滋肾益气方联合厄贝沙坦对糖尿病肾病肾脏纤维化指标和炎症因子的影响
|
摘要
目的:探讨滋肾益气方联合厄贝沙坦治疗糖尿病肾病的临床疗效,并观察其对患者肾脏纤维化指标及炎症因子的影响。方法:选取112糖尿病肾病并且辨证为肾虚血瘀、气阴两虚患者,随机分为两组。对照组给予厄贝沙坦片治疗,观察组给予厄贝沙坦片联合滋肾益气方治疗,连续治疗12周。比较两组患者治疗前后肾功能损伤指标、肾脏纤维化指标、炎症因子、中医证候积分、生活质量及临床疗效,并进行统计分析。结果:观察组总有效率91.1%,对照组总有效率78.6%,两组比较有统计学意义(P<0.05)。治疗后两组的肾功能指标(24 hPro、mAlb、Scr、BUN及UAER)、肾脏纤维化指标(LN、PCⅢ、CⅣ、TGF-β_1及CTGF)及炎症因子(hs-CRP、IL-6及TNF-α)的水平均显著降低(P<0.05),并且观察组以上指标显著低于对照组,比较有统计学意义(P<0.05)。两组患者治疗后各项中医证候积分均显著降低(P<0.05),并且观察组治疗后的各项评分较对照组低(P<0.05)。两组患者躯体功能、社会功能及情绪功能的评分均明显降低(P<0.05),并且观察组的评分较对照组低(P<0.05),而两组的认知功能、角色功能评分治疗前后没有明显差异(P>0.05)。结论:滋肾益气方联合厄贝沙坦治疗糖尿病肾病可以有效改善患者肾功能,延缓肾间质纤维化、肾小球硬化,可显著抑制糖尿病肾病病情进展,疗效确切。
Objective: To investigate the clinical efficacy of Nourishing Kidney and Supplementing Qi Decoction combined with erbesartan in the treatment of diabetic nephropathyand observe the effect of it on renal fibrosis index and inflammatory factors in patients. Methods: A total of 112 diabetic nephropathy patients with kidney deficiency, blood stasis and Qi Yin deficiency were randomly divided into two groups. The control group was treated with Irbesartan Tabletsand the observation group was treated with Irbesartan Tablets combined with Nourishing Kidney and Supplementing Qi Decoction for 12 weeks. The index of renal function injury, renal fibrosis index, inflammatory factor, TCM syndrome score, quality of life and clinical effect were compared and analyzed statistically before and after treatment in the two groups. Results: The total effective rate of the observation group was 91.1%, and the total effective rate of the control group was 78.6%. There was a significant difference between the two groups(P<0.05). After treatment, the indexes of renal function(24 hPro, mAlb, Scr, BUN and UAER), the indexes of renal fibrosis(LN, PC III, C IV, TGF-beta 1 and CTGF) and the levels of inflammatory factors(hs-CRP, IL-6 and TNF-α) were significantly decreased, and the above indexes were significantly lower than those in the control group. The two groups were significantly lower than those in the control group(P<0.05). The scores of TCM syndromes in the two groups were significantly reduced after treatment(P<0.05), and the scores in the observation group after treatment were lower than those in the control group(P<0.05). The scores of body function, social function and emotional function of the two groups were significantly lower(P<0.05), and the score of the observation group was lower than that of the control group(P<0.05). But the cognitive function and role function score of the two groups were not significantly different before and after treatment(P>0.05). Conclusion: The treatment of diabetic nephropathy can effectively improve renal function, postpone renal interstitial fibrosis and glomerulosclerosis, which can significantly inhibit the progression of diabetic nephropathy, and the curative effect is accurate.
Objective: To investigate the clinical efficacy of Nourishing Kidney and Supplementing Qi Decoction combined with erbesartan in the treatment of diabetic nephropathyand observe the effect of it on renal fibrosis index and inflammatory factors in patients. Methods: A total of 112 diabetic nephropathy patients with kidney deficiency, blood stasis and Qi Yin deficiency were randomly divided into two groups. The control group was treated with Irbesartan Tabletsand the observation group was treated with Irbesartan Tablets combined with Nourishing Kidney and Supplementing Qi Decoction for 12 weeks. The index of renal function injury, renal fibrosis index, inflammatory factor, TCM syndrome score, quality of life and clinical effect were compared and analyzed statistically before and after treatment in the two groups. Results: The total effective rate of the observation group was 91.1%, and the total effective rate of the control group was 78.6%. There was a significant difference between the two groups(P<0.05). After treatment, the indexes of renal function(24 hPro, mAlb, Scr, BUN and UAER), the indexes of renal fibrosis(LN, PC III, C IV, TGF-beta 1 and CTGF) and the levels of inflammatory factors(hs-CRP, IL-6 and TNF-α) were significantly decreased, and the above indexes were significantly lower than those in the control group. The two groups were significantly lower than those in the control group(P<0.05). The scores of TCM syndromes in the two groups were significantly reduced after treatment(P<0.05), and the scores in the observation group after treatment were lower than those in the control group(P<0.05). The scores of body function, social function and emotional function of the two groups were significantly lower(P<0.05), and the score of the observation group was lower than that of the control group(P<0.05). But the cognitive function and role function score of the two groups were not significantly different before and after treatment(P>0.05). Conclusion: The treatment of diabetic nephropathy can effectively improve renal function, postpone renal interstitial fibrosis and glomerulosclerosis, which can significantly inhibit the progression of diabetic nephropathy, and the curative effect is accurate.
引文
[1] 凌厉,劳国娟,陈立波,等. 前列地尔对糖尿病肾病患者肾血流参数及纤维化指标的影响[J]. 海南医学院学报,2016,22(2):151-153.
[2] 柳河,吴茂彬. 阿托伐他汀对糖尿病肾病患者肾功能相关血清指标及肾脏纤维化的影响观察[J]. 中国现代药物应用,2018,12(5):1-3.
[3] 叶彬华,林莉,阮诗玮,等. 益肾降糖饮对早期糖尿病肾病气阴两虚证患者尿单核细胞趋化蛋白-1、血C反应蛋白的影响[J]. 河北中医,2017,39(7):985-991.
[4] 高青. 黄葵胶囊联合厄贝沙坦对糖尿病肾病患者尿蛋白、微炎症状态的影响[J]. 现代医学,2017,45(10):1458-1462.
[5] 蓝健姿,潘奇,陶庆,等. 补肾益气活血法联合厄贝沙坦对早期糖尿病肾病尿CTGF、TGF-β1水平及肾功能的影响[J]. 四川中医,2017,35(5):115-118.
[6] 中华医学会糖尿病学分会微血管并发症学组.中国糖尿病肾病防治专家共识[S].中华糖尿病杂志,2014,6(1):1-3.
[7] 中华中医学会肾病分会. 糖尿病肾病诊断、辩证分型及疗效评定标准: 试行方案[S]. 上海中医药杂志, 2007,41(7): 7-8.
[8] 郑晓萸.中药新药临床研究指导原则[S]. 北京: 中国医药科技出版社,2002:233-238.
[9] 李剑,闫双通,龚燕平,等.厄贝沙坦和阿托伐他汀联合治疗对老年早期糖尿病肾病患者内皮素和血清胱抑素C 的影响[J].实用药物与临床,2016,19(4):458-460.
[10] 侯敬. 羟苯磺酸钙联合厄贝沙坦治疗早期糖尿病肾病对蛋白尿、血清炎症介质含量的影响[J]. 海南医学院学报,2016,22(18):2181-2184.
[11] 董喜环.血清NGAL、CysC、RBP 及MMP-2 联合检测对糖尿病肾病的诊断价值[J]. 国际检验医学杂志,2016,37(14):1965-1967.
[12] 赖晓霖,郭立华,刘常智,等. 健脾固肾活血汤联合厄贝沙坦治疗早期糖尿病肾病的临床研究[J]. 基层医学论坛,2018,22(5):579-580.
[13] 刘毅恒,符翠婷. 平糖益肾汤联合厄贝沙坦片治疗早期糖尿病肾病的疗效分析[J]. 实用中西医结合临床,2017,17(10):125-126.
[14] 于绣红. 中西医结合治疗气阴两虚型糖尿病肾病的疗效观察[J]. 中国医药指南,2018,16(9):186.
[15] 谢鑫. 益脾芪连汤治疗气阴两虚兼血瘀型糖尿病肾病临床研究[J]. 中医药信息,2017,34(6):86-90.
[16] 刘刚,王小强,刘保珠,等. 益气养阴活血方联合雷公藤多甙治疗气阴两虚兼血瘀型糖尿病肾病Ⅳ期蛋白尿的疗效观察[J]. 河北中医,2017,39(10):1463-1467.
[17] 侯敬. 羟苯磺酸钙联合厄贝沙坦治疗早期糖尿病肾病对蛋白尿、血清炎症介质含量的影响[J]. 海南医学院学报,2016,22(18):2181-2184.
[18] 鲍恩昊. 肾康注射液联合替米沙坦和盐酸贝那普利治疗糖尿病肾病的疗效观察[J]. 现代药物与临床,2016,31(4):471-474.
[19] 梁涢. 检测尿微量蛋白和Ⅳ型胶原对糖尿病肾病早期诊断的意义[J]. 影像研究与医学应用,2017,1(15):185-186.
[20] 包小燕. 补肾活血法对糖尿病肾病尿CTGF水平影响的临床研究[J]. 四川中医,2018,36(1):112-114.
[21] 陈春菊,杜文齐. 健脾益肾通络方联合缬沙坦治疗糖尿病肾病肾功能不全的疗效观察[J]. 陕西中医,2016,37(5):558-560.
[22] 柴冬梅. 前列地尔对糖尿病肾病患者血清炎症因子、肾脏纤维化指标的影响[J]. 现代医学,2017,45(9):1301-1305.
[23] 王云鹏. 血栓通与贝那普利对早期糖尿病肾病炎症因子的效果观察[J]. 实用妇科内分泌杂志(电子版),2017,4(24):36-38.
[2] 柳河,吴茂彬. 阿托伐他汀对糖尿病肾病患者肾功能相关血清指标及肾脏纤维化的影响观察[J]. 中国现代药物应用,2018,12(5):1-3.
[3] 叶彬华,林莉,阮诗玮,等. 益肾降糖饮对早期糖尿病肾病气阴两虚证患者尿单核细胞趋化蛋白-1、血C反应蛋白的影响[J]. 河北中医,2017,39(7):985-991.
[4] 高青. 黄葵胶囊联合厄贝沙坦对糖尿病肾病患者尿蛋白、微炎症状态的影响[J]. 现代医学,2017,45(10):1458-1462.
[5] 蓝健姿,潘奇,陶庆,等. 补肾益气活血法联合厄贝沙坦对早期糖尿病肾病尿CTGF、TGF-β1水平及肾功能的影响[J]. 四川中医,2017,35(5):115-118.
[6] 中华医学会糖尿病学分会微血管并发症学组.中国糖尿病肾病防治专家共识[S].中华糖尿病杂志,2014,6(1):1-3.
[7] 中华中医学会肾病分会. 糖尿病肾病诊断、辩证分型及疗效评定标准: 试行方案[S]. 上海中医药杂志, 2007,41(7): 7-8.
[8] 郑晓萸.中药新药临床研究指导原则[S]. 北京: 中国医药科技出版社,2002:233-238.
[9] 李剑,闫双通,龚燕平,等.厄贝沙坦和阿托伐他汀联合治疗对老年早期糖尿病肾病患者内皮素和血清胱抑素C 的影响[J].实用药物与临床,2016,19(4):458-460.
[10] 侯敬. 羟苯磺酸钙联合厄贝沙坦治疗早期糖尿病肾病对蛋白尿、血清炎症介质含量的影响[J]. 海南医学院学报,2016,22(18):2181-2184.
[11] 董喜环.血清NGAL、CysC、RBP 及MMP-2 联合检测对糖尿病肾病的诊断价值[J]. 国际检验医学杂志,2016,37(14):1965-1967.
[12] 赖晓霖,郭立华,刘常智,等. 健脾固肾活血汤联合厄贝沙坦治疗早期糖尿病肾病的临床研究[J]. 基层医学论坛,2018,22(5):579-580.
[13] 刘毅恒,符翠婷. 平糖益肾汤联合厄贝沙坦片治疗早期糖尿病肾病的疗效分析[J]. 实用中西医结合临床,2017,17(10):125-126.
[14] 于绣红. 中西医结合治疗气阴两虚型糖尿病肾病的疗效观察[J]. 中国医药指南,2018,16(9):186.
[15] 谢鑫. 益脾芪连汤治疗气阴两虚兼血瘀型糖尿病肾病临床研究[J]. 中医药信息,2017,34(6):86-90.
[16] 刘刚,王小强,刘保珠,等. 益气养阴活血方联合雷公藤多甙治疗气阴两虚兼血瘀型糖尿病肾病Ⅳ期蛋白尿的疗效观察[J]. 河北中医,2017,39(10):1463-1467.
[17] 侯敬. 羟苯磺酸钙联合厄贝沙坦治疗早期糖尿病肾病对蛋白尿、血清炎症介质含量的影响[J]. 海南医学院学报,2016,22(18):2181-2184.
[18] 鲍恩昊. 肾康注射液联合替米沙坦和盐酸贝那普利治疗糖尿病肾病的疗效观察[J]. 现代药物与临床,2016,31(4):471-474.
[19] 梁涢. 检测尿微量蛋白和Ⅳ型胶原对糖尿病肾病早期诊断的意义[J]. 影像研究与医学应用,2017,1(15):185-186.
[20] 包小燕. 补肾活血法对糖尿病肾病尿CTGF水平影响的临床研究[J]. 四川中医,2018,36(1):112-114.
[21] 陈春菊,杜文齐. 健脾益肾通络方联合缬沙坦治疗糖尿病肾病肾功能不全的疗效观察[J]. 陕西中医,2016,37(5):558-560.
[22] 柴冬梅. 前列地尔对糖尿病肾病患者血清炎症因子、肾脏纤维化指标的影响[J]. 现代医学,2017,45(9):1301-1305.
[23] 王云鹏. 血栓通与贝那普利对早期糖尿病肾病炎症因子的效果观察[J]. 实用妇科内分泌杂志(电子版),2017,4(24):36-38.