摘要
目的：本研究基于三焦气化理论基础上,针对糖尿病肾病Ⅲ期气阴两虚,瘀浊互阻的病机关键,运用益气养阴,化瘀通络法,并遵法拟益肾方,通过临床观察,探讨其治疗糖尿病肾病早期的疗效,为益气养阴化瘀通络法临床应用治疗DKD提供依据。
方法：所选病例均来源于2009年12月至2011年3月黑龙江中医药大学附属第一医院肾内科收治的住院及门诊患者,选取资料完整的60例2型糖尿病肾病Ⅲ期证属气阴两虚,瘀浊互阻型的患者,采用随机开放的原则分为两组,对照组给予西医基础治疗,糖尿病(DM)饮食、低盐优质蛋白饮食、控制血糖、血脂、血压等。治疗组在对照组的基础上给予自拟益肾方。观察治疗前后患者的中医证候变化,空腹血糖、餐后2h血糖、糖化血红蛋白、24h尿微量白蛋白排泄率、血脂、血压等指标的变化。
结果：①经统计学分析,本法的临床总体疗效治疗组与对照组比较有显著性差异(P<0.05)。治疗后治疗组在症状体征方面改善明显优于对照组(P<0.05)。②两组空腹血糖(FBG),餐后血糖(PBG),糖化血红蛋白(HbA1c)治疗后均有下降,治疗组明显优于对照组(P<0.05)；③两组TG、TC治疗后均有降低,治疗组明显优于对照组(P<0.05)；两组HDL-C治疗后均有升高,治疗组升高显著,与对照组比较有显著性差异,(P<0.05)。④两组治疗后患者24h尿白蛋白排泄率(UAER)均有下降,治疗组明显优于对照组(P<0.05)。⑤两组血压治疗后均下降,治疗组血压显著下降,与治疗前比较有显著性差异,(P<0.05)：与对照组治疗后比较,有显著性差异,(P<0.05)。
结论：①益气养阴化瘀通络法能减低DKD患者的中医证候积分,改善患者症状。②能降低糖尿病肾病患者Ⅲ期的24h尿白蛋白排泄率,延缓糖尿病肾病进展。③可以调节血糖和脂类代谢紊乱。④可以明显降低血压。⑤此方法治疗DKD属气阴两虚瘀浊互阻型患者疗效显著,是中医药干预治疗DKD的可行方法。
Objective:this study, based on theory of tri-jiao gasification, based onⅢperiod diabetic nephropathy qi and Yin deficiency, stasis turbidity two mutually resistance to the pathogenesis of qi qi, key, use according to law, and the method of dredging to the kiDKDeys and square, through the clinical observations, discuss the treatment of diabetic nephropathy early curative effect, qi to remove blood stasis, dredging method for treatment of provide basis for clinical application DKD.
Methods:the selected cases are all derived from the December 2009, until December 2010 heilongjiang university of traditional Chinese medicine subsidiary first hospital renal medicine hospital and clinic patients were selected material complete 60 cases of type 2 diabetic nephropathy qi and Yin III period card to belong to two empty, stasis turbidity mutual resistance type of patients, the principle of using random opening into two groups, to western medicine group based therapy, diabetes mellitus (DM) diet, low salt high-quality protein diet, control blood sugar, blood fat and blood pressure, etc. The treatment group in the control group based on the kiDKDeys from fitting to square. The patients were observed before and after treatment of TCM syndrome change, fasting blood glucose, blood glucose after a meal,2h glycosylated hemoglobin,24h urine albumin excretion rates of trace, blood fat and blood pressure etc indexes to change.
Results:①of this law by statistical analysis, the overall efficacy of clinical treatment group and control group with significant difference (P< 0.05). The treatment group in the signs and symptoms improved than in control group (P< 0.05).②two groups of fasting plasma glucose (FBG) and postprandial glucose (PBG), glycated hemoglobin (HbAlc) are down after treatment, the treatment group was better than control (P<0.05).③two groups of TG after treatment, the TC decreased significantly, the treatment group was better than control (P<0.05). Two groups of hdl-c after treatment, the treatment group were significantly increased elevated, compared with controls have significant difference (P<0.05).④the two groups after treating 24h urine albumin excretion rates with UAER) are down (, the treatment group was better than control (P<0.05).⑤two groups of blood pressure after treatment, the treatment group blood pressure decreased significantly, and before treatment, with significant differences between (P< 0.05):and the control group after treatment, a significant difference compared, (P<0.05).
Conclusions:①removing method can reduce fundermental dredging DKD patients of traditional Chinese medical syndrome, improve patients' symptoms points.②can reduce the diabetes nephrosis patient III 24h urine albumin excretion period of diabetic nephropathy, slow rate of progress.③can regulate blood sugar and lipid metabolism disorders.④can significantly reduce blood pressure.⑤the method of treatment of qi and Yin DKD two empty stasis turbidity mutual resistance type patients curative effect is distinct, TCM intervention is feasible method DKD.
引文
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