本文選題：青藤堿 + 糖尿病腎病　； 參考：《湖北中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的通過研究青藤堿對糖尿病腎病患者臨床癥狀、尿蛋白及T淋巴細(xì)胞亞群的影響,觀察其治療糖尿病腎病的臨床療效,并探討其療效的可能機(jī)制。方法1.從2013年9月到2015年9月在湖北省中醫(yī)院腎病門診或者住院部接受治療的患者中,根據(jù)本研究的納入標(biāo)準(zhǔn)選擇48例患者作為觀察病例。隨機(jī)分為治療組和對照組,每組24例。青藤堿治療組采用西醫(yī)基礎(chǔ)治療加青藤堿口服(120mg/次,每天2次);對照組僅予以基礎(chǔ)治療,觀察療程為期3個月。兩組糖尿病腎病患者在來源、性別、年齡、病程、體重指數(shù)等方面經(jīng)分析評估,均無顯著性差異。2.觀察指標(biāo):(1)治療前后青藤堿治療組與對照組的中醫(yī)臨床癥狀積分變化;(2)療效指標(biāo):24h尿蛋白定量、尿微量白蛋白、超敏C反應(yīng)蛋白、T淋巴細(xì)胞亞群(CD4+、CD8+及CD4+/CD8+)、糖化血紅蛋白;(3)安全性指標(biāo):血常規(guī)、肝功能、血清胱抑素C、心電圖等。3.統(tǒng)計學(xué)處理:觀察數(shù)據(jù)用(x±s)表示,采用SPSS19.0統(tǒng)計軟件進(jìn)行統(tǒng)計學(xué)計算分析。計數(shù)資料采用X2檢驗,等級資料采用秩和檢驗,同組數(shù)據(jù)的比較用配對t檢驗,組間資料的比較用獨立樣本t檢驗。結(jié)果1.兩組患者總療效比較:青藤堿治療組的疾病總有效率為87.5%,優(yōu)于對照組的45.8%,差異有統(tǒng)計學(xué)意義(p0.01)。青藤堿治療組的中醫(yī)證候總有效率91.6%,優(yōu)于對照組的54.2%,差異有統(tǒng)計學(xué)意義(p0.01)。2.中醫(yī)癥狀總積分比較:兩組病例治療后的臨床癥狀總積分均有所下降,差異有統(tǒng)計學(xué)意義(p0.05);青藤堿治療組癥狀總積分的改善程度優(yōu)于對照組,且差異有統(tǒng)計學(xué)意義(p0.01)。3.單項癥狀積分比較:青藤堿治療組治療后神疲乏力、氣短懶言、自汗易感、咽干口渴、腰膝酸痛等癥狀較治療前均有改善,且優(yōu)于對照組,差異有統(tǒng)計學(xué)意義(P0.01)。治療后青藤堿治療組煩熱盜汗的癥狀與對照組比較,差異無統(tǒng)計學(xué)意義(P0.05)。治療后對照組咽干口渴較治療前明顯改善,差異有統(tǒng)計學(xué)意義(P0.05)。4.24huprq、um Alb比較:青藤堿治療組與對照組經(jīng)治療后24huprq、um Alb均有下降,差異有統(tǒng)計學(xué)意義(P0.05)。青藤堿治療組患者的24huprq、um Alb下降程度優(yōu)于對照組,差異有統(tǒng)計學(xué)意義(P0.01)。5.CD4+、CD8+、CD4+/CD8+比較:青藤堿治療組治療后CD4+降低、CD8+升高、CD4+/CD8+比值下降,與治療前相比差異有統(tǒng)計學(xué)意義(P0.05);對照組治療前后比較,T淋巴細(xì)胞亞群的參數(shù)值無顯著性差異(p0.05);治療后青藤堿治療組與對照組比較,差異有統(tǒng)計學(xué)意義(p0.01)。6.CRP、Hb Alc、Cys C比較:青藤堿治療組與對照組治療后CRP都有所下降,與治療前相比差異有統(tǒng)計學(xué)意義(p0.05);但是青藤堿治療組治療后CRP下降水平優(yōu)于對照組,差異有統(tǒng)計學(xué)意義(p0.01)。治療前后兩組患者的Hb Alc、Cys C比較,無顯著性差異(p0.05)。7.其它安全性指標(biāo)評價:治療前后兩組病例的血液分析、肝功能、心電圖等指標(biāo)比較,差異無統(tǒng)計學(xué)意義(P0.05)。整個實驗觀察期間患者沒有出現(xiàn)明顯的藥物不良反應(yīng)。結(jié)論青藤堿可以有效的緩解糖尿病腎病患者的臨床癥狀,減少24huprq和um Alb,維持T淋巴細(xì)胞亞群的平衡與穩(wěn)定(降低CD4+、升高CD8+、降低其比值),降低CRP。并推斷其可能通過調(diào)節(jié)人體免疫應(yīng)答、糾正免疫功能紊亂、抑制機(jī)體炎癥反應(yīng)等作用機(jī)制來治療糖尿病腎病,從而延緩其病情的進(jìn)展。
[Abstract]:Objective To observe the effect of sinomenine on the clinical symptoms, urinary protein and T lymphocyte subsets in patients with diabetic nephropathy, observe the clinical effect of the treatment of diabetic nephropathy and explore the possible mechanism of its effect. Method 1. from September 2013 to September 2015 in patients receiving treatment in the nephrotic clinic or inpatient department of Hubei Provincial Traditional Chinese Medical Hospital According to the inclusion criteria of this study, 48 patients were selected as observation cases. They were randomly divided into treatment group and control group, with 24 cases in each group. The treatment group of sinomenine was treated with western medicine and sinomenine (120mg/ times, 2 times a day). The control group was only treated with basic treatment for a period of 3 months. Two groups of diabetic nephropathy patients were in source, sex, age and age. The course of disease, body mass index and other aspects of the analysis and evaluation, there were no significant differences in.2. observation indexes: (1) changes in the clinical symptom score of the sinomenine treatment group and the control group before and after treatment; (2) the curative effect index: 24h urine protein quantitative, urine microalbuminuria, hypersensitivity C reaction egg white, T lymphocyte subgroup (CD4+, CD8+ and CD4+/CD8+), glycosylated hemoglobin; (3 ) safety index: blood routine, liver function, serum cystatin C, electrocardiogram and other.3. statistical processing: the observation data were expressed with (x + s), and SPSS19.0 statistical software was used for statistical analysis. The count data were tested by X2 test, rank data were tested by rank sum test, the comparison of the same group data was tested by paired t, and the comparison of data between groups was compared with independent samples. T test. Results the total effective comparison between the 1. two groups: the total effective rate of sinomenine treatment group was 87.5%, superior to 45.8% in the control group. The difference was statistically significant (P0.01). The total effective rate of the TCM syndrome in the sinomenine treatment group was 91.6%, superior to 54.2% of the control group (P0.01), the total score of TCM symptoms was compared with the two groups of cases. The total score of the clinical symptoms after treatment decreased, the difference was statistically significant (P0.05); the improvement of the total symptom score of the sinomenine treatment group was better than that of the control group, and the difference was statistically significant (P0.01).3. symptom integral comparison: the sinomenine treatment group was treated with the fatigue, shortness of breath, self perspiration, thirst of the pharynx, and pain in the waist and knee. The symptoms were better than those before the treatment, and the difference was statistically significant (P0.01). There was no significant difference in the symptoms of bodyheat and night sweats in the sinomenine treatment group after treatment (P0.05). After treatment, the thirst of the control group was significantly better than before the treatment (P0.05).4.24huprq, um Alb compared: Green 24huprq, um Alb decreased after treatment in the treatment group and the control group, the difference was statistically significant (P0.05). The degree of 24huprq and um Alb in the group of sinomenine treatment group was better than that of the control group. The difference was statistically significant (P0.01).5.CD4+, CD8+, CD4+/CD8+ comparison: after the treatment group of sinomenine treatment, CD4+ decreased, increased, decreased ratio, Compared with before treatment, there was significant difference (P0.05), and there was no significant difference in the parameters of T lymphocyte subsets in the control group before and after treatment (P0.05); the difference was statistically significant (P0.01).6.CRP, Hb Alc, Cys C compared with the control group after treatment, and the CRP of the sinomenine treatment group and the control group decreased after treatment. The difference was statistically significant before treatment (P0.05), but the decrease of CRP in the sinomenine treatment group was better than that of the control group. The difference was statistically significant (P0.01). There was no significant difference in the Hb Alc and Cys C between the two groups of the patients before and after treatment, and there was no significant difference (P0.05).7. other safety index evaluation: the blood analysis, liver function, and heart of the two groups of patients before and after treatment. The difference was not statistically significant (P0.05). The patients had no obvious adverse drug reactions during the whole experimental observation. Conclusion sinomenine could effectively alleviate the clinical symptoms of diabetic nephropathy patients, reduce 24huprq and um Alb, maintain the balance and stability of the T lymphocyte subsets (lower CD4+, increase CD8+, reduce their ratio. Value), reduce CRP. and deduce that it may treat diabetic nephropathy by regulating the immune response, correcting the immune dysfunction and inhibiting the inflammatory response of the body to delay the progress of the disease.

【學(xué)位授予單位】：湖北中醫(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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