大黄为主中药灌肠治疗2型糖尿病肾病的研究

Clinical analysis of diabetic nephropathy by rhubarb-based medicine enema

目的观察大黄为主中药灌肠治疗2型糖尿病肾病慢性肾功能不全患者的疗效及分析影响治疗效果的相关因素。方法将140例2型糖尿病肾病慢性肾功能不全患者随机分为4组。常规治疗组(32例)常规口服药物治疗。大黄灌肠1组(38例)常规治疗基础上加用大黄中药灌肠每日2次;大黄灌肠2组(33例)常规治疗基础上加用大黄中药灌肠每日1次;混合灌肠组(37例)常规治疗基础上加用大黄中药灌肠每日1次和药用碳片灌肠每日1次;比较各组治疗前后血尿素氮(BUN)、肌酐(SCr)、24小时尿总蛋白(UTP)、肾小球滤过率(GFR)的变化,并分析影响SCr下降率的相关因素。结果大黄灌肠1组,混合灌肠组,大黄灌肠2组总有效率分别为84.2%、78.4%、66.6%,大黄灌肠1组总有效率明显高于常规治疗组(P<0.05);治疗后BUN大黄灌肠1组和混合灌肠组低于常规治疗组,分别为大黄灌肠1组BUN(8.54±3.02)mmol/L vs混合灌肠组(9.04±2.77)mmol/L和常规治疗组(10.85±3.79)mmol/L;24hUTP大黄灌肠1组、混合灌肠组和大黄灌肠2组均低于常规治疗组,大黄灌肠1组和混合灌肠组又低于大黄灌肠2组,分别为大黄灌肠1组24hUTP(1.66±0.46)g和混合灌肠组(1.81±0.43)g和大黄灌肠2组(2.05±0.53)g vs常规治疗组(2.35±0.57)g。GFR大黄灌肠1组和混合灌肠组均高于常规灌肠组,分别为大黄灌肠1组(45.83±8.43)ml/min、混合灌肠组(39.68±7.95)ml/min vs常规治疗组(35.23±8.82)ml/min(均P<0.01),大黄灌肠1组又高于大黄灌肠2组,(45.88±8.43)ml/min vs(37.53±7.85)ml/min(P<0.01)。多因素非条件logistic回归分析提示影响疗效的主要因素为年龄、病程、收缩压、GFR。OR值分别为0.890、0.857、0.961、1.054(P<0.05)。结论常规治疗的基础上加用大黄中药灌肠能够明显降低SCr、BUN、UTP和改善肾功能,延缓慢性肾功能的进展,改善DN患者的远期预后。

Objective To observe the clinical effect of type 2 diabetic patients with renal insufficiency by rhubarb-based medicine enema and analyze the related factors affecting the therapeutic effect. Methods 140 type 2 diabetic patients with both type 2 diabetic nephropathy and chronic renal insufficiency were randomly divided into four groups,conventional treatment group（32 cases）：conventional oral drug treatment,rhubarb enema group 1（38 cases）：conventional therapy plus rhubarb enema two times per day,rhubarb enema group 2（33 cases）：conventional therapy plus rhubarb enema once per day,mixed enema group（37 cases）：conventional therapy plus rhubarb enema once per day and an enema of medicinal carbon tablets per day. Results The total effective rate of rhubarb enema group 1,mixed enema group,rhubarb enema group 2 was 84.2%,78.4%,66.6%,respectively,the total effect of rhubarb enema group 1 was significantly greater than the conventional treatment group（P0.05）.After treatment,BUN in rhubarb enema group 1 and mixed enema group were lower than that in conventional treatment group,rhubarb enema group 1（8.54±3.02） mmol/L vs mixed enema group（9.04±2.77） mmol/L vs conventional treatment group（10.85±3.79） mmol/L,respectively;24 urine total protein was lower in rhubarb enema group 1,mixed enema group and rhubarb enema group 2 than that in conventional treatment group,rhubarb enema 1 and mixed enema group less than rhubarb enema 2,rhubarb enema group1（1.66±0.46） g vs mixed enema group（1.81±0.43） g vs rhubarb enema group 2（2.05±0.53） g vs conventional treatment group（2.35±0.57） g.Glomerular filtration rate which in rhubard enema group 1 and mixed enema group more than rhubarb enema group 2,rhubard enema group 1（45.83±8.43） ml/min vs mixed enema group（39.68±7.95） ml/min vs rhubarb enema group 2（37.53±7.85） ml/min vs conventional treatment group（35.23±8.82） ml/min,respectively（P0.01）.Multivariate non-conditional logistic regression analysis indicated that the main factors influencing efficacy included age,disease duration,systolic blood pressure,GFR.OR values were 0.890,0.857,0.961,1.054,respectively（P0.05）. Conclusion Conventional treatment plus rhubarb enema can not only reduce SCr,BUN,UTP significantly,improve renal function,but also can delay the progress of chronic renal function and improve long-term prognosis of patients with diabetic nephropathy.