参芪地黄汤联合缬沙坦治疗早期气阴两虚型糖尿病肾病的临床疗效观察

Therapeutic Effect of Shenqi Dihuang Decoction Combining with Valsartan on Diabetic Nephropathy of Qi and Yin Deficiency at Early Stage

目的:探讨参芪地黄汤联合缬沙坦治疗早期气阴两虚型糖尿病肾病的疗效和机制。方法:临床采集辨证属气阴两虚型早期糖尿病肾病样本100例,按照1∶1的比例随机分为治疗组50例和对照组50例,所有病例均参照2004年ADA糖尿病肾病治疗指南,进行常规降糖药控制血糖,低盐、优质低蛋白、低脂饮食、控制血压和运动指导等一般治理。治疗组按照辨证施治用参芪地黄汤联合缬沙坦80 mg/d治疗,对照组单纯缬沙坦80 mg/d,于8周后比较治疗前后两组尿微量白蛋白(m ALB)、尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、糖化血红蛋白(Hb A1c)、血清肌酐(SCr)、尿素氮(BUN)、空腹血糖(FBG)、血压、中医症候积分情况。结果:两组在治疗8周后,血压水平、空腹血糖、糖化血红蛋白、血清肌酐、尿微量白蛋白、尿NAG水平和中医症候积分值均有不同程度下降,与治疗前相比差异均有统计学意义(P<0.05);治疗后,治疗组与对照组组间相比,尿微量白蛋白和尿N-乙酰-β-D-氨基葡萄糖苷酶、中医症候积分值差异有统计学意义(P<0.05)。结论:参芪地黄汤联合缬沙坦治疗早期气阴两虚型糖尿病肾病,在尿微量白蛋白、尿N-乙酰-β-D-氨基葡萄糖苷酶和疾病症状改善方面,优于单独使用缬沙坦,具有临床推广意义。

Objective： To explore the efficiency and mechanism of Shenqi Dihuang Decoction combined with valsartan for the treatment of diabetic nephropathy of Qi and Yin deficiency. Methods： Referring to Traditional Chinese Medicine Diabetes Prevention Guide,we gathered 100 different extent diabetic nephropathy samples which belonged to Qi and Yin deficiency were randomly divided into two groups,50 cases in each. All cases were reference to the 2004 ADA guidelines treatment of diabetic nephropathy,demanding for controlling blood sugar,low salt,high-quality low-protein,low-fat diet,controlling blood pressure and motion guidance. The control group was treated with valsartan 80 mg / d and the treatment group with Shenqi Dihuang Decoction combined with valsartan 80 mg / d according to syndrome differentiation for 8weeks. We measured the changes of the m ALB,NAG,Hb Alc,SCr,FBG and blood pressure levels of both groups before and after treatment. Under Traditional Chinese Medicine Diabetes Prevention Guide,we designed diabetic nephropathy symptom scores table by using symptom points to contrast symptoms after treatment. Results： After 8 weeks treatment,blood pressure levels,fasting glucose,the glycosylated hemoglobin,serum creatinine,urinary albumin,urinary NAG and symptom scores of the control group and treatment group were lower than those before. Between the two groups,the difference of above indicators was statistically significant（ P〈0. 05）. After treatment,the urinary albumin,urinary NAG and symptom scores between control group and treatment group were statistically significant（ P〈0. 05）. Conclusion： Shenqi Dihuang Decoction combined with valsartan for the treatment of diabetic nephropathy of Qi and yin deficiency can improve urinary albumin,urinary N-acetyl-β-D-glucosaminidase and the symptoms of the disease. Compared with using valsartan alone,this method for improving urinary albumin,urinary N-acetyl-β-D-glucosaminidase and the symptoms of the disease is more pronounced.