本文選題：糖尿病腎病 + 糖腎寶沖劑　； 參考：《廣西中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:以宏觀辨證與微觀辨證相結(jié)合為理論依據(jù),采用益氣化瘀法為治法,觀察中藥復(fù)方糖腎寶沖劑治療糖尿病腎病(diabetic nephropathy,DN)的臨床療效,并探討其可能作用機制。方法:選擇2014年3月至2015年12月廣西中醫(yī)藥大學(xué)附屬瑞康醫(yī)院腎病內(nèi)科住院及門診隨診的DN患者,中醫(yī)證型屬氣虛血瘀型病例94例,全部為2型糖尿病。將患者按照隨機數(shù)字表法分為對照組和治療組,各47例。兩組患者在年齡、性別、糖尿病病程、DN分期、合并癥等方面無統(tǒng)計學(xué)差異(P0.05)。對照組采用控制血壓、血糖,調(diào)節(jié)血脂等常規(guī)治療,并在此基礎(chǔ)上加服予厄貝沙坦,治療組在對照組基礎(chǔ)上加服中藥復(fù)方糖腎寶沖劑,每日一劑,分2次服用,療程12周。觀察兩組治療前后空腹血糖(FPG)、糖化血紅蛋白(HbA1c)、血壓、血清肌酐(Scr)、血清胱抑素C(Cyst c)、尿N-乙酰β-D氨基葡萄糖苷酶(NAG)、尿白蛋白排泄率(UAER)、24h尿微量白蛋白、血清單核細胞趨化蛋白-1(MCP-1)、細胞間黏附分子-1(ICAM-1)、白細胞介素-6(IL-6)、白細胞介素-17(IL-17)、中醫(yī)證候總積分及中醫(yī)證候療效等的變化。結(jié)果:(1)兩組患者治療前后FPG、Hb A1c無顯著性差異(P0.05)。(2)與治療前比較,治療后兩組患者血壓均明顯降低(P0.01),但組間比較無顯著性差異(P0.05)。(3)與治療前比較,治療后兩組Scr變化均無統(tǒng)計學(xué)意義(P0.05);治療后兩組Cyst c較治療前均降低明顯(P0.05,P0.01),但治療組明顯低于對照組(P0.05)。(4)與治療前對比,兩組患者治療后24h尿微量白蛋白及UAER均明顯降低(P0.05,P0.01),但治療組低于對照組(P0.05,P0.01);治療后治療組尿NAG較治療前明顯降低(P0.01),且低于對照組(P0.01),而對照組治療前后差異無統(tǒng)計學(xué)意義(P0.05)。(5)兩組治療后血清MCP-1、ICAM-1、IL-6、IL-17的水平與同組治療前比較均有明顯降低(P0.01),但治療組明顯低于對照組(P0.05,P0.01)。(6)治療后兩組中醫(yī)證候積分均明顯降低(P0.01),但治療組治療后中醫(yī)證候積分顯著低于對照組(P0.05)。(7)治療組總有效率80.85%,對照組68.09%,差異有統(tǒng)計學(xué)意義(P0.01)。(8)治療前后,兩組患者均無惡性心律失常發(fā)生,肝功能及血常規(guī)未見明顯異常,相關(guān)指標比較,差異均無統(tǒng)計學(xué)意義(P0.05),且組間比較,均無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:(1)糖腎寶沖劑可顯著改善DN患者臨床癥狀,療效確切,無明顯毒副作用,安全性好;(2)糖腎寶沖劑能降低DN患者血清Cyst c,減少UAER及24h尿微量白蛋白,降低尿NAG,減輕腎臟損害;(3)糖腎寶沖劑能降低DN患者血清MCP-1、IL-6、ICAM-1、IL-17等多種炎癥因子水平;(4)糖腎寶沖劑對DN患者腎臟具有明顯保護作用,其機制可能與抑制炎癥反應(yīng)有關(guān)。
[Abstract]:Objective: to observe the clinical effect of Tangshenbao granule on diabetic nephropathy (diabetic nephropathy DNs) and explore its possible mechanism based on the combination of macro syndrome differentiation and micro syndrome differentiation and the method of supplementing qi and removing blood stasis.Methods: from March 2014 to December 2015, 94 patients with DN in Department of Nephrology, Ruikang Hospital affiliated to Guangxi University of traditional Chinese Medicine were selected. 94 cases of TCM syndromes belonged to qi deficiency and blood stasis, all of which were type 2 diabetes.Patients were randomly divided into control group and treatment group, 47 cases each.There was no significant difference in age, sex, DN stage and complication between the two groups (P 0.05).The control group was treated with routine therapy such as controlling blood pressure, blood glucose and regulating blood lipid, and Irbesartan was added to the control group. The treatment group was treated with traditional Chinese medicine compound Tangshenbao granule once a day for 12 weeks.Before and after treatment, fasting blood glucose (FPG), glycosylated hemoglobin (HbA1cN), blood pressure (BP), serum creatinine (SCR), serum cystatin (C(Cyst), urinary N-acetyl 尾 -D-glucosaminidase (NAGN), urinary albumin excretion rate (UAER) and 24 hours urinary microalbumin were observed.The changes of serum monocyte chemoattractant protein (MCP-1), intercellular adhesion molecule-1 (ICAM-1), interleukin-6 (IL-6), interleukin-17 (IL-17), the total integral of TCM syndromes and the curative effect of TCM syndromes, etc.Results there was no significant difference between the two groups before and after treatment (P 0.05). Compared with before and after treatment, the blood pressure of the two groups decreased significantly (P 0.01), but there was no significant difference between the two groups (P 0.05).After treatment, the changes of Scr in the two groups were not statistically significant (P 0.05), the Cyst c of the two groups were significantly lower than that of before treatment, but significantly lower in the treatment group than that in the control group.The urinary microalbumin and UAER decreased significantly in both groups 24 hours after treatment, but in the treatment group were lower than those in the control group, but the urinary NAG in the treatment group was significantly lower than that in the control group before and after treatment, and was lower than that in the control group before and after treatment, but there was no significant difference between the two groups before and after treatment.The level of serum MCP-1 ICAM-1 / IL-6IL-17 was significantly lower than that of the same group before treatment, but the treatment group was significantly lower than that of the control group (P0.05P0.01P0.01P0.01U .Y6) after treatment, the scores of TCM syndromes in both groups were significantly lower than those in the control group, but the TCM syndrome accumulation after treatment in the treatment group was significantly lower than that in the control group (P 0.05N, P 0.01N, P 0.01g / L), but after treatment, the TCM syndromes in the treatment group were significantly lower than those in the control group.The total effective rate of the treatment group was 80.85, while that of the control group was 68.09. The difference was statistically significant before and after the treatment.There were no malignant arrhythmias in the two groups, no obvious abnormality in liver function and blood routine, and there was no significant difference in the related indexes between the two groups (P 0.05), and there was no significant difference between the two groups (P 0.05).ConclusionTwenty one) Tangshenbao granules can significantly improve the clinical symptoms of DN patients, the curative effect is definite, there are no obvious side effects, and the safety is good. Tangshenbao granule can reduce serum Cyst c, UAER and 24 h urinary microalbuminuria in DN patients.Reducing urinary NAG3) Tangshenbao granule can reduce the level of various inflammatory factors, such as MCP-1T, IL-6, ICAM-1, IL-17, and other inflammatory factors in the serum of patients with DN. Tangshenbao granule has an obvious protective effect on the kidney of DN patients, and its mechanism may be related to the inhibition of inflammatory reaction.
【學(xué)位授予單位】：廣西中醫(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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