固肾化浊汤联合替米沙坦治疗早期糖尿病肾病临床研究

目的:探讨固肾化浊汤联合替米沙坦治疗早期糖尿病肾病(气阴两虚证)的临床疗效及对肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)和超敏C-反应蛋白(hypersensitivity C-reactive protein,hs-CRP)的影响。方法:104例患者随机分为观察组和对照组各52例。对照组给予西医常规疗法,观察组在对照组治疗基础上给予固肾化浊汤,1剂·d-1,疗程12周。检测治疗前后糖化血红蛋白(glycosylated hemoglobin,Hb Alc)、尿素氮、血肌酐、尿微量白蛋白排泄率(urine albumer excretion rate,UAER)、尿微量白蛋白/肌酐、胆固醇、三酰甘油(triacylglycerol,TG)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)和低密度脂蛋白胆固醇(low density lipoprotein cholesterin,LDL-C)检测、TNF-α、hs-CRP和IL-6水平;进行治疗前后气阴两虚证评分。结果:观察组患者有效率为76.92%,对照组有效率55.77%,两组比较,差异有统计学意义(χ2=5.210,P0.05);观察组中医证候有效率为86.54%,对照组为69.23%,观察组高于对照组(χ2=4.531,P0.05);治疗后观察组UAER、Hb Alc、24小时尿蛋白定量、尿素氮、血肌酐和尿微量白蛋白/肌酐水平低于对照组(P0.01);治疗后观察组HDL-C水平高于对照组,LDL-C水平低于对照组(P0.05);治疗后观察组TNF-α、hs-CRP和IL-6水平低于对照组(P0.01)。结论:固肾化浊汤联合替米沙坦治疗早期糖尿病肾病气阴两虚证患者临床疗效显著,能够减轻炎症反应,调节患者的糖脂代谢,减轻蛋白尿,改善肾功能,减轻中医证候,从而延缓肾功能损害的进展。

Clinical Study on the Treatment of Early Diabetic Nephropathy by Strengthening Kidney and Resolving Turbid Decoction Combined with Telmisartan

Objective:To investigate the clinical effect of Strengthening Kidney and Resolving Turbid Decoction combined with telmisartan in the treatment of early diabetic nephropathy (Qi and Yin deficiency syndrome) and its effect on tumor necrosis factor alpha(TNF-α),interleukin-6(IL-6) and hypersensitivity C-reactive protein(hs-CRP).Methods:104 patients were randomly divided into the observation group and the control group with 52 cases in each group.The control group received conventional therapy,and the observation group was given Strengthening Kidney and Resolving Turbid Decoction,one dose a day,12 weeks of treatment.Glycosylated hemoglobin(HbAlc),blood urea nitrogen,serum creatinine,urinary albumin excretion rate (UAER),urinary albumin / creatinine,cholesterol,triacylglycerol (TG),high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol(LDL-C) detection,TNF-α,hs-CRP and IL-6 levels before and after treatment were detected before and after treatment,Qi and Yin deficiency syndrome score.Results:The effective rate in the observation group was 76.92％,the control group was 55.77％,the difference was statistically significant(P ＜ 0.05);TCM syndrome effective rate observation group was 86.54％,69.23 ％ in the control group(P ＜ 0.05);UAER,treatment after HbAlc,24 hours urine protein,urea nitrogen,albumin / creatinine and urinary creatinine levels in the observation group lower than the control group(P ＜ 0.01);HDL-C in the treatment group was higher than the control group,the LDL-C level was lower than the control group(P ＜ 0.05);after treatment,TNF-α,hs-CRP and IL-6 levels in the observation group lower than the control group(P ＜ O.01).Conclusion:Strengthening Kidney and Resolving Turbid Decoction combined with telmisartan in treating early diabetic nephropathy with Qi and yin deficiency syndrome patients has significant clinical curative effect,which can reduce inflammation,regulate glucose and lipid metabolism of patients,reduce proteinuria,improve renal function,reduce syndromes,thus delaying the progress of renal damage.