本文關(guān)鍵詞： 大株紅景天 糖尿病腎病 氣虛血瘀型 血管內(nèi)皮生長(zhǎng)因子 熱休克蛋白70　出處：《云南中醫(yī)學(xué)院》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：隨著當(dāng)今社會(huì)經(jīng)濟(jì)的發(fā)展、人民生活水平提高、老齡化問(wèn)題的凸顯以及我國(guó)糖尿病的多發(fā),越來(lái)越多患者生命健康和生活質(zhì)量都受到了極大的影響。糖尿病腎病作為糖尿病微血管病變最常見(jiàn)也是最嚴(yán)重的并發(fā)癥之一,因其發(fā)病隱匿,病程纏綿難愈,許多患者發(fā)現(xiàn)時(shí)都已處于病情的中晚期而不能得到及時(shí)的救治和預(yù)防,相應(yīng)的治療僅能是改善癥狀以及治療相關(guān)的并發(fā)癥,減緩疾病的進(jìn)程。祖國(guó)醫(yī)學(xué)對(duì)該病的治療和記載有悠久的歷史,近幾年來(lái),很多學(xué)者和專(zhuān)家應(yīng)用中藥或是中藥制劑治療糖尿病腎病都取得了一定的療效和成果。本研究旨在通過(guò)觀(guān)察成分明確的大株紅景天注射液對(duì)糖尿病腎病(氣虛血瘀型)的相關(guān)實(shí)驗(yàn)指標(biāo)的變化以及相應(yīng)的中醫(yī)臨床癥狀的改善狀況,為糖尿病腎病的治療提供新依據(jù)。目的:通過(guò)觀(guān)察大株紅景天治療糖尿病腎病(氣虛血瘀證)患者中醫(yī)臨床癥狀積分和血管內(nèi)皮生長(zhǎng)因子(VEGF)、熱休克蛋白70(HSP70)的變化,探討大株紅景天對(duì)糖尿病腎病(氣虛血瘀型)的治療機(jī)制,為拓展藥物的治療范圍提供臨床依據(jù)和支持。方法:將糖尿病腎病(氣虛血瘀型)患者按照隨機(jī)對(duì)照的方式隨機(jī)分為對(duì)照組和治療組各30例,對(duì)照組采取常規(guī)的西醫(yī)治療,治療組在常規(guī)西醫(yī)治療對(duì)的基礎(chǔ)上加用大株紅景天注射液,療程14天。觀(guān)察兩組患者神疲乏力、面色無(wú)華、浮腫等中醫(yī)癥狀變化,以及血管內(nèi)皮生長(zhǎng)因子(VEGF)、熱休克蛋白70(HSP70)、空腹血糖、糖化血紅蛋白、血尿素氮、肌酐、尿酸、小便蛋白定量等實(shí)驗(yàn)指標(biāo)的變化,進(jìn)行數(shù)據(jù)分析,評(píng)價(jià)實(shí)驗(yàn)用藥的治療效果。結(jié)果:1.試驗(yàn)前,兩組患者的一般情況比較無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),具有臨床可比性;2.中醫(yī)部分:(1)各癥狀積分:兩組面色無(wú)華、神疲乏力及少氣懶言、腰痛、浮腫、肌膚甲錯(cuò)、肢體麻木癥狀治療后較治療前均有明顯改善,具有統(tǒng)計(jì)學(xué)意義(P0.01)。治療后治療組在面色無(wú)華、神疲乏力及少氣懶言、腰痛、肌膚甲錯(cuò)、肢體麻木癥狀改善優(yōu)于對(duì)照組,具有統(tǒng)計(jì)學(xué)意義(P0.05),而在浮腫癥狀改善方面,效果不明顯,無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(2)癥狀總積分比較:治療組和對(duì)照組在治療后癥狀總積分均有所下降,具有統(tǒng)計(jì)學(xué)意義(P0.01)。治療后治療組積分下降情況優(yōu)于對(duì)照組,有統(tǒng)計(jì)學(xué)意義(P0.05);(3)中醫(yī)療效比較:治療后治療組的總有效率為90%,治療后治療組對(duì)癥狀改善優(yōu)于對(duì)照組,具有統(tǒng)計(jì)學(xué)意義(P0.05);3.西醫(yī)方面:(1)臨床觀(guān)測(cè)指標(biāo)比較:加用大株紅景天的治療組治療后可以減少VEGF、HSP70的表達(dá)(P0.05),與對(duì)照組效果相比,具有統(tǒng)計(jì)學(xué)意義(P0.05);(2)治療后治療組降血尿素氮和尿酸的效果優(yōu)于對(duì)照組,具有統(tǒng)計(jì)學(xué)意義(P0.05);(3)治療后治療組對(duì)空腹血糖、糖化血紅蛋白、肌酐、24小時(shí)尿蛋白定量等指標(biāo)的改善,與對(duì)照組相比,無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)(4)西醫(yī)療效:治療組糖尿病腎病有效率為83.3%,與對(duì)照組比較,無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4.安全性評(píng)價(jià):兩組患者治療前后的血常規(guī)(RBC、WBC、HGB、PLT)、肝功能(ALT、AST)、大便常規(guī)+隱血、心電圖等,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);在觀(guān)察周期內(nèi),所有患者均為出現(xiàn)不良反應(yīng)。結(jié)論:1.大株紅景天可以改善糖尿病腎病患者在中醫(yī)方面的氣虛血瘀癥狀;2.大株紅景天可以降低患者血尿素氮和尿酸指標(biāo);3.大株紅景天可以影響糖尿病腎病患者血管內(nèi)皮生長(zhǎng)因子(VEGF)、熱休克蛋白70(HSP70)的表達(dá),起到抗氧化應(yīng)激的作用。
[Abstract]:With the development of social economy, people's living standards improve, highlighting the problem of aging and diabetes mellitus in China sent more, more patients health and quality of life and have been greatly affected. Diabetic nephropathy and diabetic microangiopathy as the most common complication is one of the most serious, because of its occult onset, duration of lingering many patients have been found, in the condition of advanced and can not get timely treatment and prevention, the corresponding treatment can only improve symptoms and treatment related complications, slow the progression of the disease. There is a long history of traditional Chinese medicine treatment and records of the disease, in recent years, many scholars and experts in the application Chinese medicine or traditional Chinese medicine preparation for treating diabetic nephropathy has curative effect and some achievements. This study was designed to observe the composition of clear Sofren injection for diabetes Diabetic nephropathy (Qi deficiency and blood stasis) changes in laboratory parameters and the clinical symptoms of the corresponding improvement, provide a new basis for the treatment of diabetic nephropathy. Objective: To observe the sofren treatment of diabetic nephropathy (Qi deficiency and blood stasis syndrome) in patients with clinical symptoms and vascular endothelial growth factor (VEGF), heat shock protein 70 (HSP70) changes of Rhadiola extract on diabetic nephropathy (Qi deficiency and blood stasis type) treatment mechanism, to provide clinical basis and support for the development of drug treatment. Methods: diabetic nephropathy (Qi deficiency and blood stasis type) were randomly controlled way, randomly divided into control group and treatment group with 30 cases in each group. The control group took the conventional western medicine treatment, the treatment group in the conventional western medicine treatment on the basis of on the use of Sofren injection, a course of 14 days. Two groups were observed in patients with fatigue, lusterless complexion, swelling and other traditional Chinese Medicine The changes of symptoms, and vascular endothelial growth factor (VEGF), heat shock protein 70 (HSP70), fasting blood glucose, glycosylated hemoglobin, blood urea nitrogen, creatinine, uric acid, urine protein quantitative change experiment index, data analysis, evaluation of experimental drug treatment effect. Results: 1. before the test, the general situation of two group of patients was not statistically significant (P0.05), with clinical comparability; 2. part: (1) the TCM symptom score: two groups of complexion, Shenpi fatigue, less gas lazy words, low back pain, edema, skin armour fault, numbness symptoms after treatment were significantly improved compared with before treatment, with statistical significance (P0.01). The treatment group in complexion, Shenpi fatigue, less gas lazy words, back pain, skin armour fault, numbness symptoms better than the control group, with statistical significance (P0.05), and swelling in symptom improvement, the effect is not obvious, no statistical significance (P0.05). (2) the total scores of symptoms: the treatment group and control group decreased in the total score of symptoms after treatment were, with statistical significance (P0.01). The treatment group score decreased than the control group, there was statistical significance (P0.05); (3) Chinese medicine curative effect comparison: after treatment in the treatment group the total efficiency 90%, after treatment of symptoms better than the control group, with statistical significance (P0.05); 3. (1): Western medicine clinical observation index: compared with the treatment group after treatment of sofren can reduce the expression of HSP70 (VEGF, P0.05), compared with the control group, with statistical significance (P0.05); (2) the effect of group blood urea nitrogen and uric acid treatment after treatment than the control group, with statistical significance (P0.05); (3) after treatment, the fasting blood glucose, glycosylated hemoglobin, creatinine, 24 hour urinary protein quantitative index improved, compared with the control group, no significant The significance of (P0.05) (4) the curative effect of Western medicine: the treatment group of diabetic nephropathy was 83.3%, compared with the control group, no statistical significance (P0.05).4. safety evaluation: two groups of patients before and after treatment the blood routine (RBC, WBC, HGB, PLT), liver function (ALT, AST), stool routine + occult blood, electrocardiogram, the difference was not statistically significant (P0.05); in the observation period, all patients had adverse reactions. Conclusion: 1. strains of Rhodiola can improve symptoms in traditional Chinese medicine of qi deficiency and blood stasis in patients with diabetic nephropathy; 2. strains of Rhodiola can reduce blood urea nitrogen and uric acid index; 3. strains of Rhodiola can grow effect of vascular endothelial growth factor in patients with diabetic nephropathy (VEGF), heat shock protein 70 (HSP70) expression to oxidative stress.

【學(xué)位授予單位】：云南中醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R259

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