本文選題：早期糖尿病腎病 + 胱抑素C�。� 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:通過“參芪固腎湯”聯(lián)合西醫(yī)基礎治療早期糖尿病腎病患者,觀察治療前后中醫(yī)癥候積分、尿白蛋白排泄率、胱抑素C、白細胞介素-6、白細胞介素-8水平的變化,客觀評估“參芪固腎湯”對早期糖尿病腎病的臨床療效,并試圖從炎癥角度探討本方對于糖尿病腎病早期發(fā)生發(fā)展的作用機制,為中醫(yī)藥對于糖尿病腎病保腎、延緩腎衰提供證據,為本方日后運用于臨床提供堅實基礎。方法:1課題選取為2016年1月到2017年1月于河北省中醫(yī)院內分泌科門診的符合納入標準的早期DN患者60例,將用上述患者隨機分配為對照組(30例)、試驗組(30例),兩組在性別、年齡、糖化血紅蛋白、腎病分期、病程長久等方面差異無統(tǒng)計學意義,具有可比性(P0.05)。2對照組給于糖尿病飲食、運動基礎上口服胰激肽原酶腸溶片,試驗組加用參芪固腎湯(藥物組成:黃芪、丹參、茯苓、山藥、芡實、金櫻子、太子參、白術、五味子、麥冬、川芎)進行治療。所有入組患者療程為3個月。3在入組前及治療后采空腹靜脈血檢查,檢測糖化血紅蛋白、尿白蛋白排泄率、胱抑素C、IL-6、IL-8對比前后水平變化;安全性指標采取檢測血常規(guī)、尿常規(guī)、大便常規(guī)、肝功、檢查心電圖等;觀察入組患者治療前后主要臨床癥狀及體征的變化情況、不良反應等。結果:試驗組與對照組組內前后對比,均能有效改善早期DN患者的臨床證候積分,均能降低早期DN患者血清Cys-C、IL-6、IL-8水平(P0.01),但治療后試驗組與對照組組間對比,試驗組降低患者體內炎性因子水平和尿白蛋白排泄率方面要強于對照組,二者相比具有統(tǒng)計學意義(P0.01)。兩組患者治療前后各安全性指標無明顯差異(P0.05),具有良好的安全性。結論:參芪固腎湯聯(lián)合西醫(yī)基礎治療早期氣陰兩虛兼夾瘀證DN患者療效滿意,能夠有效改的善DN患者中醫(yī)證候積分,能夠提高早期DN患者的生活質量;對于降低患者尿白蛋白排泄率、血清胱抑素C、血清炎癥因子指標IL-6和IL-8方面,效果優(yōu)于單純西醫(yī)基礎治療,這表明本方劑具有保護腎小球,修復受損腎臟的作用,能對抗和減輕早期DN患者體內炎癥損傷的作用。在對于降低早期DN患者血糖水平方面試驗組、對照組無統(tǒng)計學差異,這說明參芪固腎湯改善DN患者腎臟功能的保護機制可能是通過其它途徑實現(xiàn)的。參芪固腎湯短期服用,安全性較高。
[Abstract]:Objective: To observe the TCM syndrome score, urinary albumin excretion rate, Cystatin C, interleukin -6 and interleukin -8 level before and after treatment by "Shenqi Gu Shen Decoction" combined with western medicine, and objectively evaluate the clinical effect of "Shenqi Gu Shen Decoction" on early diabetic nephropathy and try to get from the inflammation. To explore the mechanism of the early development of diabetic nephropathy, provide evidence for Chinese medicine to protect the kidney of diabetic nephropathy, delay the renal failure, and provide a solid basis for the use of the clinic in the future. Methods: 1 subjects were selected for January 2016 to January 2017 in the Department of endocrinology of the Hospital of traditional Chinese medicine in Hebei province. 60 cases of early DN patients were randomly assigned to the control group (30 cases) and the experimental group (30 cases). The two groups had no statistically significant differences in sex, age, glycated hemoglobin, nephrotic staging, and long course of disease, with a comparable (P0.05).2 control group for diabetes diet, exercise based on oral Pancreatic Kininogenase Enteric-coated Tablets, experimental group. Addition of Shenqi Gu kidney soup (drug composition: Astragalus, Salvia miltiorrhiza, Poria, tuckahoe, yam, cherry seed, Radix stigma, Rhizoma Atractylodes, Radix Ophiopogon, Ophiopogon japonicus, Rhizoma Ophiopogon, Ligusticum chuanxiong). The treatment course of all the patients was 3 months.3 before the group and after the treatment, the hemoglobin, urinary albumin excretion rate, Cystatin C, IL-6, IL-8 were compared. Level changes; safety indexes were detected by blood routine, urine routine, routine stool, liver function, examination of electrocardiogram, and the changes of main clinical symptoms and signs before and after treatment in the group, and adverse reactions. Results: the clinical syndrome scores of early DN patients could be effectively improved by comparison between the experimental group and the control group. All the results could be reduced. The serum level of Cys-C, IL-6 and IL-8 (P0.01) in the low early DN patients, but compared with the control group after treatment, the level of inflammatory factors and urinary albumin excretion rate in the experimental group were stronger than those in the control group, and the two groups were statistically significant (P0.01). There was no significant difference between the two groups before and after treatment (P0.05). Conclusion: the effect of Shenqi Gu Shen kidney soup combined with western medicine on DN patients with Qi Yin deficiency and stagnation of blood stasis syndrome is satisfactory. The integral of TCM syndrome in patients with good DN can be effectively improved, and the quality of life in early DN patients can be improved; the urinary albumin discharge rate, serum cystatin C, and serum inflammatory factor index IL-6 can be reduced. And IL-8, the effect is better than the simple western medicine basic treatment, which shows that the prescription has the role of protecting the glomeruli, repairing the damaged kidney, and can counteract and reduce the effect of the early DN patients' inflammation in the body. There is no statistical difference between the experimental group and the control group in reducing the blood sugar level of the early DN patients. This shows that Shenqi Gu Shen decoction can improve the DN suffering. The protective mechanism of renal function may be achieved through other means. Shenqi Gu Shen decoction is safe for short-term use.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259

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