益肾固精方干预66例糖尿病肾病的临床观察

Clinical Observation on the Effects of Yishen Gujing Fang on Diabetic Nephropathy in 66 Patients

目的:通过对早、中期糖尿病肾病(DN)患者观察,探讨益肾固精方干预DN肾小管间质损害作用及机制。方法:临床纳入66例早、中期DN患者进行益肾固精方联合缬沙坦(中西医结合治疗组)与单纯缬沙坦(西药组)治疗比较,3个月后观察治疗前后空腹血糖(FPG)、血脂、纤维蛋白原(Fbg)、血粘度、血白蛋白(Alb)及肾脏损伤血、尿液标志物变化。结果:共纳入观察病例66例,脱落及剔除共6例,最终纳入统计60例。治疗前后比较:(1)两组患者中医证候积分均显著降低,中西医结合治疗组优于单用西药组(P<0.05),前者证候疗效有效率86.7%,明显高于后者的76.7%(P<0.05)。(2)中西医结合治疗组显著降低尿微量白蛋白(MA)(P<0.01)、血尿胱抑素C、尿β2-微球蛋白(P<0.05)、血脂、Fbg、血黏度(P<0.05,P<0.01),提升血Alb(P<0.05),尤其在降低尿MA、Fbg方面疗效优于单用缬沙坦组。结论:益肾固精方可有效改善DN患者的临床症候,提高生活质量,通过调节血液流变学、凝血因子,减轻肾小管间质损伤,降低尿蛋白的异常排泄,其远期疗效值得进一步关注。

Objective： To investigate the intervention effects and mechanism of Yishen Gujing Fang （YSGJF） on renal tubular interstitial damage caused by diabetic nephropathy （DN） through the observation on early and middle DN patients. Methods：The therapeutic effects of valsartan alone （ Western medicine treatment group） and in combination with YSGJF （ integrated traditional Chinese and Western medicine treatment group） were compared in 66 patients with early and middle DN by the observation of changes in fasting plasma glucose （FPG）, blood lipids, fibrinogen （Fbg）, blood viscosity, serum albumin （Alb）, and blood and urine markers indicating kidney damage after 3 - month treatment. Results： Sixty - six patients were initially observed, and data from 60 patients were finally statistically evaluated with six cases lossing and excluding. After three - month treatment, （ 1 ） TCM clinical symptoms of patients in the two treatment groups were both significantly improved; however, the effective percentage of symptom improvement of the integrated traditional Chinese and Western medicine combined treatment （86.7%） was significantly higher （P 〈 0.05） than that of Western medicine treatment alone （76.7%） ; and （2） urinary microalbumin （MA） （P 〈 0.01 ）, hematuria cystatin C, urinary β2 - MG （ P 〈 0.05 ）, and blood lipids, Fbg, as well as blood viscosity （P 〈 0. 05, P 〈 0.01 ） were significantly reduced while serum Alb （P 〈 0. 05） was significantly enhanced in the combined treatment group. Compared to treatment with valsartan alone, better therapeutic effects were achieved especially in lowering urinary MA and Fbg in the combined treatment group. Conclusion：Treating with YSGJF could be effective in improving the DN clinical syndromes, enhance living quality, and reduce tubulointerstitial injury and abnormal urinary protein excretion by regulating blood rheology and the levels of clotting factors, which indicates that the long - term efficacy of YSGJF deserves further attention.