益气补肾方治疗糖尿病肾病Ⅳ期脾肾气虚证的临床观察

Yiqi Bushen Decoction in Treatment of Diabetic Nephropathy in Ⅳ Stage with Spleen-Kidney Qi Deficiency Syndrome

目的:观察益气补肾方在糖尿病肾病IV期中脾肾气虚证的治疗疗效,探讨其作用可能参与机制。方法:将64例符合糖尿病肾病IV期脾肾气虚证患者随机分为益气补肾方加替米沙坦片联合治疗组及替米沙坦片对照组,评价治疗效果,观察治疗前后24 h尿蛋白定量、血浆白蛋白(Alb)、血肌酐(Scr)、内生肌酐清除率(Ccr)、超敏C反应蛋白(hs CRP)、血清同型半胱氨酸(hcy)等指标变化。结果:治疗组无论西医临床疗效,中医临床疗效均较对照组更为理想(P<0.01或P<0.05);两组24 h尿蛋白定量均下降,血浆白蛋白均升高,对照组治疗前后比较差异明显(P<0.05),治疗组治疗前后差异非常明显(P<0.01),与对照组比较差异明显(P<0.05);两组治疗后肾功能指标变化,血肌酐指标虽无明显差异(P>0.05),但对照组Ccr短期内则有下降趋势(P<0.05);治疗前后2组血糖及糖化血红蛋白无明显变化(P>0.05);治疗后治疗组血清Hcy、hs CRP均显著下降(P<0.01);对照组hcy指标无明显变化,hs-CRP指标下降(P<0.05),治疗组较对照组hs-CRP和hcy改善非常显著(P<0.01)。结论:联合应用益气补肾方及血管紧张素Ⅱ受体拮抗剂治疗DNIV期脾肾气虚证能明显提高临床疗效,其作用机制可能与抑制DN患者炎症反应,改善血管内皮功能受损有关。

Objective ： To observe the clinical curative effect of Yiqi Bushen Decoction combined with Telmisartan Tablets for treating diabetic nephropathy in IV stage with spleen - kidney Qi deficiency syndrome and the possible mechanisms. Methods： Sixty- four patients were randomly divided into two groups, 32 cases in each group. Treatment group were treated with Yiqi Bushen Decoction combined with Telmisartan Tablets and control group with Telmisartan Tablets a- lone. The therapeutic course for both groups was 3 months. Indexes of efficacy including 24 h urinary protein quantita- tive,blood plasma albumin（Alb） and serum creatinine（Scr） ,fasting plasma glucose,high -sensitivity C -reactive pro- tein and homocysteine were evaluated before and after treatment. The endogenous creatinine clearance rate were calculat- ed at the same time. Results：The treatment group had more dependable therapeutic effect than the control group by chi - square （P 〈 0.01 or P 〈 0.05）. After treatment, two groups＇ contents of 24 h urinary protein quantitative were decreased apparently and Alb increased apparently and there was a significant difference in the control group （ P 〈 0.05 ）. And the treatment had more significant difference（P 〈 0.01 ） and there was a significance between two groups（ P 〈 0.05 ）. SCr had no significant differences after treatment between two groups （ P 〉 0.05） but Ccr was increased in a short time in control group. Hcy and hs- CRP were significantly decreased in treatment group（P 〈 0.01 ） and hs- CRP decreased in control group only（P 〈 o. 05 ）. Blood glucose and HbA1C in two groups had no difference before and after treatment. However, the changes of Hcy and hs -CRP were decreased more significantly in the treatment group（P 〈 0.01 ） and the control group＇ s Hcy had no difference and hs - CRP decreased（ P 〈 0.05 ）. The improvement of hs - CRP and Hcy of the treatment was more obvious than that of the control group（P 〈 0.01 ）. Conclusions：Yiqi Bushen Decoction combined with Angiotensin II receptor antagonist-Telmisartan Tablets can improve the clinical effect of patients in the stage Ⅳ of DN and alleviate the damage of kidney. Its action mechanism may be related to inhibiting the inflammation state and improving the endothelial function.