雷公藤多苷治疗糖尿病肾病疗效观察

目的 :观察在控制血糖、血压及中医辨证治疗基础上应用雷公藤多苷对糖尿病肾病(DN)患者蛋白尿及肾功能的影响。方法:56例DN患者按随机数字表法分为对照组(n=30)和治疗组(n=26),对照组予控制血糖、血压等西医治疗及中医辨证治疗,治疗组在对照组基础上加用雷公藤多苷,两组均治疗6个月。观察两组治疗前后24 h尿蛋白定量(UTP)、血清肌酐(SCr)、肾小球滤过率(GFR)、清蛋白(ALB)、总胆固醇(TC)、三酰甘油(TG)等指标变化及不良反应情况,比较两组疗效。结果:(1)治疗组治疗3个月、6个月的总有效率分别为73.1%、80.8%,优于对照组的43.3%、53.3%,差异有统计学意义(P0.05)。(2)两组治疗后24 h UTP均下降,治疗组下降更明显,组间与组内比较,差异均有统计学意义(P0.05)。(3)治疗6个月后两组SCr水平均升高、GFR水平均下降。对照组与本组治疗前比较,差异有统计学意义(P0.05);与治疗组治疗6个月后比较,差异无统计学意义(P0.05)。(4)治疗后两组血清ALB、TC、TG水平变化较小,差异无统计学意义(P0.05);(5)两组不良反应发生率比较,差异无统计学意义(P0.05)。结论:在西医基础治疗及中医辨证治疗基础上加用雷公藤多苷能减少DN蛋白尿,有助于稳定肾功能,且起效相对较快,稳定性及安全性较好。

Observation of Clinical Effect of Tripterginum Wilfordii Polyglycoside on Diabetic Nephropathy

Objective:On the basis of controlling blood glucose,stabilizing blood pressure and syndrome differentiation treatment of traditional Chinese medicine(TCM),the effect of tripterginum wilfordii polyglycoside(TWP) on proteinuria and renal function of patients with diabetic nephropathy(DN) were observed. Methods:A total of 56 patients with DN were randomly divided into the control group(n=30) and the treatment group(n=26). The control group was treated with western medical treatment(controlling blood glucose,stabilizing blood pressure,etc.) and syndrome differentiation treatment of TCM. Besides the treatments of the control group,the treatment group was treated with TWP. Both the two groups were treated for 6 months.The biochemical indices including urinary total protein(UTP) of 24 hours,serum creatinine(SCr),glomerular filtration rate(GFR),serum albumin(ALB),total cholesterol(TC),triglyceride(TG) and adverse reactions of the two groups were observed before and after treatment. The clinical effects of the two groups were evaluated.Results :(1)The Clinical effect :The total effective rates of the treatment group were 73.1 %(3 months after treatment) and 80.8%(6 months after treatment),which were better than those(43.3% and 53.3%) of the control group. The difference was statistically significant(P<0.05).(2)The UTP of 24 hours of the two groups were decreased after treatment and the decrease of the treatment group was more significant. The differences in and between the two groups were all statistically significant(P <0.05).(3) The levels of SCr of the two groups were increased and the levels of the GFR of the two groups were decreased 6 months after treatment. The levels of the two indices of the control group were statistically different from those before treatment(P<0.05),but compared with those 6 months after treatment of the treatment group,there was no statistical difference(P> 0.05).(4) The changes of the levels of ALB,TC and TG were not obvious and there was no statistical difference(P> 0.05).(5)There was no statistical difference in the rate of adverse reactions between the two groups(P> 0.05). Conclusion:On the basis of basic treatment of western medicine and syndrome differentiation treatment of TCM,TWP can decrease the volume of proteinuria and it is beneficial to stabilize renal function. The treatment has a relatively fast effect and is stable and safe.