發(fā)布時間：2018-02-15 04:33

  本文關(guān)鍵詞： 益氣養(yǎng)陰通絡(luò)方 糖尿病腎病 氣陰虧虛夾瘀 單核細(xì)胞趨化因子-1(MCP-1)　出處：《南京中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：背景：糖尿病有多種常見的并發(fā)癥,而糖尿病腎病是其中之一。1期和2期DN必需要腎臟病理才能診斷,3期DN通過檢測尿液等就能診斷,臨床診斷較為方便。3期DN通過積極治療,可以修復(fù)腎臟損傷,病情得以緩解。早期DN的西醫(yī)治療措施包括控制血糖,運用ACEI或ARB,可是臨床效果往往不理想。中醫(yī)中藥在糖尿病腎病的防治方面是有比較突出的優(yōu)勢。我們依據(jù)糖尿病腎病早期多見氣陰不足,瘀阻腎絡(luò)的特點,確立了益氣養(yǎng)陰通絡(luò)的治療大法,擬訂了益氣養(yǎng)陰通絡(luò)方來治療DN3期氣陰虧虛夾瘀型患者。目的：本研究將通過對DN3期氣陰虧虛夾瘀型患者治療前后的臨床癥狀(口干、多飲、多尿等)、中醫(yī)證候積分及理化檢查(尿微量白蛋白、腎功能指標(biāo)、尿MCP-1水平等)進(jìn)行觀察,評價益氣養(yǎng)陰通絡(luò)方治療DN3期氣陰虧虛夾瘀型患者的臨床效果,并探討其可能具有的抗炎機制。方法：設(shè)立實驗組和對照組,各48例糖尿病腎病3期氣陰虧虛夾瘀型患者,對照組予常規(guī)基礎(chǔ)治療,實驗組在常規(guī)基礎(chǔ)治療的基礎(chǔ)上聯(lián)合中藥湯劑益氣養(yǎng)陰通絡(luò)方,療程均為12周,觀察分析并進(jìn)行統(tǒng)計檢驗患者的相關(guān)指標(biāo),比較兩組患者的中醫(yī)證候積分,尿微量白蛋白,及FPG、2hPG、Scr、BUN、尿MCP-1水平等的變化。結(jié)果：1、臨床綜合療效：對照組治療的總有效率為47.92%,治療組治療的總有效率89.58%,二組療效比較有統(tǒng)計學(xué)差異(P0.05)2、對中醫(yī)證候的改善作用：兩組療前后中醫(yī)證候積分差值比較差別有統(tǒng)計學(xué)意義(P0.05),治療組病人口干、多飲、舌紅少苔等證候的消失數(shù)高于對照組,兩組差別有統(tǒng)計學(xué)意義(P0.05)。3、對尿微量蛋白排除率(UAER)、空腹血漿葡萄糖(FPG)、血肌酐(Cr)、尿素氮(BUN)的影響：根據(jù)實驗前后對實驗組和對照組的尿微量蛋白排除率(UAER)進(jìn)行檢驗,得出P0.05,有顯著差異,說明效果明顯；又對空腹血漿葡萄糖(FPG)、餐后2小時血漿葡萄糖(2hPG)進(jìn)行檢驗,同樣得出P0.05,效果顯著；對血肌酐(Cr)、尿素氮(BUN)等指標(biāo)行實驗前后對比,兩組無顯著性差異(P0.05)。4、對尿MCP-1的影響：對尿MCP-1行實驗前后對比,實驗組患者尿MCP-1水平較治療前均明顯降低(P0.01),且實驗組患者的尿MCP-1水平較對照組亦明顯降低(P0.01)。結(jié)論：采用益氣養(yǎng)陰通絡(luò)方治療DN3期氣陰虧虛夾瘀型患者,能有效改善患者的臨床癥狀,改善口干、多飲、舌紅少苔等中醫(yī)證候,降低患者的尿微量蛋白排除率(UAER)、FPG、2hPG等。益氣養(yǎng)陰通絡(luò)方發(fā)揮作用的機制可能與使腎臟組織細(xì)胞產(chǎn)生MCP-1減少,從而減輕炎癥反應(yīng)有關(guān)。
[Abstract]:Background: diabetes mellitus has many common complications, and diabetic nephropathy is one of them, stage .1 and stage 2 DN must need renal pathology to diagnose stage 3 DN by detecting urine, and clinical diagnosis is more convenient for stage .3 DN through active treatment. It can repair kidney damage and alleviate the condition. Western medicine treatment for early DN includes controlling blood sugar. Using ACEI or ARB, but the clinical effect is often not ideal. Traditional Chinese medicine has more prominent advantages in the prevention and treatment of diabetic nephropathy. According to the characteristics of deficiency of qi and yin and stagnation of kidney collaterals in early stage of diabetic nephropathy, The treatment method of supplementing qi and nourishing yin and unblocking collaterals was established, and the prescription of replenishing qi and nourishing yin and dredging collaterals was formulated to treat the patients with deficiency of qi and yin and blood stasis in DN3 stage. Objective: this study will be carried out through the clinical symptoms (dry mouth, multiple drinks) before and after treatment in patients with Qi and yin deficiency and blood stasis in DN3 stage. In order to evaluate the clinical effect of Yiqi Yangyin Tongluo recipe in treating the patients with Qi and Yin deficiency and stasis in DN3, we observed the syndromes and physical and chemical examination (urine microalbuminuria, renal function index, urine MCP-1 level, etc.) of diuresis, syndromes and syndromes of traditional Chinese medicine. Methods: the experimental group and the control group were set up, 48 cases of diabetic nephropathy were treated with Qi and Yin deficiency and stasis, the control group was treated with routine basic therapy. On the basis of routine basic treatment, the experimental group combined with traditional Chinese medicine decoction Yiqi Yangyin Tongluo recipe, the course of treatment was 12 weeks. The related indexes of the patients were observed and analyzed, and the TCM syndromes score and urinary microalbumin were compared between the two groups. Results: the total effective rate of the control group was 47.92 and the total effective rate of the treatment group was 89.58. There was statistical difference between the two groups in the improvement of TCM syndrome. Before and after treatment, the difference of TCM syndromes integral difference was statistically significant (P 0.05). The patients in the treatment group were dry in the mouth. The number of disappearance of syndrome such as more drinking, less tongue red and less fur was higher than that in the control group. The difference between the two groups was statistically significant (P0.05U. 3). The effects of urinary microalbumen exclusion rate (UAERA), fasting plasma glucose FPGU, serum creatinine creatinine (Cr) and urea nitrogen bun (bun) were measured before and after the experiment, and the UAERs of the experimental group and the control group were examined. The results showed that there was a significant difference in P0.05, which showed that the effect was obvious; the fasting plasma Glucose-FPGN and the plasma Glucose-2 hPGs were also tested, and P0.05 was also found to be effective. The blood creatinine (Cr), bun (bun), and so on, were compared before and after the experiment. There was no significant difference between the two groups (P0.05. 4). The effect of the two groups on urinary MCP-1 was compared before and after the experiment on urinary MCP-1. The level of urinary MCP-1 in the experimental group was significantly lower than that before treatment, and the level of urinary MCP-1 in the experimental group was significantly lower than that in the control group. Conclusion: Yiqi Yangyin Tongluo recipe was used to treat the patients with Qi and Yin deficiency and stasis in DN3 stage, and the level of urine MCP-1 in the experimental group was significantly lower than that in the control group. It can effectively improve the clinical symptoms of patients, improve the syndromes of dry mouth, drink more, tongue red and less fur, and reduce the rate of removing trace protein in urine. The mechanism of Yiqi Yangyin-Tongluo recipe may be related to the decrease of MCP-1 production in renal tissue cells, and the mechanism of the effect of Yiqi Yangyin-Tongluo recipe may be related to the decrease of MCP-1 production in renal tissue cells. So as to alleviate the inflammatory response related.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259

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