摘要: |
目的:观察芪苓护肾方治疗2型糖尿病肾脏病(T2DKD)湿瘀阻络证患者蛋白尿、肾小球滤过率、糖脂代谢指标和中医证候方面的临床疗效。方法:采用随机平行对照原则,选取T2DKD湿瘀阻络证患者96 例,对照组47 例给予基础治疗,治疗组49 例在对照组基础上予芪苓护肾方治疗,疗程均为12周。观察2组治疗前后血压[收缩压(SBP)、舒张压(DBP)]、血糖[空腹血糖(FBG)、餐后2h血糖(2h PBG)、糖化血红蛋白(HbAlc)]、血脂[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、尿蛋白[尿白蛋白/肌酐(UACR)]、肾功能[血肌酐(SCr)、胱抑素(Cys-c)、肾小球滤过率(eGFR)]和中医证候积分的变化。结果:2组治疗后SBP、2h PBG、HbAlc均较治疗前下降(P<0.05),但组间差异无统计学意义(P>0.05),2组DBP、FBG、TC、TG、HDL-C、LDL-C、SCr、Cys-c、eGFR治疗前后组内比较及治疗后组间比较,差异均无统计学意义(P>0.05)。治疗后治疗组UACR较治疗前下降(P<0.05),且下降幅度(治疗前后差值)优于对照组(P<0.01)。2组A2期患者治疗后UACR均较治疗前下降(P<0.05或P<0.01),但下降幅度差异无统计学意义(P>0.05)。治疗组A3期患者UACR治疗后较治疗前下降(P<0.01),对照组A3期患者治疗前后UACR差异无统计学意义(P>0.05),治疗组下降幅度优于对照组(P<0.05)。2组中医证候总积分治疗后较治疗前均明显下降,且治疗组低于对照组(P<0.01)。结论:芪苓护肾方可明显降低T2DKD湿瘀阻络证患者的蛋白尿水平,尤其对于A3期大量蛋白尿的T2DKD患者疗效更佳,该作用与糖脂代谢指标和血压的改善无关;芪苓护肾方可显著改善患者中医证候,且安全性好,有广泛的临床实用价值。 |
关键词: 糖尿病肾脏病 湿瘀阻络证 利湿化瘀通络法 芪苓护肾方 蛋白尿 |
DOI: |
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Clinical effect of Qiling Hushen prescription in treatment of type 2 diabetic kidney disease:An analysis of 49 cases |
TIAN Ruina,WANG Kai,ZHU Lin |
(The Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,Jiangsu,China) |
Abstract: |
Objective:To investigate the clinical effect of Qiling Hushen prescription in the treatment of patients with type 2 diabetic kidney disease (T2DKD) with dampness-stasis obstructing collaterals in terms of proteinuria,glomerular filtration rate,glucose and lipid metabolic markers,and traditional Chinese medicine (TCM) syndrome.Methods:The randomized parallel-controlled method was used to select 96 T2DKD patients with dampness-stasis obstructing collaterals.The 47 patients in the control group received basic treatment,while the 49 patients in the treatment group received Qiling Hushen prescription in addition to the treatment in the control group,and the course of treatment was 12 weeks for both groups.The two groups were compared in terms of the changes in blood pressure (systolic blood pressure [SBP] and diastolic blood pressure [DBP]),blood glucose (fasting blood glucose [FBG],2-hour postprandial blood glucose[2h PBG],and glycosylated hemoglobin [HbAlc]),blood lipids (total cholesterol [TC],triglyceride [TG],high-density lipoprotein cholesterol [HDL-C],and LDL-C[LDL-C]),urinary protein (urinary albumin-to-creatinine ratio [UACR]),renal function (serum creatinine [SCr],cystatin C [Cys-C],and glomerular filtration rate [eGFR]),and TCM syndrome score after treatment.Results:After treatment,both groups had significant reductions in SBP,2h PBG,and HbAlc (P<0.05),with no significant differences between the two groups (P>0.05);the two groups had no significant changes in DBP,FBG,TC,TG,HDL-C,LDL-C,SCr,Cys-C,and eGFR after treatment,and there were no significant differences in these indices between the two groups (P>0.05).After treatment,the treatment group had a significant reduction in UACR (P<0.05) and a significantly greater reduction compared with the control group (P<0.01).The patients with stage A2 T2DKD in both groups had a significant reduction in UACR after treatment (P<0.05 or P<0.01),with no significant difference in such reduction between the two groups (P>0.05).The patients with stage A3 T2DKD in the treatment group had a significant reduction in UACR after treatment (P<0.01),while those in the control group had no significant change in UACR after treatment (P>0.05),and the treatment group had a significantly greater reduction than the control group (P<0.05).Both groups had a significant reduction in total TCM syndrome score after treatment,and the treatment group had a significantly lower score than the control group (P<0.01).Conclusion:Qiling Hushen prescription can significantly reduce the level of proteinuria in T2DKD patients with dampness-stasis obstructing collaterals,with a better clinical effect in stage A3 T2DKD patients with macroproteinuria,which is not associated with the improvement in glucose and lipid metabolic markers and blood pressure.Qiling Hushen prescription can significantly improve TCM syndrome and has a favorable safety profile and a high value of wide clinical application. |
Key words: type 2 diabetic kidney disease dampness-stasis obstructing collaterals diuresis-promoting,stasis-resolving,and collateral-dredging therapy Qiling Hushen prescription proteinuria |