益肾汤对糖尿病及糖尿病肾病患者血液流变学指标的影响(英文)

Influence of Yishen decoction on hemorheological indexes in patients with diabetes mellitus and diabetic nephropathy

背景:多数糖尿病患者经过数年病理积累,特别是血液流变学异常所致的微循环障碍,最终导致严重的并发症。目的:观察益肾汤对糖尿病和糖尿病肾病患者血液流变学的影响,并与健康体检对照进行比较。设计:对比观察实验。单位:哈尔滨医科大学第一临床医学院。对象:选择1998-01/2000-12哈尔滨医科大学第一临床医学院中西医结合科住院糖尿病患者76例为糖尿病组。选择本院1994-01/2001-02住院糖尿病肾病患者65例为糖尿病肾病组。选择本院1993年进行体检的健康者130名为对照组,男98名,女性32名,平均年龄(42±12)岁,均无糖尿病者。3组对象均对检测项目知情同意。方法:患者经常规治疗,加服益肾汤(仙灵脾、坤草、黄芪各20g,枸杞子、黄精、首乌、山药、大黄各15g,王不留行25g,水蛭0.8g(冲服)),将上方剂中药用文火煎200mL,每日早晚分服疗程为4周。病例组均空腹采静脉血2mL,于治疗前后进行血液流变学测定,对照组在体检时做血液流变学测定。主要观察指标:血液流变学指标。结果:糖尿病患者76例、糖尿病肾病患者65例、健康体检的130名均进入结果分析。①治疗前,糖尿病组患者的全血黏度、血浆黏度及血浆纤维蛋白原含量与正常对照组相比,均明显升高(P<0.05～0.01)。这种变化在糖尿病肾病组更为明显(P<0.01),糖尿病肾病组红细胞压积及血沉方程K值亦明显高于正常对照组(P<0.01)。糖尿病肾病组患者治疗前全血黏度、红细胞压积、血沉方程K值明显高于糖尿病组(P<0.05～0.01)。②治疗后糖尿病组和糖尿病肾病组全血和血浆黏度、红细胞压积、血沉方程K值明显降低并基本恢复正常,与正常对照组相近(P>0.05)。结论:益肾汤可改善糖尿病及其肾脏并发症患者的血液流变学指标。

BACKGROUND： Many diabetic patients get microcirculation disturbance due to abnormal hemorheology in a long-term angiopathy, which finally induces severe complications. OBJECTIVE： To observe the influence of Yishen decoction on hemorheology in patients with diabetes mellitus and diabetic nephropathy and compare with the healthy controls. DESIGN： Controlled observational experiment SE-n-ING： First Clinical Medical College, Harbin Medical University PARTICIPANTS： Seventy-six inpatients with diabetes mellitus were enrolled at Department of Integrated Traditional and Western Medicine, First Clinical Medical College, Harbin Medical University from January 1998 to December 2000 as diabetes mellitus group. Sixty-five inpatients with diabetic nephropathy were selected at the same hospital from January 1994 to February 2001 as diabetic nephropathy group. 130 healthy subjects, who did body examination, were selected at the same hospital in 1993 as control group, including 98 males and 32 females, with an average age of （42±12） years. All subjects in the three groups knew the program and agreed to participate in the experiment. METHODS： The patients received conventional treatment combined with Yishen decoction containing herba epimedii, herba leonuri, astragalus mongholicus, each 20 g, barbary wolfberry fruit, solomonseal rhizome, gold theragran, dioscorea root, rhubarb, each 15 g, cowherb seed 25 g, as well as sanguisuge 0.8 g （taken medicine after mixing with water）. These Chinese herbs were decocted at a simmer （200 mL）, taken in the morning and evening respectively for 4 weeks. 2 mL venous blood was collected from fasting subjects in the case groups. Hemorheology was measured before and after treatment in the case groups, whereas in body examination in the control group. MAIN OUTCOME MEASURES： Hemorheolocjical indexes RESULTS： A total of 76 subjects with diabetes mellitus, 65 subjects with diabetic nephropathy and 130 healthy subjects were involved in the result analysis. ①Whole blood viscosity, plasma viscosity and plasma fibdnogen levels were obviously higher in the subjects of the diabetes mellitus group compared with the control group before treatment （P 〈 0.05-0.01 ）. These changes were more significant in subjects of the diabetic nephropathy group （P 〈 0.01 ）. Hematocrit and erythrocyte sedimentation equation K value were obviously higher in the diabetic nephropathy group than the control group （P 〈 0.01 ）. Whole blood viscosity level, hematocrit and erythrocyte sedimentation equation K value were markedly higher in the diabetic nephropathy group than the diabetes mellitus group before treatment （P 〈 0.05-0.01 ）. ②Whole blood viscosity and plasma viscosity levels, hematocrit and erythrocyte sedimentation equation K value were remarkably decreased in the case groups and most recovered to normal （P 〉 0.05）. CONCLUSION： Yishen decoction can ameliorate the hemorheology of diabetes mellitus and diabetic nephropathy patients.