本文選題：Ⅲ期糖尿病腎病 + 消渴腎病方　； 參考：《山西中醫(yī)學(xué)院》2016年碩士論文

【摘要】：目的:本研究通過對高繼寧教授經(jīng)驗方“消渴腎病方”治療早期(Ⅲ期)糖尿病腎病(氣陰兩虛,瘀血阻絡(luò)型)隨機對照的臨床研究,為消渴腎病方治療糖尿病腎病有效性及安全性提供循證醫(yī)學(xué)證據(jù)。同時以氧化應(yīng)激及腎臟纖維化為切入點,探討消渴腎病方多途徑、多靶點治療糖尿病腎病的微觀作用機理,為中醫(yī)藥治療糖尿病腎病提供新的思路和啟發(fā)。方法:將66例Ⅲ期糖尿病腎病患者按就診順序編號,運用隨機數(shù)字表法隨機分為治療組和對照組,各33例。兩組患者均給予西醫(yī)糖尿病常規(guī)治療,包括健康教育、飲食、運動、藥物控制血糖、血壓、血脂等,治療組在此基礎(chǔ)上口服消渴腎病方治療。在治療前、治療第12周、第24周時觀察相關(guān)療效性及安全性指標(biāo)。觀察指標(biāo)包括:患者癥狀、體征、中醫(yī)癥候積分及相關(guān)理化檢查指標(biāo)如尿常規(guī)、尿NAG酶、24小時尿蛋白、血糖、糖化血紅蛋白、血清肌酐、尿素氮、胱抑素水平以評估臨床療效;檢測丙二醛(MDA)的含量和超氧化物歧化酶(SOD)的活性水平,以反映氧化應(yīng)激水平;測定尿轉(zhuǎn)化生長因子-β1(TGF-β1)水平和IV型膠原水平,評估腎纖維化程度,從而對自擬消渴腎病方的臨床療效做出客觀評價,同時檢測不良反應(yīng)并及時記錄。結(jié)果:(1)總有效率:治療第12周,治療組有效率為83.33%,對照組有效率為59.38%,差異具有統(tǒng)計學(xué)意義(P0.05);治療第24周,治療組有效率為93.33%對照組有效率為62.50%,差異具有統(tǒng)計學(xué)意義(P0.05)。(2)中醫(yī)證候積分:治療第12周,與對照比較,治療組患者癥候明顯改善差異具有統(tǒng)計學(xué)意義(P0.05);治療第24周,與對照組比較,治療組患者癥候改善尤為明顯,(差異具有統(tǒng)計學(xué)意義P0.01);且第24周治療效果優(yōu)于第12周。(3)血糖及糖化血紅蛋白:治療前、治療第12周、治療第24周,兩組患者空腹血糖(FPG)組間比較,差異無統(tǒng)計學(xué)意義(P0.05);而餐后2小時血糖及糖化血紅蛋白在治療第12周、第24周差異有統(tǒng)計學(xué)意義(P0.05),消渴腎病方組療效優(yōu)于對照組,24周末效果尤其明顯。(4)蛋白尿及腎保護作用:與對照組比較,治療第12周、治療第24周,治療組尿蛋白排泄水平、尿NAG酶及胱抑素C都明顯減低,差異有統(tǒng)計學(xué)意義(P0.01),其中尿NAG酶及胱抑素C在24周末效果優(yōu)于12周末效果(P0.01)。而尿素氮及血清肌酐水平治療前后變化無統(tǒng)計學(xué)差異(P0.05)。(5)抗氧化應(yīng)激及抗纖維化:治療前、治療第12周、治療第24周,兩組患者血清MDA含量和SOD活性組間比較,治療后MDA含量明顯降低,差異有統(tǒng)計學(xué)意義(P0.01),SOD活性明顯升高,差異有統(tǒng)計學(xué)意義(P0.01),且24周末效果優(yōu)于12周末(P0.01)。治療前、治療第12周、治療第24周,兩組患者尿TGF-β1含量和Ⅳ型膠原水平組間比較,治療組TGF-β1和Ⅳ型膠原水平明顯降低,差異有統(tǒng)計學(xué)意義(P0.01),且24周末效果優(yōu)于12周末(P0.01)。結(jié)論:1)由上述結(jié)果得出,與西醫(yī)常規(guī)治療相比,加用消渴腎病方可顯著改善早期糖尿病腎病患者餐后血糖及糖化血紅蛋白水平,能夠有效地降低尿白蛋白排泄率,降低尿NAG酶及血清胱抑素水平,提示有一定的腎保護作用,具有一定的推廣應(yīng)用價值。2)消渴腎病方可通過調(diào)節(jié)MDA和SOD水平,對抗機體氧化應(yīng)激反應(yīng)水平,從而減輕腎臟損害,發(fā)揮對糖尿病腎病的防治作用。本方可減少尿中TGF-β1和Ⅳ型膠原水平,證明消渴腎病方具有抗腎臟纖維化,延緩DN進展的作用。
[Abstract]:Objective: to provide evidence based evidence-based medical evidence for the efficacy and safety of diabetes nephropathy in the treatment of early (stage III) diabetic nephropathy (Qi Yin deficiency and blood stasis blocking type) by Professor Gao Jining's empirical prescription "Xiaoke nephrosis recipe", and the evidence of the efficacy and safety of diabetes nephropathy in the treatment of diabetic nephropathy. In order to provide new ideas and inspiration for the treatment of diabetic nephropathy by traditional Chinese medicine, 66 patients with stage III diabetic nephropathy were randomly divided into treatment group and control group by random digital table, which were given in 33 cases. All patients were given two groups. The routine treatment of diabetes in western medicine, including health education, diet, exercise, medicine control blood sugar, blood pressure, blood lipid, etc., the treatment group was treated with oral thirst nephritic syndrome on this basis. Before treatment, the treatment was twelfth weeks, and the related safety indexes were observed at twenty-fourth weeks. The observation index included symptoms, signs, TCM syndrome scores and related principles. The examination indexes such as urine routine, urine NAG enzyme, 24 hour urine protein, blood sugar, glycated hemoglobin, serum creatinine, urea nitrogen and cystatin were used to evaluate the clinical efficacy; the content of MDA and the activity level of superoxide dismutase (SOD) were detected to reflect the level of oxygen stress; the level of urine transforming growth factor beta 1 (TGF- beta 1) and IV type were measured. Collagen level, evaluate the degree of renal fibrosis, so as to make an objective evaluation of the clinical efficacy of self-made thirst nephritic syndrome, and detect the adverse reaction and record it in time. Results: (1) the total effective rate: Twelfth weeks of treatment, the effective rate of the treatment group was 83.33%, the control group was 59.38%, the difference was statistically significant (P0.05); the treatment group was treated for twenty-fourth weeks. The treatment group had a treatment group. The efficiency of the 93.33% control group was 62.50%, the difference was statistically significant (P0.05). (2) TCM syndrome score: Twelfth weeks of treatment, compared with the control, the symptoms of patients in the treatment group were significantly improved (P0.05), and the treatment group was more obvious than the control group for twenty-fourth weeks, and the difference was statistically significant. The treatment effect of twenty-fourth weeks was better than that of twelfth weeks. (3) blood sugar and glycated hemoglobin: before treatment, Twelfth weeks of treatment and twenty-fourth weeks of treatment, the difference between the two groups of patients with fasting blood glucose (FPG) was not statistically significant (P0.05), while 2 hours after meal and glycated hemoglobin were statistically significant (P0.05) in the twenty-fourth week treatment (P0.05). The effect of thirst nephritic group was better than that of the control group, and the effect of 24 weekend was especially obvious. (4) proteinuria and renal protective effect: compared with the control group, the urinary protein excretion level, urinary NAG enzyme and cystatin C were significantly reduced in the treatment group for Twelfth weeks, and the difference was statistically significant (P0.01), in which the effect of urinary NAG and cystatin C was better than 12 at the end of the 24 week. There was no significant difference in the weekend effect (P0.01). There was no statistical difference (P0.05) before and after treatment of urea nitrogen and serum creatinine level. (5) antioxidant stress and anti fibrosis: before treatment, Twelfth weeks of treatment and twenty-fourth weeks of treatment, the serum MDA content and SOD activity group were compared between the two groups. The content of MDA decreased significantly after treatment, the difference was statistically significant (P0.01), SOD activity was clear. The difference was statistically significant (P0.01), and the effect of the 24 weekend was better than the 12 weekend (P0.01). Before treatment, Twelfth weeks and twenty-fourth weeks of treatment, the levels of TGF- beta 1 and type IV collagen in the two groups were compared, the levels of TGF- beta 1 and type IV collagen in the treatment group were significantly lower, the difference was statistically significant (P0.01), and the effect of 24 weekend was better than 12 weekend (P0 .01) conclusion: conclusion: 1) from the above results, compared with the conventional treatment of Western medicine, the addition of Xiaoke nephropathy can significantly improve the postprandial blood glucose and glycosylated hemoglobin levels in patients with early diabetic nephropathy, effectively reduce the urinary albumin excretion rate, reduce the urinary NAG enzyme and serum Cystin levels, suggesting certain renal protective effects. To promote the application value.2) Xiaoke nephropathy can be used to regulate the level of MDA and SOD to combat the level of oxidative stress reaction in the body, thus alleviating renal damage and playing a role in the prevention and treatment of diabetic nephropathy. This prescription can reduce the level of TGF- beta 1 and type IV collagen in urine, and prove that Xiaoke nephropathy has the effect of anti renal fibrosis and retarding the progress of DN.
【學(xué)位授予單位】：山西中醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259

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