益气养阴消癥通络中药治疗 IV 期糖尿病肾病的临床研究

目的：探讨益气养阴消通络中药对 IV 期糖尿病肾病的治疗作用。方法将符合纳入标准的160例 IV 期糖尿病肾病患者随机分为中药组81例和对照组79例，在基础治疗相同的情况下，中药组加益气养阴消通络中药治疗，对照组加厄贝沙坦治疗，总观察期为6个月。治疗前后分别观察2组患者终点事件发生率，症状改善情况，并检测尿微量白蛋白排泄率（mAlb）、24 h 尿蛋白定量（U-pro ／24 h）、血肌酐（Scr）、尿素氮（BUN）、空腹血糖（FPG）、糖化血红蛋白（HbAlc）、胆固醇（TC）、甘油三酯（TG）等指标。结果中药组在随访过程中未出现进展至 V 期糖尿病肾病患者，对照组有2例治疗后血肌酐＞133μmol ／L，但2组比较差异无统计学意义（P ＞0．05）。中药组患者乏力、口干、腰痛、水肿症状缓解有效率显著高于对照组（P ＜0．01）。与治疗前相比，2组 mAlb、U-pro ／24 h 均明显降低（P ＜0．01）。与对照组治疗后相比，中药组治疗后 mAlb、U-pro ／24 h 降低更为显著（P ＜0．05），并能降低甘油三酯水平（P ＜0.05）。结论益气养阴消通络中药对 IV 期糖尿病肾病蛋白尿具有确切的治疗作用，并能降低甘油三酯水平，纠正脂代谢紊乱，且能改善糖尿病肾病患者症状，提高患者生存质量。

Clinical efficacy of Yiqi Yangyin xiaozheng Tongluo Fang on patients with stage IV diabetic nephropathy

Objective To investigate the clinical efficacy of Yiqi Yangyin xiaozheng Tongluo Fang (YYXTF),a Chinese medicine compounds formulated by the principle of replenishing qi,nourishing yin,eliminating abdominal masses,and freeing the collateral vessels,on patients with stage IV diabetic nephropathy (DN).Methods A total of 160 patients with stage IV diabetic nephropathy according to inclusion criteria were randomly divided into traditional Chinese medicine group (TCM group,n =81 ) and control group (n =79).In addition to general treatment,patients in TCMgroup took orally YYHXF and those in control group took irbesartan for consecutive six months.The incidence of end point events, improvement of clinical symptoms and urine micro-albumin excretion rate (mAlb),24 hours urine total protein (U-pro /24 h),serum creatinine (Scr),blood urea nitrogen (BUN),fasting plasma glucose (FPG),glycosylated hemoglobin (HbAlc),total cholesterol (TC)and triglycerides (TG)were recor-ded before and after treatment.Results During the follow-up period,compared with control group whose two patients with Scr >133 μmol /L,TCMgroup without patients progressing to stage V showed no statistical significance (P >0.05).Efficacy rate of relieving symptoms of hypodynamia,mouth dryness, back pain,edema in TCMgroup were significantly higher than that of control group (P <0.01).Intra-group comparison showed that mAlb and U-pro /24 h decreased after treatment (P <0.01).After treat-ment,mAlb and U-pro /24 h of TCM group were significantly lower than that of control group (P <0.05),and the level of TG of TCMgroup also decreased(P <0.05).Conclusion Yiqi Yangyin Hua-yu Tongluo Fang showed definite therapeutic effect on stage IV diabetic nephropathy proteinuria.It could reduce TG levels and protected against dyslipidemia.In addition,it relieved the symptoms and improved the quality of patients’life.