生脉地黄汤加减联合中药保留灌肠疗法治疗糖尿病肾病Ⅲ~Ⅳ期病人的疗效观察

目的探讨生脉地黄汤加减联合中药保留灌肠疗法治疗糖尿病肾病(DN)Ⅲ~Ⅳ期病人的疗效及对病人肾血管内皮功能、血清基质金属蛋白酶组织抑制物-1(TIMP-1)、转化生长因子-β1(TGF-β1)的影响。方法选取100例Ⅲ~Ⅳ期DN病人作为研究对象，随机分为3组，观察组34例，对照A组33例，对照B组33例。3组均予以常规西医治疗，于此基础上，对照A组予以生脉地黄汤加减治疗，对照B组予以中药保留灌肠疗法治疗，观察组予以生脉地黄汤加减联合中药保留灌肠疗法治疗。观察对比3组临床疗效、治疗前后中医证候积分、血糖指标空腹血糖(FBG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbAlc)]、肾功能指标血清肌酐(SCr)、尿素氮(BUN)、24 h尿蛋白排泄率(UAER)]、肾血管内皮功能指标内皮素-1(ET-1)、可溶性细胞间黏附分子-1(sICAM-1)、动脉血流介导的内皮依赖性舒张功能(FMD)]、血清TIMP-1、TGF-β1水平。结果观察组治疗总有效率97.06%，高于对照A组75.76%、B组69.70%(P < 0.05)；治疗1、3个月后，观察组中医证候积分低于对照A、B组(P < 0.05)；治疗1、3个月后，FBG、2hPG、HbAlc、BUN、UAER、SCr、ET-1、sICAM-1、FMD、TIMP-1、TGF-β1水平: 观察组 < 对照A组 < 对照B组(P < 0.05)。结论DNⅢ~Ⅳ期病人予以生脉地黄汤加减联合中药保留灌肠疗法治疗，可显著改善病人症状、体征，降低血糖水平，促进肾功能及肾血管内皮功能恢复，调节血清TIMP-1、TGF-β1水平，进一步提高临床治疗效果。

Observation on the curative effect of Shengmai Dihuang Decoction combined with retention enema of traditional Chinese medicine on treating stage Ⅲ- Ⅳ patients with diabetic nephropathy

ObjectiveTo investigate the curative effect of Shengmai Dihuang Decoction combined with retention enema therapy of traditional Chinese medicine on the treatment of patients with diabetic nephropathy(DN) stage Ⅲ-Ⅳ, the renal vascular endothelial function, the serum tissue inhibitor of matrix metalloproteinase-1(TIMP-1) and transforming growth factor-β1(TGF-β1).MethodsA total of 100 patients with stage Ⅲ-Ⅳ DN were selected as the research objects, and they were randomly divided into 3 groups, with 34 cases in the observation group, 33 cases in the control group A, and 33 cases in the control group B.ALL groups were treated with conventional Western medicine.On this basis, the control group A was treated with Shengmai Dihuang Decoction, the control group B was treated with traditional Chinese medicine retention enema therapy, and the observation group was treated with Shengmai Dihuang Decoction combined with traditional Chinese medicine retention enema therapy.The clinical efficacy, TCM syndrome scores before and after treatment, blood glucose indicators fasting blood glucose(FBG), 2 h postprandial blood glucose(2hPG), glycosylated hemoglobin(HbAlc)], renal function indicators serum creatinine(SCr), urea nitrogen(BUN), 24-hour urinary protein excretion rate(UAER)], renal vascular endothelial function indexes endothelin-1(ET-1), soluble intercellular adhesion molecule-1(sICAM-1), arterial blood flow media Guided endothelium-dependent relaxation function(FMD)], serum TIMP-1, TGF-β1 levels were observed and compared in the three groups.ResultsThe total effective rate of treatment in the observation group was 97.06%, which was higher than the control group A(75.76%), and the control group B 69.70%(P < 0.05);after 1 and 3 months of treatment, the observation group's TCM syndrome score was lower than that in the control group A and B(P < 0.05).After 1, 3 months of treatment, FBG, 2hPG, HbAlc, BUN, UER, SCr, ET-1, sICAM-1, FMD, TIMP-1, TGF-β1 levels: observation group < control group A < Control group B(P < 0.05).ConclusionsThe treatment of patients with DNⅢ-Ⅳ stage of Shengmai Dihuang Decoction combined with traditional Chinese medicine retention enema therapy can significantly improve the symptoms and signs of patients, reduce blood glucose levels, promote the recovery of renal function and renal vascular endothelial function, and regulate serum TIMP-1 and TGF-β1 level, which further improves the clinical treatment effect.