本文關(guān)鍵詞： 滋陰活血湯 陰虛血瘀型 糖尿病腎病 臨床研究　出處：《云南中醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:觀察和研究以燈盞花和生地黃為君藥自擬“滋陰活血湯”配合常規(guī)治療措施,治療陰虛血瘀型糖尿病腎病(Ⅲ期)的臨床療效,以及本方對糖尿病腎病陰虛血瘀型患者相關(guān)實驗室指標(biāo)的影響,從而客觀探討“滋陰活血湯”治療陰虛血瘀型糖尿病腎病的臨床療效。方法:1.收集符合該研究納入標(biāo)準(zhǔn)的患者(Ⅲ期糖尿病腎病,符合中醫(yī)證型陰虛血瘀型)70例,采取單盲法,按照就診次序隨機(jī)分組,試驗組35例,對照組35例。2.在臨床研究前,用統(tǒng)計學(xué)方法檢測兩組患者的性別、年齡、病程、主要癥狀、腎功能等,確定兩組之間差異無統(tǒng)計學(xué)意義。3.治療方法:對兩組入選受試者同時行糖尿病腎病常規(guī)療法,具體治療措施是:⑴對受試者進(jìn)行糖尿病相關(guān)知識的教育講解,規(guī)范患者飲食習(xí)慣,囑其進(jìn)行適量運(yùn)動;肥胖者,可運(yùn)動減肥。⑵征求內(nèi)分泌科醫(yī)生意見,給予患者注射胰島素控制血糖(血糖控制水平:7.0mmol/L≥空腹血糖≥3.9mmol/L,11.1mmol/L≥餐后2小時血糖≥3.9mmol/L)。⑶給予血管緊張素轉(zhuǎn)換酶抑制劑(ACEI)及血管緊張素Ⅱ阻滯劑(ARB)降壓,血壓控制在90-140/60-90mm Hg。⑷糾正水、電解質(zhì)及酸堿平衡的紊亂。對照組:在對受試者進(jìn)行上述常規(guī)治療的同時,密切關(guān)注患者的生命體征和病情進(jìn)展情況,確保患者生命安全,同時記錄患者癥狀、體征及相關(guān)實驗室指標(biāo)。試驗組:在上述常規(guī)治療方法上加用自擬的滋陰活血湯,水煎服,1劑/日,200-300ml/次,早、中、晚各1次。4.療程及治療:4周為一療程,治療并觀察12周。治療期間嚴(yán)格按照擬定方案對兩組病人進(jìn)行治療,不得運(yùn)用或配合使用其他治療陰虛血瘀證型的藥物或措施。5.在第0周及第12周分別對試驗對象的安全性指標(biāo)進(jìn)行檢測,從而對患者的服藥安全性作出客觀評價。結(jié)果:1.經(jīng)過12周的臨床試驗后,比較兩組的總有效率,對照組為41.94%,試驗組為74.19%,p=0.0470.05,差異有統(tǒng)計學(xué)意義;說明試驗組療效明顯優(yōu)于對照組。2.在中醫(yī)癥候療效方面,對照組總有效率32.26%,試驗組總有效率70.97%;二者比較,p=0.0030.05,差異有統(tǒng)計學(xué)意義;說明滋陰活血湯在改善患者中醫(yī)癥候方面,療效顯著。3.將對照組與試驗組試驗后的尿微量白蛋白水平進(jìn)行分析,結(jié)果,p=0.020,說明試驗組效果優(yōu)于對照組;將兩組受試對象試驗后的尿蛋白定量水平進(jìn)行分析,結(jié)果,p=0.002,說明差異存在統(tǒng)計學(xué)意義,試驗組效果優(yōu)于對照組;以上兩個結(jié)果說明滋陰活血湯在抑制糖尿病腎病患者尿蛋白流失方面效果顯著。4.將對照組和試驗組試驗前后的血漿纖維蛋白原進(jìn)行比較,對照組p=0.0910.05,差異無統(tǒng)計學(xué)意義;試驗組p=0.0000.05,差異有統(tǒng)計學(xué)意義。說明滋陰活血湯能降低糖尿病腎病患者血漿纖維蛋白原。5.治療前后對照組和試驗組的安全性指標(biāo)對比無統(tǒng)計學(xué)意義(p0.05)。結(jié)論:通過對本試驗的臨床觀察及數(shù)據(jù)處理可知,采用滋陰活血湯聯(lián)合糖尿病腎病基礎(chǔ)療法的試驗組總有效率高于單用糖尿病腎病基礎(chǔ)療法的對照組,且試驗后試驗組的尿微量白蛋白和尿蛋白定量均明顯低于對照組,整個試驗過程中無患者出現(xiàn)不良反應(yīng),說明滋陰活血湯對糖尿病腎病(Ⅲ期)陰虛血瘀型患者安全有效,可應(yīng)用于臨床服務(wù)患者。
[Abstract]:Objective: To observe and study with Breviscapine and Radix Rehmanniae for routine treatment with drug by "Ziyin Huoxue Decoction" in treatment of diabetic nephropathy, yin deficiency and blood stasis type (III) clinical efficacy, and the formula on diabetic nephropathy in patients with Yin deficiency and blood stasis type related laboratory index influence, so as to explore the objective clinical effect of nourishing yin and promoting blood circulation kidney yin deficiency and Blood Stasis Decoction "in the treatment of diabetes. Methods: 1. collect meet the inclusion criteria of the study patients (stage III diabetic nephropathy with TCM syndrome of yin deficiency and blood stasis type) 70 cases, using single blind method, according to the order of treatment were randomly divided into experimental group 35 cases, control group 35 cases of.2. before clinical studies, two groups of patients with gender, age of detection using statistical methods, the course of disease, the main symptoms of kidney function, determine the difference between the two groups was not statistically significant.3. treatment method: two groups of enrolled subjects and diabetic nephropathy usually Conventional therapy, specific treatment is as follows: diabetes related knowledge on subjects of the education on standard diet, have their regular exercise; obese, can exercise to lose weight. The doctors give patients for Department of Endocrinology, injection of insulin to control blood sugar (glucose control level: 7.0mmol/L or fasting blood glucose than 3.9mmol/L, 11.1mmol/L more than 2 hour postprandial blood glucose over 3.9mmol/L). The given angiotensin-converting enzyme (ACEI) inhibitors and angiotensin II antagonist (ARB) blood pressure, blood pressure control in the 90-140/60-90mm Hg. the correct water, electrolyte and acid-base disorders. The control group in the conventional treatment on the subjects at the same time, close attention to the vital signs of the patients and the progression of the disease, ensure the safety of patients, and record the patient's symptoms, signs and laboratory indexes. The test group: in the conventional treatment method By using the self-made ziyinhuoxie soup, water decoction, 1 dose / day, 200-300ml/ time, early, late 1 times.4. treatment and treatment: 4 weeks for a course of treatment and observation of 12 weeks. During the treatment, in strict accordance with the plan of two groups of patients were treated with drug use or not use the other treatment of yin deficiency and blood stasis type or.5. and measures in zeroth weeks, 12 weeks respectively on the test object safety indexes were detected, so as to make an objective evaluation on the medication safety of patients. Results: after 1. clinical trials after 12 weeks, total efficiency of two groups, 41.94% in the control group, experimental group 74.19%, p=0.0470.05, the difference was statistically significant; the experimental group was significantly better than the control group.2. in TCM symptoms curative effect, the total efficiency of the control group 32.26%, experimental group total efficiency of 70.97%; the two, p=0.0030.05, the difference was statistically significant; indicating ziyinhuoxie soup In the improvement of TCM symptoms, the curative effect of.3. control group and the experimental group after the experiment of the urinary albumin levels were analyzed, the results show, p=0.020, the experimental group was better than the effect of the control group; the two groups of urine protein quantitative level test object was analyzed. Results show, p=0.002, the difference had statistical significance the effect of the experimental group than the control group; the above two results indicated that ziyinhuoxie soup in the inhibition of urinary protein loss has significant effect.4. the control of plasma fibrinogen before and after the original test group and test group compared to control group p=0.0910.05, the difference was not statistically significant; the test group p=0.0000.05, the difference was statistically significant. Ziyinhuoxie decoction can reduce diabetic nephropathy patients before and after plasma fibrinogen.5. therapy compared with safety indexes of the control group and the experimental group had no statistical significance (P0.05). Conclusion: through the clinical observation and experimental data processing show that the experimental group of Ziyin Huoxue Decoction Combined with diabetic nephropathy based therapy the total efficiency is higher than that of control group with single therapy of diabetic nephropathy, experimental group, urinary albumin and urinary protein and test weight were significantly lower than the control group, no adverse the reaction in the whole experimental process, description yin Huoxue Decoction on diabetic nephropathy (phase III) safety of yin deficiency and blood stasis patients effectively, and can be applied to clinical services for patients.

【學(xué)位授予單位】：云南中醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R259

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