中医药干预对早期糖尿病肾病证素演变的影响

目的 观察中医药干预糖尿病肾病(DN)早期患者证素演变规律.方法 收集早期DN患者152例,随机分为治疗组78例和对照组74例,治疗组予中药辨证论治,对照组予厄贝沙坦片150mg口服,每日1次.两组患者均3个月为1个疗程,观察3个疗程.分别于入组时、治疗后4周、8周、12周共4个时点收集患者证候学资料,进行辨证及证素的提炼,对两组患者气虚、阴虚、阳虚、血虚、血瘀、痰湿、湿浊证素变化趋势进行分析,并对变化趋势进行二次曲线拟合,绘制各证素演变趋势图.结果 治疗组和对照组气虚、阴虚、阳虚、血虚、血瘀、痰湿、湿浊证素都有随时间变化的趋势(P＜0.05)；两组间气虚证素随时间变化的趋势不同(P＜0.05)；阴虚、阳虚、血虚、血瘀、痰湿、湿浊证素组间变化差异无统计学意义(P＞0.05).治疗组气虚证素积分曲线下降斜率大,对照组曲线斜率小,说明治疗组的气虚证素改善速度大于对照组. 结论 中药组方和厄贝沙坦对DN证素都有改善作用,中药组方对早期DN气虚证素的疗效好于厄贝沙坦.

Effect of TCM Intervention on the Evolution of the Syndrome Factors in Early Diabetic Nephropathy

Objective To observe the effect of TCM intervention on the evolution regularity of syndrome factors in the patients with diabetic nephropathy(DN).Methods Totally 152 cases of early DN were randomized into treatment group of 78 cases and control group of 74 cases.The treatment group was given Chinese medication on the basis of syndrome identification.The control group was given 150mg of Irbesartan tablet orally,once daily.One treatment course lasted for 3 months and the observation lasted for 3 courses.The syndrome data was collected before treatment and in the 4th,8th and 12th week of treatment.The syndromes were indentified and the syndrome factors were extracted.The evolution regularities of syndrome factors in the syndromes of yin deficiency,qi deficiency,yang deficiency,blood deficiency,blood stasis,phlegm damp and damp turbidity were analyzed.Then the quadratic curve of the evolution trend was fitted and evolution trend graph was drawn.Results The syndrome factors of yin deficiency,qi deficiency,yang deficiency,blood deficiency,blood stasis,phlegm damp and damp turbidity changed over time in both groups(P<0.05).The difference between groups was statistically significant in the evolution of syndrome factors in qi deficiency syndrome(P<0.05).There was no significant difference between groups in the evolution of syndrome factors in other syndromes(P>0.05).Comparing with the control group,the syndrome factor of qi deficiency syndrome in the treatment group was improved obviously as the curve slope of syndrome factor score in the treatment group was higher than that in the control group.Conclusion Both Chinese formulas and Irbesartan could improve the syndrome factors of early ND.Chinese formulas are more effective in syndrome factors of qi deficiency syndrome as compared with Irbesartan.