益气养阴、祛瘀生新疗法治疗临床期糖尿病肾病的疗效观察及机理探讨

Therapeutic Effect of Qi-strengthening and Yin-nourishing,Stasis-removing and Regeneration-promoting Therapy for Clinical Diabetic Nephropathy and Its Mechanism

【目的】观察益气养阴、祛瘀生新中药治疗气阴两虚、瘀阻肾络型临床期糖尿病肾病(DN)的疗效,并探讨其作用机理。【方法】采用随机数字表法将80例气阴两虚、瘀阻肾络型DN患者按3∶1随机分为治疗组(60例)和对照组(20例),2组西医治疗措施相同(包括控制血糖、降血压、降血脂、优质低蛋白饮食、纠正水电解质紊乱和调节酸碱平衡、防治并发感染等),治疗组加服益气养阴、祛瘀生新中药(基本方:黄芪、桑椹子、玄参、当归、丹参、大黄、玉米须、川芎等),系统观察2组的临床症状、空腹血糖、肾功能、24 h尿蛋白量、血液流变学指标、血脂、血纤维蛋白原、血浆内皮素(ET-1)、肿瘤坏死因子(TNF-α)、白细胞介素-1(IL-1)含量的变化。【结果】益气养阴、祛瘀生新中药能明显改善患者的症状和体征,有效降低24 h尿蛋白量,改善肾功能不全代偿期与失代偿期的肾功能指标,使肾功能不全衰竭期与尿毒症期的肾功能指标趋于稳定;降低患者血脂、空腹血糖水平,改善血液流变学相关指标,降低血IL-1、ET-1水平(P<0.05或P<0.01);其综合疗效优于对照组(P<0.05)。【结论】益气养阴、祛瘀生新中药治疗气阴两虚、瘀阻肾络型临床期DN具有较好疗效,其机理可能与降低血脂,改善血液流变学指标,减少尿蛋白排泄,降低血IL-1、ET-1等肾小球硬化相关因子水平有关。

[Objective] To observe the therapeutic effect of Qi-strengthening and yin-nourishing, stasis-removing and regeneration-promoting therapy for clinical diabetic nephropathy （CDN） and to explore its mechanism. [ Methods] Eighty CDN patients with Qi-yin deficiency and stasis blocking kidney collaterals were randomized into groups A and B at the proportion of 3 ： 1 by using random number table. Group B （ n = 20） was given routine western treatment involving decreasing blood glucose, blood pressure and blood lipid, taking good quality diet with low protein, regulating waterelectrolyte disturbance and acid-base balance, and preventing and curing complicated infection. Group A （ n = 60） was treated with Qi-strengthening and yin-nourishing, stasis-removing and regeneration-promoting herbal medicine （mainly composed of Radix Astragali, Fructus Mori, Radix Scrophulariae, Radix Angelicae Sinensis, Radix Salviae Miltiorrhizae, Radix et Rhizoma Rhei, Stigma Maydis and Rhizoma Chuanxiong）. After treatment , the therapeutic effect was compared in the two groups. Meanwhile, the changes of fasting blood glucose, renal kidney, 24-hour urinary protein, blood rbeology, blood lipid and fibrinogen （FIB）, as well as plasma endothelin 1 （ET-1）, tumor necrosis factor α （TNF-α） and interleukin 1 （IL-1） were observed. [Results] Qi-strengthening and yin-nourishing, stasis-removing and regeneration-promoting herbal medicine relieved the symptoms and signs of the patients, decreased 24-hour urinary protein content, and improved the renal function parameters in renal compensatory and decompensatory stages. The herbal medicine could also decrease blood lipid and fasting blood glucose levels, improve blood rheology indexes, and decrease serum IL-1 and ET-1 levels （P 〈 0.05 or P 〈 0.01 ）. The comprehensive effect in group A was superior to that in group B （ P 〈 0.05）. [ Conclusion ] Qi-strengthening and yin-nourishing, stasis-removing and regeneration-promoting herbal medicine has an effect for the treatment of CDN with Qi-yin deficiency and stasis blocking kidney collaterals. Its therapeutic mechanism is probably related to the decrease of blood lipid, urinary protein excretion and glomerulosclerosis factors of IL-1 and ET-1, and to the improvement of blood rheology.