本文選題：補(bǔ)脾腎活血法　切入點(diǎn)：早期糖尿病腎病　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:觀察早期糖尿病腎病患者用補(bǔ)脾腎活血中藥治療前后尿液中尿NGAL、β2-MG、NAG,血糖、血脂等生化指標(biāo)及炎癥反應(yīng)標(biāo)志物IL-6、氧化應(yīng)激標(biāo)志物SOD的變化,從而探討補(bǔ)脾腎活血中藥對早期糖尿病腎病患者腎小管保護(hù)作用的可能機(jī)制。方法:選擇在廣州中醫(yī)藥大學(xué)祈福醫(yī)院腎內(nèi)科住院的符合納入標(biāo)準(zhǔn)的早期糖尿病腎病患者60例,隨機(jī)分為對照組和治療組,對照組予基礎(chǔ)治療,治療組在對照組的基礎(chǔ)上加用補(bǔ)脾腎活血中藥。4周后,分別檢測兩組治療前后尿NGAL、尿β2-MG、尿NAG,血肌酐、內(nèi)生肌酐清除率、血糖、血脂等各項(xiàng)生化指標(biāo),炎癥指標(biāo)IL-6以及氧化應(yīng)激標(biāo)志物SOD水平。結(jié)果:(1)兩組治療前后尿NGAL、尿β2-MG、尿NAG比較:相比治療前,治療組治療后尿NGAL、β2-MG、NAG均有所下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05);兩組間比較,治療后治療組尿NGAL、β2-MG均較對照組低,差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療組尿NAG低于對照組,但兩者間無顯著差異(P0.05)。(2)兩組治療前后血糖、血脂、血壓比較:相比治療前,治療組治療后血糖、血脂、血壓均有所下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05);兩組間比較,治療后治療組血糖、血脂明顯較對照組低,差異有統(tǒng)計(jì)學(xué)意義(P0,05);治療后治療組舒張壓明顯低于對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療后治療組收縮壓稍低于對照組,但差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(3)兩組治療前后炎癥指標(biāo)IL-6、氧化應(yīng)激指標(biāo)SOD比較:治療前后比較,治療后治療組IL-6較治療前降低,SOD較治療前升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05);治療后兩組間比較,治療組IL-6較對照組降低,SOD較對照組升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)兩組治療前后腎功能比較:治療組治療前后比較,治療后血肌酐較治療前低,差異無顯著意義(P0.05);內(nèi)生肌酐清除率較治療前下降,差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療后兩組間比較,治療組血肌酐、內(nèi)生肌酐清除率較對照組低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)(5)相關(guān)性分析:尿NGAL與其他腎損傷標(biāo)志物尿β2-MG、尿NAG、尿微量白蛋白呈正相關(guān)關(guān)系,r值分別為0.502、0.422、0.684(P0.05);尿NGAL與血糖、血脂、收縮壓、舒張壓呈正相關(guān)關(guān)系,r值分別為0.281、0.435、0.355、0.611(P0.05);尿NGA1與炎癥反應(yīng)標(biāo)志物IL-6呈正相關(guān)關(guān)系,r值為0.325(P0.05);尿NGAL與氧化應(yīng)激標(biāo)志物SOD呈負(fù)相關(guān)關(guān)系,r值為-0.570(P0.05);尿NGAL與血肌酐無相關(guān)關(guān)系,r值為-0.004,(P0.05);與內(nèi)生肌酐清除率呈正相關(guān)關(guān)系,r值為0.562(P0.05)。結(jié)論:(1)補(bǔ)脾腎活血法可降低早期糖尿病腎病患者尿NGAL水平,有效保護(hù)早期糖尿病腎病患者的腎小管,延緩糖尿病腎病進(jìn)展。(2)補(bǔ)脾腎活血法可降低早期糖尿病腎病患者IL-6水平,提高早期糖尿病腎病患者SOD水平,可有效改善早期糖尿病腎病患者體內(nèi)微炎癥狀態(tài)及氧化應(yīng)激反應(yīng),具有抗炎癥反應(yīng)、抗氧化應(yīng)激作用。(3)補(bǔ)脾腎活血法可有效調(diào)節(jié)早期糖尿病腎病患者血糖、血脂水平。(4)補(bǔ)脾腎活血法可有效調(diào)節(jié)早期糖尿病腎病患者血壓水平,降低腎小球?yàn)V過壓,降低腎內(nèi)高灌注。(5)尿NGAL可與尿β2-MG、尿NAG、尿微量白蛋白共同成為糖尿病早期腎損傷標(biāo)志物。(6)補(bǔ)脾腎活血法保護(hù)早期糖尿病腎病患者腎小管的機(jī)制可能是與其具有調(diào)節(jié)血糖、血脂、血壓,抗炎癥反應(yīng),抗氧化應(yīng)激,降低腎內(nèi)高灌注等作用有關(guān)。
[Abstract]:Objective: To observe the effect of early diabetic nephropathy patients with spleen and kidney blood before and after treatment of traditional Chinese medicine supplement urine NGAL, beta 2-MG, NAG, blood glucose, blood lipid and other biochemical indicators of inflammation and oxidative stress markers IL-6, changes of markers of SOD, and to explore the possible mechanism of bupishenhuoxue therapy on early diabetic nephropathy in patients with renal tubule protective effect. Methods: Clifford Hospital of Nephrology at the Guangzhou University of Chinese Medicine hospital in accordance with the inclusion criteria of patients with early diabetic nephropathy in 60 cases, were randomly divided into control group and treatment group, control group received basic treatment, the treatment group in the control group based on the use of bupishenhuoxue therapy after.4 weeks, were detected before and after two the treatment group NGAL urine, urine beta 2-MG, urine NAG, serum creatinine, creatinine clearance, blood glucose, blood lipids and other biochemical indexes, inflammation index IL-6 and markers of oxidative stress in SOD level. Results: (1) the two groups before and after treatment Urine NGAL, urine beta 2-MG, urinary NAG compared before treatment, after treatment of urinary NGAL, beta 2-MG, NAG were decreased, the difference was statistically significant (P0.05); comparison between the two groups, the treatment group NGAL urine after treatment, beta 2-MG was lower than the control group, the difference was statistically significant (P0.05 the treatment group), urine NAG lower than the control group, but there was no significant differences between them (P0.05). (2) the two groups before and after treatment of blood glucose, blood lipid, blood pressure compared before treatment, after treatment, blood glucose, blood lipid, blood pressure decreased, the difference was statistically significant (P0.05); comparison between the two groups. The treatment group after treatment of blood glucose, blood lipids were significantly lower than the control group, the difference was statistically significant (P0,05); after treatment, diastolic blood pressure was significantly lower than the control group, the difference was statistically significant (P0.05). After treatment, the systolic blood pressure was slightly lower than the control group, but the difference was not statistically significant (P0.05). (3) IL-6 the inflammatory indexes before and after treatment in two groups, Comparison of oxidative stress index SOD: comparison before and after treatment, after treatment, IL-6 was decreased, SOD increased than that before treatment, the difference was statistically significant (P0.05); comparison between the two groups after treatment, IL-6 treatment group than the control group decreased, SOD increased compared with the control group, the difference was statistically significant (P0.05). (4) comparison of renal function before and after treatment in two groups: the treatment group after treatment, serum creatinine after treatment than before treatment, no significant difference (P0.05); creatinine clearance rate decreased than that before treatment, the difference was statistically significant (P0.05). The comparison between the two groups after treatment, treatment group, serum creatinine, creatinine clearance rate is lower than the control group, the difference was statistically significant (P0.05) (5) correlation analysis: markers of urine beta 2-MG, urinary NGAL and other renal injury urinary NAG, urinary albumin positive correlation, r = 0.502,0.422,0.684 (P0.05); urine NGAL and blood glucose, blood lipid, blood pressure Shu. The pressure was positively correlated, r = 0.281,0.435,0.355,0.611 (P0.05); urinary NGA1 and inflammatory markers of IL-6 were positively correlated. The R value was 0.325 (P0.05); urinary NGAL and markers of oxidative stress is negatively related to SOD, r = -0.570 (P0.05); no correlation between urinary NGAL and serum creatinine, R value is -0.004 (P0.05); the clearance rate was positively correlated with the endogenous creatinine, r = 0.562 (P0.05). Conclusion: (1) bupishenhuoxue therapy can reduce the level of urinary NGAL in patients with early diabetic nephropathy, the effective protection of early diabetic nephropathy in patients with renal tubule, slow the progression of diabetic nephropathy (. 2) bupishenhuoxue therapy can reduce the level of IL-6 in patients with early diabetic nephropathy, improve the level of SOD in patients with early diabetic nephropathy, can effectively improve the patients with early diabetic nephropathy and oxidative stress state of micro inflammation, has anti-inflammatory, anti oxidative stress. (3) bupishen Circulation can effectively regulate blood sugar and blood lipid levels in patients with early stage diabetic nephropathy. (4) bupishenhuoxue therapy can regulate the level of blood pressure in patients with early diabetic nephropathy, reduce glomerular filtration pressure, reduce renal hyperperfusion. (5) the urine NGAL and urine beta 2-MG, urinary NAG, urinary albumin as early diabetic renal injury markers. (6) bupishenhuoxue therapy of early diabetic nephropathy in patients with renal tubular protective mechanism may be associated with regulating blood glucose, blood lipid, blood pressure, anti-inflammatory, anti oxidative stress, reduce a kidney high perfusion effect.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.2;R692.9
，

本文編號：1609214