progressing life quantity.
方法：将60例病例随机分为A组及B组。两组在年龄、性别、24小时尿蛋白定量和血肌酐经统计学处理，未见显著差异。经饮食、运动及降糖药物治疗，有效严格地控制血糖，空腹血糖＜7.0mmol／L者，糖基化血红蛋白＜8％的情况下。A组为洛汀新治疗对照组，B组为益气活血汤+洛汀新组。治疗时间2个月，检测治疗前后24小时尿蛋白定量、Scr及血尿素氮(BUN)水平，观察指标用均数±标准差((?)±s)表示，治疗前后用成对t检验及组间对照用t检验。
结果：洛汀新组、益气活血汤+洛汀新组治疗前后Scr水平均无显著差异(p＞0.05)。洛汀新、益气活血汤+洛汀新组治疗后见尿蛋白定量的下降，有统计学意义(p＜0.05)。两组间比较，益气活血汤+洛汀新组降低尿蛋白的疗效明显优于洛汀新(p＜0.05)。
结论：中西医治疗在延缓糖尿病肾病肾功能恶化，改善患者生活质量方面疗效优于单用ACEI。
Objective:To explore the effective therapeutic method of combination of TCM and western medicine to postpone renal function deterioration of diabetic nephropathy.
Method:According to WHO diagnosis criteria and TCM differentiation criteria, we selected 60 cases (29 male and 31 female), Which were divided into two groups (A and B) at random.Two groups have no significant difference by statistics in age,sex,urine protein/24h and serum creatinine.With control die,sport and have hypoglycemic drug or subcutaneous injection insulin therapy to control blood glucose strictly , fasting plasms glucose(FPG) < 7.0mmol/L,glycosylated hemoglobin <8%,A group was treated by Lotensin ( 10mg-20mg. Qd ) for 2 months,B groups was treated by both yiqihuoxue decoction and Lotensin for 2 months,detected urine protein /24h, serum creatinine(SCR) and blood uria nitrogen(BUN),observing marker indicated by mean and standard deviation before and after theraphy,contrasted by paired
sample T-Test or independent sample T-Test between before and after theraphy for two groups.
Result: Scr and BUN of A group had no significant difference than those of B group (p>0.05 ) . urine protein/24h of two groups descented after theraphy , which has signficance difference in statistics . B group is prior to A group.
Conclusion: It's better to treat with combination of TCM and western medicine than only ACEI in postponing renal function deterioration of diabetic
nephropathy and progressing life quantity.
引文
1. 熊曼琪，苗理平．加味桃核承气汤对糖尿病鼠肾超微结构的影响．中国医药学报，1990，5(5)：25～27
2. Ravid M, Lang R,Rachmani R. Lishner M:Longterm renoprotective effect of angiotensin-converting enzyme inhibition in non-insulin-dependent diabetes mellitus.A 7-year follow-up study.Arch Intern med. 1996, 156:286-289.
3. Ruggenenti P, Perna A,Benini R,Remuzzi G:Effects of dihydropyridine calcium channel blockers,angiotensin-converting enzyme inhibition.and blood pressure control on chronic,nondiabetic nephropathies.J Am Soc Nephrol. 1998,9:2096-2101.
4. KeaneWF, EknoyanG:Proteinuria.Albuminuria, RiskAssessment.Detection,Eliminiatio n(PARADE):A position paper of the National Kidney Foundation. Am J Kidney Dis. 1999,33:1004-1010,
5. Randomised placebo-controlled trial of effect Of ramipril on decline in glomerular filtration rate and risk of terminal failure in proteinuric, non-diabetic nephropathy.The GISEN group(Gruppo Italiano di Studi Epidemiologici in Nefrologia).Lancet. 1997,349:1857-1863.
6. Hebert LA,Bain RP, Verme D,Cattran DE,Whittier FC,Tolchin N.Rohde RD,Lewis EJ:Remission of nephrotic range proteinuria in type 1 diabetes.Collaborative Study Group.Kidney Int. 1994,46:1688-1693
7. Bakris GL.Copley JB,Vicknair N,Sadler R,Leurgans S:Calcium channel blockers versus other antihypertensive therapies on progression of non-insulin-dependet diabetes mellitus associated nephropathy.Kidney Int. 1996,56:1641-1650.
8. Wilmer WA,Hebert LA,Lewis EJ.Rohde RD.Whittier F,Cattran D,Levy AS, Lewis JB,Spitalewitz S.Blumenthal S,Bain RP:Remission of nephrotic syndrome in type 1 diabetes:Long term follow-up of patients in the Captopril Study.Am J Kidney Dis
1999,34:308-314
9. Lebovitz HE,Wiegmann TB,Cnaan A. Shahinfar S,Sica DA,Broadstone V, Schwartz SL,Mengel MC,Segal R,Versaggi JA:Renal protective effects of enalapril in hypertensive NIDDM:Roke of baseline albuminuria.Kidney Int Suppl. 1994,45:150-155.
10. Bakris GL.Mangrum A, Copley JB,Vicknair N, Sadler R:Effect of calcium channel or beta-blockade on the progression of diabetic nephropathy in African Americans.Hypertension. 1997,29:744-750
11. Badris GL,Weir MR.DeQuattro V, McCahon FG:Effects of ACE inhibitor/calcium antagonist combination on proteinuria in diabetic nephropathy. Kidney Int 54:1283-1289,1998 Bucala R, etal. Am J Kidney Dis;1995;26(6):875
12. Liu Zhihong, Zhang Jin, Chen Zhaohong et al. Identification of GLUT1 in human mesangial cells and its modulation by rhein and TGF-β 1. J Am Soc Nephrol, 1998, 9: 636A
13. Bucala R, etal. Am J Kidney Dis;1995;26(6):875
14. Monnier V M et al.N Engl. J Med, 1986;314:403
15. Yan SD,Schmidt AM,Anderson GM,et al, Enhanced cellular oxidant stress by the i nteraction of advanced glycation end products with their receptors/binding prote ins, J Biol Chem,1994,269:9889
16. WBB,Thomas EA.Transforming growth factor B contributes to progressive diabetic nephropathy.Proc Nat Acad Sci USA,2000,97:7667
17. Mclennan SV, Kelly DJ, Cox AJ,et al. Decreased matrix degradation in diabetic nephropathy:effects of ACE inhibition on the exprexxion and activities of matrix metallonroteimases.Diabetologia,2002,45(2):268-275
18. Leehey DJ,Singh AK,Alavi N,et al. Role of angiotension Ⅱ in diabetic nephropathy. Kidney Int, 2000,58(Suppl77):93-98
19. Guohua D,Harry VG, Sharon D et al. Oxidized LDL stimulates the expression of TGF-B and fibronectin in human glomerular epithelial cells. Kidney Int, 1997,51:147
20. Lynda FB.Regulation and regulatory activities of transforming growth factor B.Crit Rev,1999,9:33
21. 周钦，王远程，兰洋，等 肾小球系膜细胞转化生长因子β_1基因启动子中氧化低密
度脂蛋白应答元件的研究 肾脏病与透析肾移植杂志。2002，11(3)
22. Gilbert RE,Cox A,Wu LL,et al.Expression of transforing growth factorβ1 and type Ⅳ collAngen in the renal tubulointerstitium in experimental diabetes:effects of ACE inhibition.Diabetes, 1998,47:414-421
23. 余毅，吴永贵，林善锬．苯那普利对糖尿病大鼠肾皮质血小板衍化生长因子-β及其β受体表达的影响[J]．中华肾脏病杂志，1999，15(4)207-211
24. Wolf G, Ziyadeh R,Coma D,et al. The renoprotective properties of angiotensin-converting enzyme inhibitors on a chronic model of memtramous nephropathy are solely due to inhibition of angiotensin Ⅱ:evidence based on comparative studies with a receptor antAngonist.Am J Kideney Dis, 1997,29:254-264]
25. 林兰主编．糖尿病中西医结合论治[M]．北京：北京科学技术出版社，1992．229
26. 丁鹤林，傅祖植．接近正常的血糖对糖尿病微血管并发症的影响．国外医学内科学分册，1995，22(9)：373～375．)
27. 王海燕，李惊子，潘缉圣．中药黄芪当归合剂对肾病综合征肾损伤的保护作用及对代谢紊乱的影响[J]．北京大学学报(医学版)．2002，34(5)：542-552．
28. 文晖，林善锬．血管紧张素受体拮抗剂缬沙坦对糖尿病大鼠肾脏的保护作用[J]．中华内科杂志1999，38(3)157-160
29. 苏彦君，马文秀，林琼真．Valsartan对糖尿病肾病肾保护作用的实验研究[J]．中国中西医结合肾病杂志[J]．2003，4(4)196-198
30. Maschio G, et al. Effect of the Angiotensin-Converting-Enzyme Inhibitor. Benazepril on the Progression of Chronic Renal Insufficiency, the New Eng.J of Med. 1996,334:939-945.
31. 黄宇峰，林善锬．糖尿病肾小球内非酶糖化与苯那普利的抑制作用及机制[J]．中华肾脏病杂忘 1999 15(4)：241-245
32. 张史昭，潘达亮，于伟，等．肾络瘀阻与肾纤维化关系的临床研究．中国中西医结告肾病杂志2003，4(8)；458-459
33. 晏子友，皮持衡，高书亮等．化瘀解毒汤对TGF-β及Ang Ⅱ作用的研究[J]．江西中医学院学报，2002，14(2)2：13-14
34. 赖雁妮，俞茂华，朱秋毓，等．黄芪多糖对糖尿病大鼠肾组织转化生长因子β_1的影晌．复旦学报(医学版)2002，29(4)；255-258
35. 方文军，秦利，金杰．黄芪与氯沙坦治疗临床期糖尿病肾病的对比研究[J]．中国医师杂志．2003年增刊70-72]
36. 鲁盈，李惊子，郑欣，等．黄芪当归合剂对肾病综合征血清脂谱和肾小球硬化的影响[J]．中国中西医结合杂志．1997，17(8)：478-480
37. 余凌，张峻峰，李惊子，等．黄芪当归合剂防治肾病综合征鼠时进行性肾小管间质损伤[J]．中华肾脏病杂志．2000，16(5)：282-286
38. 杨俊伟，黎磊石．大黄对实验性糖尿病大鼠肾脏肥大及高滤过作用影响．中国中西医结合亲志，1993，13：286
39. 戴春笋，刘志红，陈惠萍．大黄酸治疗STZ诱导糖尿病大鼠的远期实验研究[J]．肾脏病与透析肾移植杂志．1999，8(5)：413-
40. 刘志红，朱加明，黄海东，等．大黄酸对转化生长因子诱导内皮细胞纤溶酶原激活物抑制物1表达的影响．中华肾脏病杂志．2002，18(5)；337-341
41. 张杰，屈燧林，王剑勤．大黄素对血管肾张素Ⅱ刺激人肾成纤维细胞增殖胶原表达的抑制效应研究[J]．四川医学．2002，23(11)：1114-1117
42. 黄翠玲，李才，邓义斌，等．大黄对糖尿病大鼠组织非酶促糖基化的影响[J]．中国糖尿病杂志．1996，4(2)：103-106
43. 李景新，薛冰，陈连壁．沙苑子总黄酮对高血压大鼠的降压作用及血管肾张素含量的影响[J]．Chinese Journal Of Pharmacology and Toxicology. 2002, Oct,16(5): 336-338
2. Ravid M, Lang R,Rachmani R. Lishner M:Longterm renoprotective effect of angiotensin-converting enzyme inhibition in non-insulin-dependent diabetes mellitus.A 7-year follow-up study.Arch Intern med. 1996, 156:286-289.
3. Ruggenenti P, Perna A,Benini R,Remuzzi G:Effects of dihydropyridine calcium channel blockers,angiotensin-converting enzyme inhibition.and blood pressure control on chronic,nondiabetic nephropathies.J Am Soc Nephrol. 1998,9:2096-2101.
4. KeaneWF, EknoyanG:Proteinuria.Albuminuria, RiskAssessment.Detection,Eliminiatio n(PARADE):A position paper of the National Kidney Foundation. Am J Kidney Dis. 1999,33:1004-1010,
5. Randomised placebo-controlled trial of effect Of ramipril on decline in glomerular filtration rate and risk of terminal failure in proteinuric, non-diabetic nephropathy.The GISEN group(Gruppo Italiano di Studi Epidemiologici in Nefrologia).Lancet. 1997,349:1857-1863.
6. Hebert LA,Bain RP, Verme D,Cattran DE,Whittier FC,Tolchin N.Rohde RD,Lewis EJ:Remission of nephrotic range proteinuria in type 1 diabetes.Collaborative Study Group.Kidney Int. 1994,46:1688-1693
7. Bakris GL.Copley JB,Vicknair N,Sadler R,Leurgans S:Calcium channel blockers versus other antihypertensive therapies on progression of non-insulin-dependet diabetes mellitus associated nephropathy.Kidney Int. 1996,56:1641-1650.
8. Wilmer WA,Hebert LA,Lewis EJ.Rohde RD.Whittier F,Cattran D,Levy AS, Lewis JB,Spitalewitz S.Blumenthal S,Bain RP:Remission of nephrotic syndrome in type 1 diabetes:Long term follow-up of patients in the Captopril Study.Am J Kidney Dis
1999,34:308-314
9. Lebovitz HE,Wiegmann TB,Cnaan A. Shahinfar S,Sica DA,Broadstone V, Schwartz SL,Mengel MC,Segal R,Versaggi JA:Renal protective effects of enalapril in hypertensive NIDDM:Roke of baseline albuminuria.Kidney Int Suppl. 1994,45:150-155.
10. Bakris GL.Mangrum A, Copley JB,Vicknair N, Sadler R:Effect of calcium channel or beta-blockade on the progression of diabetic nephropathy in African Americans.Hypertension. 1997,29:744-750
11. Badris GL,Weir MR.DeQuattro V, McCahon FG:Effects of ACE inhibitor/calcium antagonist combination on proteinuria in diabetic nephropathy. Kidney Int 54:1283-1289,1998 Bucala R, etal. Am J Kidney Dis;1995;26(6):875
12. Liu Zhihong, Zhang Jin, Chen Zhaohong et al. Identification of GLUT1 in human mesangial cells and its modulation by rhein and TGF-β 1. J Am Soc Nephrol, 1998, 9: 636A
13. Bucala R, etal. Am J Kidney Dis;1995;26(6):875
14. Monnier V M et al.N Engl. J Med, 1986;314:403
15. Yan SD,Schmidt AM,Anderson GM,et al, Enhanced cellular oxidant stress by the i nteraction of advanced glycation end products with their receptors/binding prote ins, J Biol Chem,1994,269:9889
16. WBB,Thomas EA.Transforming growth factor B contributes to progressive diabetic nephropathy.Proc Nat Acad Sci USA,2000,97:7667
17. Mclennan SV, Kelly DJ, Cox AJ,et al. Decreased matrix degradation in diabetic nephropathy:effects of ACE inhibition on the exprexxion and activities of matrix metallonroteimases.Diabetologia,2002,45(2):268-275
18. Leehey DJ,Singh AK,Alavi N,et al. Role of angiotension Ⅱ in diabetic nephropathy. Kidney Int, 2000,58(Suppl77):93-98
19. Guohua D,Harry VG, Sharon D et al. Oxidized LDL stimulates the expression of TGF-B and fibronectin in human glomerular epithelial cells. Kidney Int, 1997,51:147
20. Lynda FB.Regulation and regulatory activities of transforming growth factor B.Crit Rev,1999,9:33
21. 周钦，王远程，兰洋，等 肾小球系膜细胞转化生长因子β_1基因启动子中氧化低密
度脂蛋白应答元件的研究 肾脏病与透析肾移植杂志。2002，11(3)
22. Gilbert RE,Cox A,Wu LL,et al.Expression of transforing growth factorβ1 and type Ⅳ collAngen in the renal tubulointerstitium in experimental diabetes:effects of ACE inhibition.Diabetes, 1998,47:414-421
23. 余毅，吴永贵，林善锬．苯那普利对糖尿病大鼠肾皮质血小板衍化生长因子-β及其β受体表达的影响[J]．中华肾脏病杂志，1999，15(4)207-211
24. Wolf G, Ziyadeh R,Coma D,et al. The renoprotective properties of angiotensin-converting enzyme inhibitors on a chronic model of memtramous nephropathy are solely due to inhibition of angiotensin Ⅱ:evidence based on comparative studies with a receptor antAngonist.Am J Kideney Dis, 1997,29:254-264]
25. 林兰主编．糖尿病中西医结合论治[M]．北京：北京科学技术出版社，1992．229
26. 丁鹤林，傅祖植．接近正常的血糖对糖尿病微血管并发症的影响．国外医学内科学分册，1995，22(9)：373～375．)
27. 王海燕，李惊子，潘缉圣．中药黄芪当归合剂对肾病综合征肾损伤的保护作用及对代谢紊乱的影响[J]．北京大学学报(医学版)．2002，34(5)：542-552．
28. 文晖，林善锬．血管紧张素受体拮抗剂缬沙坦对糖尿病大鼠肾脏的保护作用[J]．中华内科杂志1999，38(3)157-160
29. 苏彦君，马文秀，林琼真．Valsartan对糖尿病肾病肾保护作用的实验研究[J]．中国中西医结合肾病杂志[J]．2003，4(4)196-198
30. Maschio G, et al. Effect of the Angiotensin-Converting-Enzyme Inhibitor. Benazepril on the Progression of Chronic Renal Insufficiency, the New Eng.J of Med. 1996,334:939-945.
31. 黄宇峰，林善锬．糖尿病肾小球内非酶糖化与苯那普利的抑制作用及机制[J]．中华肾脏病杂忘 1999 15(4)：241-245
32. 张史昭，潘达亮，于伟，等．肾络瘀阻与肾纤维化关系的临床研究．中国中西医结告肾病杂志2003，4(8)；458-459
33. 晏子友，皮持衡，高书亮等．化瘀解毒汤对TGF-β及Ang Ⅱ作用的研究[J]．江西中医学院学报，2002，14(2)2：13-14
34. 赖雁妮，俞茂华，朱秋毓，等．黄芪多糖对糖尿病大鼠肾组织转化生长因子β_1的影晌．复旦学报(医学版)2002，29(4)；255-258
35. 方文军，秦利，金杰．黄芪与氯沙坦治疗临床期糖尿病肾病的对比研究[J]．中国医师杂志．2003年增刊70-72]
36. 鲁盈，李惊子，郑欣，等．黄芪当归合剂对肾病综合征血清脂谱和肾小球硬化的影响[J]．中国中西医结合杂志．1997，17(8)：478-480
37. 余凌，张峻峰，李惊子，等．黄芪当归合剂防治肾病综合征鼠时进行性肾小管间质损伤[J]．中华肾脏病杂志．2000，16(5)：282-286
38. 杨俊伟，黎磊石．大黄对实验性糖尿病大鼠肾脏肥大及高滤过作用影响．中国中西医结合亲志，1993，13：286
39. 戴春笋，刘志红，陈惠萍．大黄酸治疗STZ诱导糖尿病大鼠的远期实验研究[J]．肾脏病与透析肾移植杂志．1999，8(5)：413-
40. 刘志红，朱加明，黄海东，等．大黄酸对转化生长因子诱导内皮细胞纤溶酶原激活物抑制物1表达的影响．中华肾脏病杂志．2002，18(5)；337-341
41. 张杰，屈燧林，王剑勤．大黄素对血管肾张素Ⅱ刺激人肾成纤维细胞增殖胶原表达的抑制效应研究[J]．四川医学．2002，23(11)：1114-1117
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