本文關(guān)鍵詞： 清熱利濕益氣養(yǎng)陰活血法 糖尿病合并尿路感染 中醫(yī)藥　出處：《北京中醫(yī)藥大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的觀察清熱利濕益氣養(yǎng)陰活血法的中西醫(yī)結(jié)合方案治療糖尿病合并尿路感染的臨床癥狀、實(shí)驗(yàn)室指標(biāo)及總體療效,探索中西醫(yī)結(jié)合治療糖尿病合并尿路感染的優(yōu)勢(shì),為糖尿病合并尿路感染提供診療方案。研究方法采用前瞻性、隨機(jī)對(duì)照研究,收集2013年12月1日～2015年1月1日望京醫(yī)院門診及住院病例中符合納入標(biāo)準(zhǔn)的69例患者,將患者隨機(jī)分成試驗(yàn)組34例,對(duì)照組35例,試驗(yàn)組剔除3例,脫落1例,對(duì)照組剔除2例,脫落3例,試驗(yàn)組、對(duì)照組各完成30例。試驗(yàn)組給予中藥配合西醫(yī)治療,對(duì)照組給予西醫(yī)治療。西醫(yī)治療包括西醫(yī)強(qiáng)化降糖治療和抗生素抗感染治療,中醫(yī)藥治療采用清熱利濕益氣養(yǎng)陰活血法,療程共計(jì)2周,停藥后6周進(jìn)行隨訪。治療后2周比較兩組治療后中醫(yī)癥狀、細(xì)菌清除率、實(shí)驗(yàn)室指標(biāo)的差異,停藥后6周隨訪統(tǒng)計(jì)復(fù)發(fā)率,觀察中西醫(yī)綜合治療方案治療糖尿病合并尿路感染的臨床療效。研究結(jié)果：1、對(duì)全部入組病例的年齡、性別、糖尿病病程、BMI、糖化血紅蛋白、空腹及餐后血糖結(jié)果分析顯示,糖尿病合并尿路感染患者年齡多集中于50-75年齡段；高發(fā)人群為絕經(jīng)后中老年女性；高發(fā)于DM病程在5年以上,BMI指數(shù)大于23kg/m2及糖化血紅蛋白水平高于7%,FPG大于7.3mmol/L,2hPG大于8.7mmol/L的患者。2、對(duì)致病菌種分布情況分析結(jié)果顯示,主要致病菌為革蘭氏陰性桿菌共計(jì)48株占80%,革蘭氏陽性菌共計(jì)10株,占16.7%,真菌2株,占3.3%。大腸埃希氏菌為最主要致病菌,共分離出41株,占總體68.3%,其次為葡萄球菌屬,共分離出6株,占總體10%,糞腸球菌4株,占總體6.7%,肺炎克雷伯菌共分離出4株,占總體6.7%。3、試驗(yàn)組、對(duì)照組療效結(jié)果比較,總體療效試驗(yàn)組的總有效率93.3%,對(duì)照組的總有效率86.7%,試驗(yàn)組總體療效顯著優(yōu)于對(duì)照組(P0.05)。試驗(yàn)組中醫(yī)證候療效總有效率96.7%,對(duì)照組中醫(yī)證候療效總有效率86.7%,試驗(yàn)組中醫(yī)證候療效顯著優(yōu)于對(duì)照組(P0.05),小便頻急而短、尿道澀痛、倦怠乏力、咽干口渴4個(gè)主癥,氣短懶言、手足心熱2個(gè)次癥改善試驗(yàn)組極顯著優(yōu)于對(duì)照組(P0.01),尿道灼熱、小腹刺痛2個(gè)次癥試驗(yàn)組顯著優(yōu)于對(duì)照組(P0.05),腰酸痛癥狀的改善試驗(yàn)組與對(duì)照組未顯示統(tǒng)計(jì)學(xué)差異(P0.05)。4、治療后試驗(yàn)組細(xì)菌清除率為90%,對(duì)照組細(xì)菌清除率76.7%,試驗(yàn)組細(xì)菌清除率大于對(duì)照組,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。療后停藥6周隨訪試驗(yàn)組尿路感染復(fù)發(fā)率為11.1%,對(duì)照組為34.8%,兩組具有顯著統(tǒng)計(jì)學(xué)差異(P0.05)。5、治療前后試驗(yàn)組與對(duì)照組尿鏡檢WBC均值下降結(jié)果顯示,試驗(yàn)組WBC均值小于對(duì)照組WBC均值,有顯著統(tǒng)計(jì)學(xué)差異(P0.05)。治療前后試驗(yàn)組與對(duì)照組患者的空腹、餐后2h血糖均值下降,無統(tǒng)計(jì)學(xué)差異(P0.05)。治療前后兩組尿鏡檢WBC差值與餐后2小時(shí)血糖差值的相關(guān)性分析結(jié)果顯示尿鏡檢WBC差值與餐后2小時(shí)血糖差值存在線性關(guān)系,說明2hPG差值越大,尿鏡檢WBC差值越大,提示積極控制餐后2小時(shí)血糖對(duì)控制感染有意義。結(jié)論：清熱利濕益氣養(yǎng)陰活血法聯(lián)合抗生素治療糖尿病并發(fā)尿路感染可有效緩解臨床癥狀,提高細(xì)菌清除率,降低尿路感染復(fù)發(fā)率,并且療效優(yōu)于抗生素治療。中西醫(yī)綜合治療可有效防治糖尿病并發(fā)尿路感染,提高尿路感染患者痊愈率。
[Abstract]:Objective: To observe the qingrelishi bvqnyabc combining traditional Chinese and Western medicine clinical symptoms in treatment of diabetes complicated with urinary tract infection, laboratory index and overall curative effect, treatment of diabetes complicated with urinary tract infection and the advantage of combining traditional Chinese and Western medicine treatment of urinary tract infection, provide for diabetic patients. Methods a prospective, randomized study, collection from December 1, 2013 to January 1, 2015 in Wangjing Hospital outpatient and inpatient cases in 69 cases in accordance with the inclusion criteria were randomly divided into experimental group 34 cases, control group 35 cases, 3 cases were removed, off 1 cases, control group 2 cases were excluded, 3 cases of loss, experimental group, control group completed 30 cases. The experimental group was given traditional Chinese medicine combined with western medicine treatment, the control group received western medicine. Western medicine including western medicine intensivehypoglycemictherapies and antibiotic treatment, Chinese medicine treatment with Yiqi Qingre dampness Nourishing yin and activating blood, 2 weeks of treatment, follow-up 6 weeks after drug withdrawal. 2 weeks after treatment were compared between the two groups after treatment of TCM symptoms, the bacterial clearance rate, the difference of laboratory index, 6 week follow-up recurrence rate after stopping, to observe the clinical effect of integrated traditional Chinese and Western medicine treatment regimen in the treatment of diabetes complicated with urinary tract infection. Results: 1 of all the patients, age, gender, duration of diabetes, BMI, HbA1c, fasting and postprandial blood glucose results, more concentrated in the 50-75 age age in patients with diabetes complicated with urinary tract infection; high risk population for postmenopausal elderly women; high incidence in the course of DM in more than 5 years. The BMI index is greater than 23kg/m2 and HbA1c levels higher than 7%, FPG greater than 7.3mmol/L, 2hPG than 8.7mmol/L in patients with.2, the pathogenic bacteria distribution analysis showed that the main pathogens were gram negative bacilli 48 strains accounted for 80% Gram positive bacteria, 10 strains, accounting for 16.7%, 2 strains of fungi, accounting for 3.3%. of Escherichia coli as the main pathogenic bacteria were isolated from 41 strains, accounting for 68.3% of the overall, followed by Staphylococcus, 6 strains were isolated, accounting for 10% of the overall, Enterococcus faecalis 4 strains, accounting for 6.7% of the overall primary pneumonia, Craig 4 strains of bacteria were isolated, accounting for the overall 6.7%.3, experimental group, control group curative effect comparison, total effective rate was 93.3% in the overall efficacy of the experimental group, the control group the total efficiency of 86.7%, the overall effect of the experimental group was significantly better than the control group (P0.05). The efficacy of TCM treatment group total effectiveness 96.7%, the control group curative effect the total effective rate of TCM Syndromes of 86.7% groups, TCM syndrome curative effect was significantly better than the control group (P0.05), acute urinary frequency and short, urethral acerbity pain, lassitude, throat thirsty 4 main symptoms, shortness of breath, hand foot heart heat 2 times improvement test group was significantly better than the control group (P0.01) the hot thorn, urethral, abdomen 2 times of pain in experimental group was significantly better than the control group (P0.05), improve the symptoms of lumbar pain in experimental group and control group showed no significant difference (P0.05.4), experimental group after treatment, the bacterial clearance rate was 90%, the control group, the bacterial clearance rate was 76.7%, the bacterial clearance rate of experimental group than the control group, the difference was not statistically significant (P0.05) after discontinuation of therapy. The recurrence rate was 11.1% after 6 weeks of test group, urinary tract infection, the control group was 34.8%, two groups had significant difference (.5, P0.05) before and after treatment in the experimental group and the control group of urine microscopic examination results showed that the average WBC decreased, the mean WBC of the experimental group than the control group with WBC mean. Significant difference (P0.05) before and after treatment. The experimental group and the control group of patients with fasting and postprandial 2H mean blood glucose decreased, no significant difference (P0.05). The two groups before and after treatment urine microscopy WBC difference and postprandial blood glucose difference correlation analysis showed that 2 hour urine microscopy WBC There is a linear relationship between the difference of blood glucose 2 hours after meal difference and 2hPG difference, the greater the greater the difference in microscopic examination of urine WBC, suggesting that the positive control 2 hour postprandial blood glucose control of infection. Conclusion: the significance of infection can effectively relieve the clinical symptoms of qingrelishi bvqnyabc combined with antibiotics in the treatment of diabetes complicated with urinary bacteria, improve the clearance rate, reduce the recurrence rate of urinary tract infection, and the curative effect is better than antibiotic treatment. Treatment of TCM and Western medicine can effectively prevent diabetes complicated with urinary tract infection, improve the cure rate of the patients with urinary tract infection.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.1;R691.3

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