附子理中丸和真武汤加减联合治疗糖尿病肾病脾肾阳虚证的临床研究

Clinical Study of Fuzi Lizhong Pill Combined with Zhenwu Decoction in Treatment of Diabetic Nephropathy with Syndrome of Spleen-Kidney Yang Deficiency

目的观察附子理中丸和真武汤加减联合治疗糖尿病肾病(DN)脾肾阳虚证的疗效以及对血清超敏C反应蛋白(hs-CRP)和肿瘤坏死因子(TNF)-α水平的影响。方法筛选2016年5月—2018年5月在天津市医科大学宝坻临床学院收治DN患者104例作为研究对象,将所有按随机数字表法分为对照组和观察组,每组均为52例。两组按指南给予常规治疗;对照组患者接受还原型谷胱甘肽注射液,1.8 g/次,1次/d;观察组在对照组治疗基础上给予附子理中丸和真武汤加减治疗,l剂/d,2次/d。两组连续治疗12周。比较两组血糖指标、肾功能、脾肾阳虚证症状评分、临床疗效以及血清hs-CRP和TNF-α水平。结果与对照组比较,观察组患者治疗后空腹血糖(FPG)、餐后2 h血糖(PPG)、糖化血红蛋白(HbA1c)以及血肌酐(SCr)、血尿素氮(BUN)、24 h尿总蛋白下降更明显(P<0.01);与对照组比较,观察组患者治疗后脾肾阳虚证症状评分降低更明显(P<0.01);观察组和对照组的总有效率分别为84.62%(44/52)和65.38%(34/52),差异有统计学意义(P<0.05);与对照组比较,观察组患者治疗后血清hs-CRP和TNF-α水平降低更明显(P<0.01)。结论附子理中丸和真武汤加减联合治疗糖尿病肾病脾肾阳虚证的疗效明显,抑制血清hs-CRP和TNF-α水平可能与其疗效有关。

Objective To observe the efficacy of Fuzi Lizhong Pill combined with Zhenwu Decoction on diabetic nephropathy(DN)with syndrome of spleen-kidney Yang deficiency and the effect on serum levels of hypersensitive C-reactive protein(hs-CRP)and tumor necrosis factorα(TNF-α).Methods One hundred and four DN patients admitted to Baodi Clinical College of Tianjin Medical University from May of 2016 to May of 2018 were selected as research objects.All patients were divided into control group and observation group according to the random number table method,with 52 cases in each group.The two groups were given routine treatment according to the guidelines.The control group received reduced glutathione injection(1.8 g/time and 1 time/day).On the basis of the treatment of the control group,the observation group was treated with Fuzi Lizhong Pill combined with Zhenwu Decoction with l dose/d and 2 times/d.The two groups were treated for 12 weeks.Blood glucose index,kidney function,scores of symptoms of syndrome of spleen-kidney Yang deficiency,the efficacy and serum levels of hs-CRP and TNF-αwere compared between the two groups.Results Compared with the control group,fasting blood glucose(FPG),postprandial 2 h blood glucose(PPG),glycosylated hemoglobin(HbA1 c),blood creatinine(SCr),blood urea nitrogen(BUN),and total urinary protein of the observation group were significantly decreased(P<0.01).Compared with the control group,symptoms scores of syndrome of spleen-kidney Yang deficiency were significantly decreased in the observation group(P<0.01).The total effective rate of observation group and control group was 84.62%(44/52)and 65.38%(34/52),respectively and the difference was statistically significant(P<0.05).Compared with the control group,serum levels of hs-CRP and TNF-αin the observation group were significantly reduced after treatment(P<0.01).Conclusion The efficacy of Fuzi Lizhong Pill combined with Zhenwu Decoction in treating diabetic nephropathy with syndrome of spleen-kidney Yang deficiency is significant,and inhibiting of serum levels of hs-CRP and TNF-αmay be related with the efficacy.